Thread by @genderlogindia

[TW] It would be impossible to talk of health disparities in India and not address mental health. India ranked 43rd in the world on rates of suicide (in descending order) in 2009.

https://twitter.com/genderlogindia/status/1026639111740907520

It is hard to find reliable data on suicide, as it is punishable offense in India, leading to under reporting. Death by suicide is frequently reported as due to illness or accidents to avoid involving the police. Official figures underestimate the problem

ncbi.nlm.nih.gov/pmc/articles/P…

It also varies widely by state, region, gender, caste, socioeconomic background. Young adults(15-29) are the most vulnerable, having the highest rates of suicide, attempted suicide, and suicidal ideation and accounted for 34.5% of suicides in the country.

In young adults, suicidal behaviour is associated with female gender, not attending school or college, physical abuse at home, lifetime experience of sexual abuse, violence, psychological stress, and other coexisting common mental disorders, especially in rural populations.

Globally there is an increasing trend of suicide among the elderly, but India seems to have much lower rates, possibly due to the Indian family structure that prevents social isolation and abandonment of the elderly. Note: overall life expectancy in elderly is much lower in India

It is widely accepted around the world that men have higher rates of suicide than women. While it's true than men are less likely to seek or get help for mental health, but it is important to recognise that women ATTEMPT suicide at nearly 3x the rate that men do.

However suicide attempts among men are generally 3x more successful than women (leading to the somewhat misleading statistic often shared on social media.) This is attributed to the methods of suicide chosen - men reportedly choose more lethal methods.

verywellmind.com/gender-differe…

In the west, marriage is considered 'protective' against suicide. In India sociocultural factors like arranged marriages, familial pressure to stay in abusive relationships, dowry demands all contribute to higher suicide rates (70.4% of suicide victims are married.)

Housewives in India account for 18.6% of total suicides - the largest group. Those in farming and agriculture consist of 11.9%, and students 5.5%. The agrarian crisis over the last two decades accounts for over 300,000 but official figures fluctuate wildly from year to year.

NCRB reports a 'fall' in farmer suicides in 2014 (by almost half!) as reported by the state governments but a closer look reveals that a vast number were simply 'reclassified' from farmers to 'agricultural labourers' or an ambiguous 'other'.

psainath.org/the-slaughter-…

Along with sociopolitical circumstances, many intersecting factors contribute to suicidal behaviour, including other psychological conditions. Support for mental health in India is scarce and it is often ignored. 56m Indians have depression, and 38m have anxiety disorders.

Mental illnesses are so stigmatised that 26% of people in one study said they were afraid of the mentally ill, and 47% were 'highly judgemental'. Interestingly, the higher the education and socioeconomic background, the more they villanised mental illness

qz.com/india/1237314/…

The National Mental Health Survey across 12 states in 2015-16 found about 150m people in need of mental healthcare, but only 0.3 psychiatrists, 0.07 psychologists and 0.07 social workers per 100,000 people in India, and concentrated mainly in urban areas.

devex.com/news/in-india-…

To reach the rural population Karnataka has launched a one day training program for ASHA workers recognize common mental health problems like schizophrenia, anxiety, depression, and alcohol abuse, teaching them to refer patients to a professional, to provide basic counselling.

While this could help to detect and recognise mental illnesses it's an added burden on ASHA workers who are already responsible for a host of other health care related services. But once recognised, the nearest psychiatrist may be 100km away, making help effectively inaccessible.

Tying back to the previous discussion, caste discrimination is prevalent among ASHA workers, with reports of them refusing to go to houses in SC/ST communities for even emergency care or deliveries, further neglecting a very vulnerable population.

In urban spaces too, where access to counsellors and therapists is relatively better, many mental health professionals are ill equipped to address the issues faced by their patients with sensitivity and discretion.

Women, LGBTQIA+, and SC/ST populations are at highest risk but also teh least represented. There is little or no literature in India about the effects on mental health of caste discrimination, intergenerational caste trauma, homophobia, transphobia, and patriarchial societies.

While Section 377 is still in place, and 'caste-blindness' seems to be the official approach, it is unlikely that that marginalised people are provided the care they need by mental health professionals.

From Skin Stories series by @slayjamoons
medium.com/skin-stories/n…

Women are reportedly more prone to anxiety disorders (like generalised anxiety, panic disorders, PTSD, and eating disorders) but also medical professionals are more likely to dismiss women's complaints while referring men to mental health professionals.

ncbi.nlm.nih.gov/pmc/articles/P…

Women with psychosocial and intellectual disabilities in India are often involuntarily institutionalised, medicated, abused, and stripped of their rights, often by their families or relatives.



hrw.org/news/2014/12/0…

hrw.org/report/2014/12…

Speaking up about domestic violence and sexual abuse can have horrifying consequences for many women.

medium.com/skin-stories/m…

As pointed out by @caselchris1, we must first acknowledge the many coexisting oppressions and marginalisations that intersect including gender, sexuality, caste, and disability to properly tackle mental health in India.

https://twitter.com/povmumbai/status/1024543752369528834

To that end there's been an increase in online counselling services and startups like @shipradawar 's ePsyclinic that promise a convenient accessible inclusive way to provide mental healthcare.

forbes.com/sites/suparnad…

Other resources include the White Swan Foundation @mentalhealthind; The Alternative Story by @WiseDonkay; @zaharaesque; @guptasonali; @ahlamatra; and @NainaShahri

My DMs are open as well at @GalatFemme and finally a basket of puppies to make up for this very difficult possibly triggering thread!

Thread in article form for those using screen readers 😊

threadreaderapp.com/thread/1026864…

An excellent article by @devanikindia about suicide among Indian housewives.
indiaspend.com/cover-story/bh…