Violence, stigma and identity: Why the queer mental health crisis requires attention

During the Covid-19 pandemic, mental health re-emerged as a neglected global crisis. Somewhere in the midst of these urgent discussions, the critical gaps in queer mental health, or the well-being of LGBTQI++ communities that are historically excluded and stigmatised, lay languishing.

This is not surprising as a large section of these discussions are led by heteronormative constituencies of experts whose approach to mental health is unilateral.

In regions such as South Asia, where mental health issues exist at an epic scale, the ask to focus specifically on queer mental health is often considered an overreach and privilege. It is crowded out among discussion and in programmes.

Good mental health and well-being is critical for everyone but for some vulnerable communities such as LGBTQI++ folks, the dangers are immediate and pressing. In plain sight, the crisis is much more severe in these communities.

On the margins

In India, for instance, despite progressive movements in queer rights, mental health remains a critical, unaddressed challenge. By some measures, 17% of India’s population identifies as non-heterosexual. Yet, the access to information, support and mental health services in these communities is as good as negligible.

These communities may not differ in terms of access to services from the rest of the populations but the health system is openly discriminatory and they are much more vulnerable.

Despite having legal rights they still struggle to be accepted, and often in accepting themselves. The public discourse and overall social environment is oppressive, patriarchal and encourages discrimination with the impending fear of violence within social settings and also homes.

In such environments, even coming out can be traumatic and an invitation for physical and sexual abuse, corrective conversion therapy, and abandonment. Naturally, in these circumstances, mental health and well-being deteriorates and queer communities live excluded at the fringes of society, trying to form their own support networks.

This is much worse if they are economically and socially disadvantaged, unable to build communities, without economic independence and/or access to supportive social networks.

High risk

What is the impact? It means that the communities remain at a much higher risk of mental health issues, suicidal ideation, and substance use. Their lived experiences are often filled with dissonance and dislocation leading to fragmented and often difficult lives. They struggle every day and often suffer from severe to moderate mental health issues.

This remains a life-long struggle as discrimination, stigma and lack of social acceptance further exacerbates mental health issues. Also, cases of LGBTQI++ individuals being assaulted sexually remains a frequent occurrence.

While mental health stats about the LGBTQI++ community in India are hard to find, American numbers show that issues such as depression and anxiety are the most common. LGBTQI++ youth are likely to suffer 1.75 times more anxiety and depression. The transgender community, on the other hand, is said to be even more vulnerable as they suffer 2.4 times higher anxiety and depression.

What is worse, queer affirmative mental health services are hard to find. A large majority of the psychiatrists in India still consider homosexuality and other sexual orientations and gender identities as a disorder and practice “correctional therapy”. Only a few psychiatrists and therapists have recognised sexual and gender diversity homosexuality as acceptable.

The pandemic has further widened the inequalities in access to mental health support for India’s LGBTQ community. Several helplines during the few months of the first wave of the pandemic in India in 2020 received thousands of distress calls on their helpline number from LGBTQI++ individuals. A similar pattern was visible during the second wave between April-May 2021.

Acting early

How can this be addressed? India needs a defined and targeted strategy for addressing the mental health needs for LGBTQI++ communities.

It needs a national plan that works at multiple levels with educational institutions, communities, health care providers, mental health professionals, police personnel and even the judiciary to build an understanding of the need for acceptance, non-discrimination and queer mental health issues as also structural challenges these communities face.

In any case, India urgently needs a youth mental health programme, especially in schools, to destigmatise mental health and address the challenge of mental health early.

An integrated plan, which especially targets LGBTQI++ youth and adolescents early, could work in consonance with such a programme and work to build inclusiveness, de-stigmatisation, mental health awareness and self-care skills among its adolescents and youth.

These programmes could include strong components of creating awareness building capacity for self-care and seeking help.

Community building, both by community members themselves and in conjunction with service providers, is an important part of improving the mental health for LGBTQI++ individuals. These act as supportive, safe and educative spaces, access points for healthcare and information on healthy living.

One such project that we have been working on through a participatory methodology has opened a host of issues that LGBTQI++ communities in leading colleges deal with on an ongoing basis. It is critical that such issues are addressed holistically and in an ongoing and sustainable way.

Such programmes hold the revolutionary power to build understanding, address social discrimination, destigmatise mental health and build self-care capacity within these groups. Information is key but capacity building and recognising mental health challenges early is crucial.

These efforts and resources, if initiated early, can normalise gender and sexual diversity and improve the mental health of not just these communities but also society more broadly, thereby reducing discrimination, violence and stigma.

The challenge though is that such programmes are likely to be heavily opposed. This is because we live in an intrinsically heteronormative society that is determined not to change the status quo. They do not wish to allow the future generations to accept themselves, constructing their own identity, and making life choices.

The question before us, then, is if the lives of LGBTQI++ individuals matter. Because if they do, their well-being, their safety and freedom matters too. As does their mental health.

Chapal Mehra is Director, The Rahaat Project, and a Public Health specialist.