Depression, harassment, relationship problems, loneliness, and social isolation, were among the few pressing mental health concerns that were highlighted during interactions with members from men-who-have-sex-with-men (MSM) and transgender community. The existing services for MSM and transgender people, firstly, are decimal and not reaching a vast majority of community members, and secondly, they seldom serve their mental health needs optimally.So what do the MSM and transgender people do when confronted with mental health challenges? "We are referred to our friends or community people. We rarely go to official psychologist or psychiatrist" was the response from one of the members of the transgender communities. HIV and STI counselling is more concerned with sexual and reproductive health, and doesn't adequately address mental health concerns beyond HIV prevention and to some extent care and support issues. There were strong remarks made on the inadequate counselling on HIV treatment, care and support.
"When there is adequate self-esteem and self-respect, there is a natural desire to be healthy, to take care of one self, to engage in safer sexual practice. So none of what we do will be successful if we ignore mental health issues" remarked another member.
"Everybody has some problem or the other – depression, etc, but when it becomes so much that everyday life becomes difficult then professional help from psychological counsellor or psychiatrist might be needed" said a member.
"We speak about behaviour change – there is a big gap between acquiring knowledge and behaviour change, there is a gap between information and practice. This is where good mental health might help reduce the gap. When we are healthy enough, when we have adequate sense of what our worth is and how important we are to ourselves and when we have a tendency to take care of ourselves, behaviour may change" said Aniruddh Vasudevan, Director of The Shakti Centre in Chennai to CNS correspondent last year.
"We have artificially set up a hierarchy that attending to physical health is more important than attending to our mental health. Body and mind are not split, rather they are together. So we better attend to the mind too when we are attending to the body" had said Aniruddh.
People are often reluctant to accept that they might be needing mental healthcare. "When there is an emotional problem one might be finding it difficult to deal with, somehow we think that taking help is bad, it is a defeat, it is like giving in" had said Aniruddh.
"But if there is a physical health issue, we don’t hesitate in taking help and even go to the pharmacy and self-treat at times. But we don’t do this when there is a mental health issue and hesitate to seek help" further adds Aniruddh.
"Even when we have accepted ourselves as we are, there are emotional issues like break-up, or when one of our friends is dying, people will think that we have these issues because we are MSM, transgender. I think we are blaming others in advance even before they say it, because in some corner of our minds, we think we are the source of our problems. Even the best of us who are comfortable with ourselves, in some corner there is a doubt that we are the source of our problems" ponders Aniruddh.
"At times, we think that it is because of us, we are causing so many problems to our parents or to our sister who might not be getting married on time. Sometimes the source of the problem is not us, but because we are concerned about the people around us. It is a sign of humanity that we are concerned about people around us. We have extra mental health problem because we are different and that is causing problems around us" added Aniruddh.
Another significant comment Aniruddh made was that the members of affected communities need capacity building and must be competent enough to contribute effectively in programmes addressing their community. "Just coming from a community doesn’t mean that the person is automatically equipped to peer counsel – we have to do something to equip ourselves" said Aniruddh.
"At times, it is easier to talk to somebody you don’t know. Professional counsellors or psychiatrists can’t proactively reach out to people and counsel, they can only counsel those who come to them and ask for the counselling. However the peer counsellors can go out to the community and help those who might need help" said Aniruddh.
"Most basic thing in counselling is listening and the person sitting in front of counsellor is most important person. We are not arguing to say that peer counselling can replace professional counselling, but we believe that peer counselling can supplement professional counselling. Peer counsellors cannot handle all cases like suicidal cases at times, so should do referral services to professional counselling" said Aniruddh.
Peer counselling is not about offering solution – because the message that gets across is the person being counselled is not capable enough of finding solutions.
Bobby Ramakant - CNS
