Why
a special service catering to women's needs?
Seher
was started in Pune city because, we believe that the subject
of women's mental health should be viewed separately from a
general notion of mental health.
Differential
social stressors: Women, as a result of patriarchy
and their unequal social status, experience a different social
reality, which strongly impacts their emotional health.
Differential
role constraints: Due to the way our society, and
the social roles within it are structured, women invest more
in family, children and other care giving roles. As cultural
standards for these roles are near impossible to achieve,
women are riddled with guilt, shame and diminished self worth.
Differential
work satisfaction: While women may be overburdened
with household labour and paid work, such work does not obtain
much value or power for them in social or family negotiations.
For example, even a highly educated woman may be forced to
accept conventional roles driven by stereotypes, such as, "women
are better at being wives or mothers".
Differential
socialization: Women, right through their developmental
years, are taught to prioritize others' emotional needs over
their own. They are often pushed into care giving roles very
early, even before their own developmental needs are met.
Their physical development, stamina, capacity to defend themselves
or set boundaries in relationships, is not encouraged.
Violence
against women: Women are often victims of abuse
and violence within their own families. Women are more often
victims of hate crimes by men.
Differential
health needs: Women's nutritional, health and reproductive
health needs are often unmet, causing minor to major mental
health problems.
Differential
mental health needs: Women's mental health is affected
by the cumulative effect of all the above. Common mental
health problems (depression, anxiety, phobias, panic and
trauma) are two or three times more frequent in women than
among men. Recent data from the World Health Organisation
suggest that depressive disorders account for 30% of neuro-psychiatric
disability among women in the developing countries, but only
12.6% of that among men. Women are more likely to experience
a chronic and longer-term episode of depression, with a higher
likelihood of recurrence as compared to men. 10% of women
experience post-natal depression in weeks following childbirth.
A
diversity of needs:
Among
the population of women, mental health needs may be diverse,
depending on age, marital and educational status, employment
status, cultural or religious background, caste and class status.
Women traversing different thresholds in their reproductive
life cycle, women subjected to communal conflict or other calamities
and women with different sexual identities may have special
needs.
Seher
- A woman centered service:
Seher
was created to fill a gap in mental health service provision
for addressing this diversity of needs among women. Through
Seher, we want to create healing alternatives, which anchor
a woman's emotional health meaningfully within the context
of her lived experiences, rather than on medical diagnosis.
We are striving to create a woman centered mental health service.
Medical
diagnosis of mental disorder, while being a useful tool to
manage complex psychological realities, tends to be gender
biased. The diagnostic categories reflect a bias in the concept
of a "mentally healthy person" itself. Masculine
attributes (rational, balanced, decision maker, logical thinking,
assertion, etc.) describe the desired standard, whereas feminine
attributes (emotional, sensitive, dependent, submissive, etc.)
describe standards of mental disorder. Seher does not place
a premium value on psychiatric evaluation and diagnosis, in
planning individual interventions.
The
social life of the woman and her relationships are not very
relevant in a medical model of intervention. Issues concerning
inequality in the household or community, domestic violence,
sense of powerlessness and lack of hope or joy do not get addressed.
Since mental ill health is seen as "disease", women
are told to "adjust"
to their life situations. Their troubles are seen as symptoms
of the disease. At Seher, the psycho-therapist will situate the
intervention around issues concerning a woman's resistance and
struggles for empowerment.
| Seher's
objectives: |
|
To
offer a need-based cafeteria of mental health options to
women in emotional distress |
|
Promotion
of emotional well-being of women, users, carers and the community
at large |
|
Offering
holistic, gender sensitive, and user-centric mental health
services |
|
Raise
awareness and enhance capacity on mental health issues, as
a way of preventing mental ill health. |
| |
|
| Seher's
cardinal principles: |
1. |
Women
will be index clients. |
2. |
A
gender and role analysis will inform and structure intervention. |
3. |
Intervention
will be based on an understanding of the structural and social
determinants influencing her emotional health. |
4. |
Intervention
will be holistic: The program will include nutritional, health,
reproductive health status in the planning and treatment
through appropriate program protocols / referrals / consultations. |
5. |
The
service provider (sp) will establish an equal relationship
with the client (a fully informed process with mutual goal
setting). |
6. |
The
sp will be mindful of the client's present situation and
avoid victim blaming and other such misuse of therapist power. |
7. |
The
client will be assured of an enabling space where she can
explore barriers to her personal growth, her abilities, creativity
and resilience. |
8. |
The
client will be assured of a respectful space where her experiences
and perspectives will be valued, yet allowing for discussion
on opportunities for growth and empowerment. |
9. |
The
sp will give importance to client self-determination and
will facilitate self help. |
10. |
The
sp will not withhold treatment options (drugs, alternative
treatments) or appropriate referrals if the client expresses
a desire to try them. |
11. |
The
program advocates against the use of shock therapy in the
treatment of mental disorder. |
Seher's
approach and activities:
Seher
approaches women's mental health and in general, common mental
ill health, in a holistic manner. Seher offers psychotherapies
(individual, group, family and CBT). Seher believes in the
prevention of mental disorder and conducts training and capacity
building programs for community case-workers. Seher works with
a multi-disciplinary team - (user, activist, medical doctor,
nutritional therapist, psychologist, psychiatric social worker,
psychiatrist) - to give direction to the work, to build capacity
of Seher staff, peer review and to offer consultations to Seher
users. Seher's referral system, in due course, will include
clinical referrals (health, reproductive health, psychiatry,
ISM, clinical psychology, nutrition) and social referrals (lawyers,
support organisations).
The program invests in sufficient study time and capacity building
time for the staff, so that the program remains tied to current
knowledge. The program also encourages staff to take steps to
enhance their own psychological well-being and prevention of
burn out.
| Seher's
indicators of woman centered psychotherapy: |
1. |
Seher's
clientele is mostly women. |
2. |
Seher's
clientele come from diverse backgrounds |
3. |
Case
work data, referral data and peer review evaluation indicates
that the sp has considered- |
|
holistic
health assessments (health, nutrition, psychiatry) |
|
assessment
of referral needs (clinical, social) |
|
clients'
gender orientation, social determinants, role analysis and
bargaining position |
|
client's
present position in goal setting |
|
client's
agency and resilience |
|
consistency
with client's own interest |
|
impact
of psychological evaluation (diagnosis) on her life |
4. |
The
sp's academic work (seminar presentations, publications)
and capacity building (trainings attended, use of trainings
in clinical work) indicates updation of concepts and information
on gender, psychological ill health and clinical management. |
5. |
Client
satisfaction data indicates sp's mindfulness of - |
|
maintaining
quality and consistency of interaction (trust, empathy, warmth,
respectfulness, affirmation) |
|
not
forcing either normative or subversive stereotypes on client |
|
providing
necessary and sufficient information for client consent |
|
addressing
requests for referral to other agencies, treatments |
|
client's
full participation in process and goal setting |
|
client's
requests for education / awareness have been addressed |
Seher's
legal compliance:
Seher,
being a Bapu initiative, is committed to compliance with respect
to the extant laws on disabilities and equal opportunities,
sexual harassment at the work place and human rights.
Funding
Seher
is presently funded by Sir Dorabji Tata Trust, Mumbai.
Co-ordinator
Ketki
Ranade, M. Phil. [Psychiatric Social Work]
[This document has been developed by various
internal discussions at Bapu, meetings with the trustees and
a value clarification workshop with resource persons.]
