A community and a health issue of concern

During the recent celebration of Pride Month (June) globally and in India, we witnessed an incredible social media presence filled with stunning images and stories. It is not wrong to pause for a moment and reflect on the state of mental health of LGBTQIA++ communities in India. The reflection would undoubtedly have been a serious one.

India’s class, caste and regionally diverse LGBTQIA++ communities remain at risk of mental illnesses and challenges throughout their lives, despite the decision of the National Legal Services Authority (NALSA) read out Section 377, as well as progressive movements. This can take the form of severe mental illness or transient and long-lasting dysfunctional harmful behaviors.

stigma and pain

Why? It is because of the life-long incompatibility, deep stigma, discrimination and often abuse that the community experiences. This often leads to extreme distress and poor self-worth, resulting in self-loathing and suffering. The community is often intimidated and has such a deep internal stigma that it is challenging to even express what it feels – forget about asking for help.

While the mental health needs of LGBTQIA++ communities are no different from those of others, their identities, social context, and discrimination give them stressors that continue to affect their mental health from an early age. Sexual orientation and gender identity are rarely discussed in our social, educational or family environments, and if ever, these discussions are stigmatizing. Society marginalizes LGBTQIA++ people throughout their lives, no matter how adept they may be. It is a payment drawn out by a heterogeneous normative society that demands assimilation.

It is difficult to come out on your own in such an environment; Forget others. Even within LGBTQIA++ communities, lines are easily fractured by race, class, and, more recently, religious affiliation. It is difficult to find friends and family who understand what the person feels.

If they are able to cope with it, then there is constant otherness. The life a person leads and experiences has little or no overlap with those around him. In every respect the person remains an outsider. If a person’s gender identity is different from the gender assigned to him at birth, this conflict and otherness is at its peak. The person feels trapped and conflicted, which feeds on to their gender dysphoria.

This relentless dissonance and otherness can result in intrinsic homophobia, which often leads to anxiety, loneliness, and substance abuse. It is not surprising, then, that LGBTQIA++ youth are 1.75 times more likely to suffer from anxiety and depression than the rest of society, while the transgender community is even more vulnerable as its members are 2.4 times more likely to suffer from anxiety and depression. Huh.

In India and elsewhere, from an early age, everyone is openly or structurally pressured to accept gender roles and sexual identities. Those who do not comply are threatened, abused and assaulted on the pretext of correcting them.

inadequate health services

Queuing positive mental health services are rarely available when help is sought by even the most empowered. Most psychiatrists in India still consider diverse sexual orientation and gender identity to be a disorder and practice ‘corrective medicine’. This is also true of general health care. In an ongoing study, the Relief Project found that a large number of trans and gay men preferred to pay and seek help in the private sector rather than access government health care because of harassment and stigma.

How then do we build communities that maintain the good mental health of LGBTQIA++ communities? We need a national focus on LGBTQIA++ mental health, which has been further intensified by the global COVID-19 pandemic.

We need comprehensive long-term solutions that prioritize and meet the needs of the community with delinquent mental health, but that engage all to transform the environment in which they exist. These solutions must engage with all stakeholders, including educational institutions, communities, health care providers, mental health professionals, police personnel and families, who are often a major source of mental health stress. It is not easy because it is not a priority for the government and funding agencies, and is also neglected in the society.

Awareness and other steps

One way to change the status quo is to ensure that every aspect of mental health work in India includes aspects of bizarre mental health issues, particularly in schools and universities, to perpetuate different gender and sexual identities. An important aspect is building self-care skills among queer teens and youth. Behavior change and strong components of awareness and capacity building are also important ways to build agency among these young populations. To change societal attitudes we need a movement on quirky mental health guided by non-discrimination and public awareness.

Community building is an important part of improving the mental health of LGBTQIA++ people. We need to create supportive, safe and educative places, access points for health care and information on mental health. One such project, which the Relief Project is working on in participatory ways, has given rise to many of the issues that the LGBTQIA++ community faces on an ongoing basis at leading colleges. The challenge is how to address these issues holistically when institutions are so quirky.

In the end, ignoring the mental health needs of LGBTQIA++ communities comes at a great cost to them and to society. Without addressing both the preventive and support aspects of the mental health of LGBTQIA++ people, we will be complicating an already neglected problem of mental illness, which will be difficult to handle in the future. This would not only be injustice, but also a crisis resulting from willful neglect.

Chapal Mehra is a public health expert and director of the relief project