Mental health as a universal human right sounds noble, but like all things ‘universal’, it fails to recognise the challenges facing it
Published Date – 26 February 2024, 11:59 PM
By Dishita Swaika
The theme of World Mental Health Day 2023 carried with it a powerful statement: “Mental health is a universal human right”, highlighting that mental well-being is a fundamental right for all. However, like all things ‘universal’, it fails to recognise the challenges behind making this a lived experience for all. Consider the example of Rekha:
Rekha, a young woman, struggles to wake up each morning with a knot in her stomach, dreading the day ahead. No matter how hard she tries, she cannot shake off the feeling of hopelessness and helplessness. She knows that it is not just stress or a passing phase but something deeper – possibly a mental health condition that has the power to consume her deeper if left unchecked. Growing up amid an environment of poverty and violence, trauma became her constant companion. Yet, seeking mental healthcare seems futile.
In her community, resources are scarce and stigma pervasive. Systemic inequalities perpetuate a vicious cycle: they breed mental illness, yet hinder access to help. As Rekha scrolls through social media, she encounters countless posts advocating for mental health awareness. But these messages feel like distant echoes – well-intentioned but unattainable.
The idea of mental health as a universal human right sounds noble, but for Rekha and countless others, it remains an elusive dream.
Diagnostic Criteria
One of the biggest problems lies in the diagnostic criteria set by institutional bodies. The foundation of psychiatric diagnosis lies in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the DSM’s overreliance on Western-centric norms hinders effective mental healthcare for individuals from diverse backgrounds and contributes to the perpetuation of biases in mental health treatment.
Further, the current diagnostic criteria fail to capture the complexities of individual experiences. With a rigid checklist approach, many nuances of mental health challenges are overlooked. Often, individual’s experience of a certain condition, intertwined with questions about identity and purpose, does not neatly fit the given checkboxes. This leads to misdiagnosis or a sense of invalidation for those seeking help, fostering an inability for individuals who require serious mental healthcare to access the same.
Cultural Perceptions
Cultural differences exist in the way communities view mental health conditions and accept treatment. For example, many Asian cultures view mental illness as possibly resulting from divine curses. With a focus on family values and harmony, these cultures also often discourage seeking mental healthcare due to social stigma and the need to maintain their image in society (Kramer et al, 2002; Tiwari & Pandey, 2013).
When cultural beliefs like these are so deeply ingrained, individuals hesitate to seek mental healthcare due to the adverse consequences they may face like shame and discrimination. Thus, achieving universal human right to mental health involves navigating these complex cultural narratives to address the needs of individuals from various communities.
Inaccessible Care
For many, accessing mental healthcare becomes a privilege available only to those with the means and opportunities. Widespread discrimination in accessing care based on gender, race, caste, sexuality and socioeconomic status, among other factors, exacerbates already existing injustices feeding into a vicious cycle where marginalised communities encounter insurmountable obstacles. In the United States, minority communities receive treatment for mental health concerns at approximately 50-70% lower rates than White Americans (Cohut, 2020).
The story in India is not very different with factors like caste playing a huge role in determining access to resources. As researcher Rachelle Bharathi Chandran writes, “Caste plays a role in what help we get in terms of health care. It’s that feeling of loneliness when we don’t know of places where we can speak about our lives, and hope that our journey is understood” (Chandran, 2018). Hence, the road to making mental health a universal human right will require a systematic review of these inequalities which impede equitable access to mental healthcare.
Therapeutic Space
While all these biases hinder access to care, there are many problems that persist even after an individual accesses mental healthcare. Effective therapy is influenced by an important factor which is often ignored — the therapist-client fit. However, there is a marked underrepresentation of diversity among professionals, which means that clients do not have access to counsellors who are from similar backgrounds.
Atkinson and Thompson (1992) reported that African-American clients rating high on cultural mistrust tend to prematurely terminate their therapy when paired with white counsellors, and rated them as less accepting and trustworthy. As expressed by psychologist Charmain Jackman, “With our history of experiencing racism and oppression, it’s very difficult to enter therapy and wonder, is this person going to harm me or alienate me in this vulnerable space?” (Calkins, 2020). Therefore, an important facet of making mental health a universal human right involves making therapy a more culturally informed process.
Way Forward
The understanding of these subtle nuances is important for professionals and policymakers to keep in mind while implementing changes. One possible policy recommendation includes encouraging diversity within the mental health workforce by incentivising education for individuals from different backgrounds through scholarships and mentorship as well as allowing for adequate representation of diverse communities in universities.
Further, professionals should be provided mandated cultural competence training which should be integrated into licensing or certification requirements to ensure they are culturally sensitive and adopt an intersectional approach. Structural inequalities should be addressed through providing wider insurance coverage for mental health conditions. Quality community-based infrastructure should be built to accommodate the needs of different communities.
To sum up, it is important to re-emphasise that mental health is veiled in stigma and caught in a space where separating life’s challenges from external structures is futile since these struggles persist inside an intrinsically unjust system. Something as real and genuine as vulnerability is stigmatised. As a result, it continues to exist in a state of oblivion where it cannot be completely revealed, thus burdening the person who is living with it. The attainment of the goal of mental health as a universal human right requires a transformation that looks at mental health conditions beyond “chemical imbalances” to also encompass “power imbalances” to truly respect and care for the well-being of every citizen of this world.
Dishita Swaika is Undergraduate Student of Psychology at FLAME University
