"Planning
Gender Sensitive Community Interventions- Women and Mental
health"
was the theme of a workshop held from 17-18 September 1999 at
YMCA, Pune, India.
The
motivation for the workshop was the fact that mental health
professionals in India are not sensitive to gender issues in
their approach to interventions. For NGOs who see mental health
problems frequently in their community work, there have been
many issues needing discussion, especially in addressing women's
mental health needs.
The
workshop aimed broadly
To introduce
women's mental health as an agenda for action to local organisations;
To give
a socio-political perspective to mental health interventions
for women;
To highlight
policy, service, ethical and legal issues concerning women
with a psychiatric diagnosis;
To provide
a platform for deliberations between the medical professionals,
NGOs and women's organisations in Pune
And to
integrate our work on women's mental health with local movements
in health and feminist activism.
Over
40 participants from health and mental health NGOs, community-based
organisations, counselling centres, shelters and other women's
organisations from Pune and Bombay attended the workshop. The
resource persons included feminist activists, activists in
mental health, a disability and human rights advocate, psychiatrists
and feminist counsellors. The workshop was funded partially
by the Sir Dorabji Tata Trust of Bombay. The workshop introduced
the theme of women's issues in mental health by reviewing feminist
work in mental health in India in the last decade.
For
many of us in the women's movement in India, the movement itself
has provided us with many social spaces for personal change
and healing. Social change has also brought about individual
change. We are averse to psychiatric labelling, and see "mental
disorder"
as a way by which women resist patriarchy. However, the disabling
aspects of emotional suffering also need to be addressed and
slowly, in India, we see the growth of feminist alternatives
in mental health, addressing the diversity of women's needs.
The
workshop contents included:
The social
aetiology of women's mental illhealth - that is, the mental
health impact of a hierarchical social life, powerlessness,
domestic / reproductive violence, and the socio-cultural
violence in a globalizing society.
The relevance
of discussing "common mental disorders" and NGO
opportunities for addressing these in community based work
with women.
The national
policy on mental health and its limitations from a gender
as well as NGO perspective. The policy propaganda was on "community
mental health" and NGO involvement but the policy did
not envisage a creative role for NGOs. They were seen as
somewhat inferior conduits for making an informed referral
to mainstream psychiatric services. The policy did not address
social inequality issues.
Bias and
prejudices within the mental health service system- The many
ways in which the sciences had labelled and "treated"
women's ways of self-expression and dissent as mental illness.
Professionals needed to respond sensitively and professionally
to victimisation and create standardised clinical protocols
for diagnosis and treatment.
Alternatives
from a feminist psychological perspective- The need for feminist
counselling and for women to assert their own spaces and
legitimate experience within therapeutic transactions.
The overwhelming
disempowerment of persons with mental illness, particularly
women, by present mental health laws- The workshop emphasised
the need for legal reform from the women's perspective, the
need for legal literacy and vigilance about judgements.
The problems
of institutionalised women and the need to struggle for a
realm of positive rights and a life of dignity for these
women.
A brief
history of legal activism in mental health in India was given,
where the interests of different stake holders was emphasised.
The recent
Equal Opportunities Act for persons with disabilities from
the mental health perspective.
Brief
panel discussions on the ethics and good practices in community
mental health and the role of self-help groups in mental
health work.
Our
recommendations included:
Change
in community mental health perspective from the medical model
of mental disorder to a more social psychological model
Recognition
of the mental health impact of social powerlessness of women
Change
in sexist attitudes and paternalistic practices towards women
who are receiving mental health care
Minimal
use of and professional regulation of ECT (Electro-convulsive
therapy)
Change
in professional attitudes and practices towards women who
are facing violence in the domestic or political sphere
Changes
in community mental health policy from a top-down approach
to a more participatory approach
Standardised
clinical assessments, instead of subjective and incompetent
professional assessments
Women-sensitive
law reform to address the human rights violations of institutionalised
women
Networking
among NGOs and user groups and creation of feminist as well
as self help alternatives at the community level
The
specific outcome of the workshop was creation of a local platform
for discussion on women and mental health, which has since
strengthened networks and activities locally. The workshop
created a local demand for Bapu Trust to get into an active
support giving and resource-building role with NGOs, women’s
organisations, carer groups, health organisations and with
individual users of mental health services.
What
was unique about this workshop was the emphasis given to the
policy, ethical, social and gender aspects of mental health,
aspects that are rarely addressed in other mental health forums
in India. With this, important linkages between mental health,
development and human rights have been forged.
As
follow up, our Center has cultivated local networks with many
women’s organizations and conducted similar awareness and sensitisation
workshops for them.
Funding
support: Funding for this program was given by Sir
Dorabji Tata Trust, Mumbai.
