Mental healthcare seems to be the most-discussed topic these days. Despite recent attempts at increasing awareness as well as the enactment of a separate law in India, people with mental illnesses continue being stigmatised. Due to the absence of visible symptoms which manifest themselves in case of physical illnesses, mental illnesses often remain undiagnosed for extended periods of time, and, in many cases, are neglected even after diagnosis.

Untreated mental illnesses can have severe consequences, including the onset of various physical ailments, higher propensity to abuse drugs and illegal substances, and loss of employment. The longer a mental health condition exists, the harder it is to treat.

I am queer. Why should I worry about my mental health?

Mental health problems become more pronounced when they are discussed in the context of the queer community. Although official statistics of India’s queer population are not available, it has been estimated that 6-8% of the country’s total population comprises queer people. That makes it one of the largest such population groups in the world.

Continuous discrimination and stigma results in members of the queer community living under constant distress. Social prejudices also prevent many people from discussing emotional problems and conflicts with others, which aggravates stress levels. People with gender dysphoria experience intense emotional upheaval. Queer people also face bullying and social exclusion. Under these circumstances, it is not uncommon for them to experience psychological distress which can seriously impair their mental health. 

When should I seek professional help?

Although some amount of stress is common (and can, in many cases, act in a positive way), it should become a cause for worry when it persists for longer than normal and starts interfering with your lifestyle. The most commonly-occurring conditions which should act as warning signs include:

• Depression, perpetual feelings of sadness or wanting to cry
• Anxiety, unexplained fear or a feeling of dread
• Frequent mood swings
• Low self-esteem
• Self-harming behavior and suicidal thoughts

Other than the above, it is time to seek professional help when you notice persistent behavioral changes, such as finding it difficult to enjoy life, worrying all the time, not wanting to spend time with your loved ones, and disturbed sleep patterns.

Who should I reach out to for help?

Psychiatrist, psychologist, counselor – it can be quite confusing to decide which professional to reach out to. Use the following as a ready-reckoner:

• Psychiatrist: Medical doctor specializing in diagnosing, prescribing medication for and treating mental illnesses. Psychiatrists are trained to differentiate mental illnesses from other underlying medical conditions which may exhibit psychiatric symptoms. They also monitor the relationship between mental illnesses and physiological problems.   
• Psychologist: Doctor specializing in the study of the mind and human behavior. A psychologist is qualified to offer counseling and psychotherapy as interventions to deal with emotional issues of individuals. However, psychologists in India cannot prescribe medication. They hold a Master’s degree in Psychology as a minimum qualification.
• Mental health counselor: Provides basic mental health support. Counselors typically hold a degree or diploma in counseling. Counseling focuses on specific issues or problems (example: managing stress) and is a short-term intervention compared to therapy.

What is the legal position on rights of queer people to receive mental healthcare?

The Supreme Court’s reading down of Section 377 of the IPC in September 2018, which decriminalized same-sex relations between consenting adults, marked a defining moment for not only the queer community but for Indian society as a whole. Then Chief Justice of India, Dipak Misra, along with Justice AM Khanwilkar, quashed the notion of homosexuality being a mental illness. A large part of the judgment also dealt with the mental health needs of the queer community and its equal right to receive mental healthcare.

With so many positive developments and a definitive Supreme Court judgment, it would seem that all problems have been addressed. But is that really the case? While the law has conferred rights to the queer community, its members continue being stigmatized and ostracized by society. Even today, a majority of mental health professionals in the country don’t accept the fact that alternative sexuality is not the equivalent of a mental illness. Mental health professionals continue operating within the confines of their prejudiced environments, with the result that the queer community’s mental health needs suffer.

Are mental health professionals prejudiced towards queer people like me?

Now that can be a tricky one to figure out. While attitudes have changed, there are multiple instances of doctors and medical professional being prejudiced towards queer people. Instead of treating the mental illness, they may end up offering advice on the non-virtues of being queer, which will not be helpful in any way. With changing attitudes, a small section of the medical community, including mental health professionals, have started calling themselves ‘queer-friendly’ or professing to offer ‘queer-affirmative’ treatment.

If you are willing to disclose your identity, ask your therapist/counselor if they have worked with queer people in the past. If they are active on social media, check their views to determine if there are any negative attitudes towards queer people. Check their reviews from other patients or from social media (if available). In case you feel uncomfortable during counseling or therapy sessions, it will be better to evaluate if the particular professional is indeed right for you.

iCALL (Initiating Concern for All), a psychosocial helpline which was started in 2012 by the School of Human Ecology, TISS, has published a crowdsourced list of ‘mental health professionals we can trust.’ The list can be accessed by visiting this link.

Is mental healthcare for the queer community affordable?

The honest answer is: yes and no. And that is simply because of the complex components of the question: it is mental healthcare for the queer community which should be affordable. In India, there is a significant gap in the doctor-patient ratio for mental healthcare. When that is narrowed down to the ratio of queer-friendly mental health professionals, the statistics are likely to be even more dismal.

The few queer-friendly mental health practitioners are, in most cases, very expensive. This renders them out of reach for a vast majority of queer people. Although counselors are relatively more affordable, they lack the necessary expertise to deal with complex mental health issues. Moreover, counselors may also suffer from prejudiced beliefs and stigma towards queer people.

Are other support systems available?

Yes there are. Efforts are being made by not-for-profit organizations, advocacy groups and even networks of parents to provide critical support for the emotional well-being of queer people. Communities are also taking up initiatives targeted towards the well-being of queer people and providing safe spaces to discuss issues which are responsible for causing stress and emotional problems. In many organizations, people take up the role of allies to help queer people in initiating conversations regarding mental health, among other issues.

Most importantly, you are your biggest support system. If you take proper care of yourself, chances are that some of the minor emotional distress will automatically get resolved. Eating healthy, exercising regularly and surrounding yourself with positive people are some of the ways in which you can improve your own mental health. This will not be easy in the beginning, but only if it becomes ingrained in your DNA will actual results be visible. The choice, as is mostly the case, is in your hands.