Why mental health professionals must shift from being queer friendly to queer affirmative

In response to a petition filed by two lesbian women facing police harassment, Justice Anand Venkatesh of the Madras High Court on June 7 outlined a range of guidelines to help uphold the safety and wellbeing of the LGBTQIA+ community.

In addition to instructing the police to stop harassing consenting LGBTQIA+ couples, the judgement directs the relevant ministries and authorities to work with LGBTQIA+ organisations, take cognisance of offences committed against LGBTQIA+ persons and provide social supports such as counselling, legal assistance, shelter, along with monetary support as needed.

Crucially, the judgement also directs the education system to make curricula and spaces LGBTQIA+ inclusive – ranging from gender neutral bathrooms to provision of queer-trans affirmative counsellors. To that end, the court has prohibited the pathologisation (or labelling as “abnormal”) of gender and sexuality as well as attempts to “medically cure” or “convert” LGBTQIA+ individuals. It has also indicated the need for sensitisation programmes for judiciary, police, education systems and families.

This necessitates having a large pool of queer affirmative mental health counsellors who are able to work with courts, district legal services, in education systems and of course, with families. So, while this judgement is a welcome one, upholding it is going to be no mean task.

Aversive therapies

The fields of mental health and psychiatry have been particularly responsible for pathologising genders and sexualities that fall outside of the norm. Gay men, transgender women and hijra communities have been criminalised, incarcerated, or faced attempts of “cure” through Electroconvulsive therapy, and other aversive therapies. Other medical disciplines learned from these measures, and there were surgical interventions (including hysterectomy, ovariectomy, clitoridectomy, castration and more) to “cure” homosexuality, some of which continue to take place without consent on young intesex individuals.

Given that the mental health community has itself played a significant role in rendering invalid the lives, identities, and experiences of LGBTQIA+ communities, it is now imperative for them to do the work to challenge what they have learned.

Preceding the Madras High Court judgement was the Mental Health Care Act of 2017. This requires medical professionals to affirm the rights of people from communities marginalised by gender and sexuality, and to develop and provide appropriate services. In addition, the National Health Policy 2017 acknowledges the crucial role of social determinants of health (such as economic stability, access to education, and social and community context), and the need to address them in health services.

Lastly, in 2018, when the Supreme Court read down Section 377 of Indian Penal Code, it effectively decriminalised consensual same sex relations between adults.

After Section 377 of the Indian Penal Code was read down by the Supreme Court, there was a spate of announcements about “queer-friendly” mental health services for the LGBTQIA+ community. While there is unquestionably a need for more services, the sudden widespread interest in the mental health and wellbeing of queer people right after the Supreme Court verdict made us question: is it enough to be queer-friendly while working with LGBTQ+ clients?

Unique stressors

LGBTQIA+ individuals face unique life stressors such as familial violence, discrimination and violence in public places and institutions, as well as struggles with self acceptance. This combination has a significant mental health impact.

A service that is “queer friendly” might educate practitioners about the spectrum of queer identities, but will not take into account the history of erasure and marginalisation that LGBTQIA+ communities have faced. It will not help practitioners do the work to unlearn their biases and hold them accountable for their complicity in this historical pathologisation. Importantly, it will not be equipped to respond to the needs of queer clients by incorporating the issues and stressors inherent in living on the margins of a heterosexually defined world.

For too long, mental health practitioners have considered queer sexuality through the lens of heterosexuality. This was an incomplete, incorrect and harmful gaze. To begin to unlearn it, we need to shift from being queer friendly to being queer affirmative.

Queer affirmative knowledge is knowledge generated by queer people – drawn from our lives, our politics, and our struggles, and based on our lived realities and felt experiences. To put queer affirmative care into practice entails creating spaces and curriculum that centre our lived experiences.

For example, Peer Counseling Practices – a form of care and support located within collectives and communities – has a long history. It is a model that resists and challenges the idea of an “expert” opinion, and looks instead to the needs and concerns of lives lived on the margins. Peer counseling is about lending hope and strength through empathy that comes from shared experience, and providing role-modelling and possibilities for living non-normative lives.

As such it is an experience-based, rather than discipline-based expertise that is considered knowledge. In India, organisations and collectives such as Sappho For Equality, Moitrisanjog Society, Sahayatrika, Xukia have been practising peer counselling for more than 18 years.

Helplines are another example of care that is accessible and can play an important role in providing support to LGBTQIA+ communities whether they use expert-led or lay-counsellor-based models. Because of their anonymous nature, such services have the potential to address problems of discrimination and exclusion whether it is harassment on public transport, or controls on mobility that marginalised people face when they try to access care.

In addition, the caller in this interaction has some power, knowing they can disconnect and end the interaction at any point. Examples of such helplines in India include iCall (a national helpline that focuses on making mental health accessible for communities that have faced historical discrimination), and Ya_All (a helpline for LGBTQ+ youth, operating in English and Meitei, based in Imphal).

Lastly, and most importantly, if we are to follow the Madras High Court judgement and stop pathologising LGBTQIA+ lives, we need to radically alter medical and mental health syllabi. To this end, in 2019 Mariwala Health Initiative (the foundation we are affiliated with) launched QACP, a course designed by queer-identified mental health practitioners, to help practitioners recognise inequalities and their impact on mental health.

Today, mental health practitioners have a responsibility to their queer clients. The lure of the pink rupee and the reading down of Section 377 saw many players entering the field of queer mental health with enthusiasm, but without any real understanding of our lived realities. This needs to change, and to do so, our own critical voices needed to be registered as part of the discourse.

Shruti Chakravarty is Chief Advisor, Mariwala Health Initiative, and faculty of Queer Affirmative Counselling Practice Course.

Raj Mariwala is Director, Mariwala Health Initiative.

Pooja Nair is faculty of Queer Affirmative Counselling Practice Course and independent therapist.