Reducing the Stigma of Therapy and Mental Health: An Indian Perspective

Bivita Chhetri, MA

Counselling Psychologist, Auramah Care, Kerala 678501, India; E-mail: contact@bivitachhetri.com; singhbivita@gmail.com

Reducing public stigma has been the aim of India’s mental health policy since April 2017, when India passed the Mental Health Act, which focused on protecting the rights to equality and non-discrimination of people with mental illness.¹ Stigma is a social injustice that discredits many people with serious mental illness, terribly harming them in the process.² Six-years after the government acknowledged and recognized the importance of mental health, the stigma enveloping mental health still has its roots in our society. This editorial examines the challenges and opportunities in reducing the stigma of therapy and mental health in India, shedding light on the cultural context and potential strategies for changing the Indian perspective.

India’s cultural fabric is woven with intricate threads of tradition, religion, and social norms.³ While these elements contribute to the nation’s diverse and vibrant identity, they have also created barriers to open discussions about mental health.⁴ A review of studies on stigma shows that most of the public may accept a mental health disorder and the need for therapy, but many people in our country still have a negative viewpoint of that mental illness.⁵ The prevalent stigma often originates from the deeply rooted belief that seeking therapy is a sign of personal weakness or failure, leading to ostracization and discrimination.⁶ This, in turn, has contributed to delays in seeking care and hindrances in timely diagnosis and treatment for mental disorders, serving as an impediment to recovery and rehabilitation and ultimately reducing the opportunity for a better life.⁶ The rapid pace of modernization, urbanization, and the pressures of contemporary life—for instance, interpersonal conflicts at the workplace, professional burnout, conflicts in family, struggles to pay bills, etc. It has brought about new challenges such as stress, anxiety, and depression in people’s daily lives. It requires a more holistic approach, where a need arises for a balance between tradition and modernity to dismantle the stigma surrounding therapy.⁷ The Acceptance and Commitment Therapy (ACT) model is one of the most effective ways, including traditional cognitive behavioral therapy (CBT), which has proven to be more effective than other active treatments across a range of mental health issues. ACT is part of a larger portion of behavioral and cognitive therapies through the use of mindfulness and acceptance. It has been proven crucial and helpful in working towards eliminating the sociocultural factors that can assist in addressing and eradicating the mental health stigma.⁸

More than 50% of India’s population is below the age of 25, and more than 65% is below the age of 35 (according to the 2022 revision of the World Population Prospects).⁹ The youth of India lack knowledge about the causes of mental health issues and believe that limited or no treatment exists for such problems.⁵ A study regarding stigma conducted among young people in India revealed a lack of identification of the common symptoms of disturbed mental health. Consequently, they may not even recognize everyday mental health problems or consider themselves susceptible to acute problems. Fear, shame, sadness, pity, or sympathy were expressed by the youth of India, similar to the global attitudinal responses of “stigmatisers”.⁵

Most of the impact of stigma is an interplay between self-stigma and perceived stigma. Self-stigma includes societal bias, encompassing personal, social, familial, medical, and treatment-related aspects. Conversely, perceived stigma centers around an individual’s interpretation of societal prejudice, which influences their coping style with the challenges they face. The consequences of stigma can be life-threatening and humiliating for an individual. A mentally ill person still carries a weight of shame that causes the person or their family to lose face. In our country, having a family member with a mental health condition casts a shadow on the prospects of progress for other family members.⁶ In some cases, seeking professional help or therapy for mental illness may be contrary to the cultural values of a family, including emotional restraint and avoiding shame.

A lot of research conducted on addressing stigma shows that individuals experiencing mental illness should speak out and share their stories, which can have a positive impact.¹⁰ When we know someone with mental illness, it becomes less scary and more relatable and real.

RECOMMENDATIONS

• A comprehensive mental health education system is required, and age-appropriate mental health education should be introduced in schools. This curriculum should focus on promoting understanding, empathy, and open discussions about mental health issues, thereby dispelling myths and misconceptions from an early age.¹¹
• Accessible mental health services must be provided, especially in rural and undeserved areas. Establishing serviceability, accessibility, and integrating mental health into primary healthcare settings as a part of a public mental health approach will be culturally sensitive in Indian settings.¹¹
• Workplace mental health programs are required to encourage employers to implement mental health support programs within their workplaces, including stress management workshops, counseling services, and flexible work arrangements to accommodate mental health needs.¹¹
• Public figures, politicians, and policymakers must be encouraged to publicly support mental health initiatives and promote open dialogue about mental health. Their endorsement can help legitimize mental health discussions and policies, reducing stigma and increasing awareness.¹¹

As India continues to evolve and embrace its diverse identity, it is imperative that the nation come together to create a compassionate and understanding environment that supports the mental well-being of all its citizens.^10,12

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5. Gaiha SM, Taylor Salisbury T, Koschorke M, Raman U, Petticrew M. Stigma associated with mental health problems among young people in India: A systematic review of magnitude, manifestations and recommendations. BMC Psychiatry. 2020; 20: 538. doi: 10.1186/s12888-020-02937-x

6. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002; 1(1): 16-20.

7. Corrigan PW, Roe D, Tsang HW. Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates. New Jersey, USA: John Wiley & Sons; 2011. doi: 10.1002/9780470977507

8. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther. 2006; 44(1): 1-25. doi: 10.1016/j.brat.2005.06.006

9. American Psychiatric Association (APA). Stigma, Prejudice and Discrimination Against People with Mental Illness. 2021. Website. https://www.psychiatry.org/patients-families/stigma-and-discrimination. Accessed August 11, 2023.

10. Ahuja KK, Dhillon M, Juneja A, Sharma B. Breaking barriers: An education and contact intervention to reduce mental illness stigma among Indian college students. Psychosoc Interv. 2017; 26(2): 103-109. doi: 10.1016/j.psi.2016.11.003

11. Adhikari SR, Pradhan SN, Sharma SC. Experiencing stigma: Nepalese perspectives. Kathmandu Univ Med J (KUMJ). 2008; 6: 458-465. doi: 10.3126/kumj.v6i4.1736

12. Chandra PS, Lakshmi S, Nanjundaswamy MH, Shiva L. The impact of urbanization on mental health in India. Curr Opin Psychiatry. 2018; 31(3): 276-281. doi: 10.1097/YCO.0000000000000408