Raj Mariwala is the director of Mariwala Health Initiative, which supports organisations in India to provide mental health services to all. We interviewed them as part of our #PassTheMic campaign. Here’s some of what they had to say.
COVID has shown a lot of the fault lines in our health systems, particularly around leaving people behind.
We’re only as strong as the system is. So if it’s built for a certain type of person, and we know that COVID affects marginalised communities disproportionately, we need to make some structural changes in a coordinated global fashion. This means ensuring everyone is protected, not just the privileged.
It’s also important to join the dots between public health, disaster response, humanitarian relief, and mental health. We cannot pick these apart and work on them in silos, and COVID is really showing us that.
In terms of the response to COVID, we really need to be looking at a psychosocial rights-based response. So if we start by asking: “Is the right to health assured for everyone?” And, if it is: how do we make that possible during COVID?
With COVID, it’s not just about falling ill. We’ve seen in the context in which we work, for example, that COVID has meant lack of HIV/AIDS medication and lack of sexual and reproductive health aids. So if we’re looking at health, we can’t just look at providing ventilators and oxygen. We need to also look at human rights and the responsibility of our international governmental organisations as they work with civil society organisations to provide this.
Considering mental health specifically, other than the actual effects of lockdown, the fear around getting COVID and the anxiety about being stuck in your home or losing your job, there’s a very real and dangerous rise in stigma and discrimination. We’ve seen a massive rise in it, to the extent that in India, we’ve had over 200 suicides because people have been scared of having COVID, or are having alcohol withdrawals, or a lack of livelihood options. So, we can see that the long-term effects of COVID and the casualties around it are very far reaching.
Each media portal puts up counters of how many people are infected, how many people have died, how many people have recovered. But it’s very reductive in terms of a mental health sense, because we’re missing out on the suicides and the very real mental health stress.
When it comes to populations like India or other low- and middle-income countries, we cannot just provide mental health services. When we talk about mental health, we say “psychosocial support.” If I break that down there is the word psycho, which means psyche — related to the mind, cognitive, and emotional. Then there’s the social support — providing food security, a place to live in, access to clean water. Support is not going to be effective unless we have both.
If we look at marginalised populations and how it’s impacting them, in the US, for example, we’ve seen that black and minority populations face disproportionate effects related to COVID. Similarly, in India, persons from marginalized class backgrounds or LGBTQIA populations are facing the same lack of access services to information.
For a lot of LGBTQIA persons, living with families who may be homophobic or biphobic is an issue. Similarly, for trans persons who may have to misgender themselves to keep safe. India has also seen a huge spike in domestic violence and violence against children.
So, I think the long-term impacts of COVID in global health are going to be wide-ranging. There is distress that comes with the losses that we face from COVID, and I’m not just talking about the loss of life. I’m talking about the loss of plans, jobs, and whatever futures we may have planned for the next six to eight months. Especially in India, there’s going to be wide unemployment and economic insecurity.
One of the things we need to look at is how to build community. I believe that community mental health is one of the stronger options when we consider uncertainty, anxiety, loss, and grief around COVID. We cannot do this on our own.
So, building these communities or reaching out to these communities is important. This also means challenging the need to continuously go to an expert; not everyone needs a psychiatrist or psychologist. What are the roles that our peers can play and how do we take care of ourselves so that we can be there for each other?
These excerpts from the interview were edited for length and clarity.
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