Raising awareness and supporting the mental health of the LGBT+ community in India

Evangeline Arethwala

26 July 2023

This is an article from the CSC Development Theme: Strengthening health systems and capacity

I think the biggest change I have brought about until now is that I have modified my mental health therapeutic practice to make it more accessible and equitable for Indians. 

Dhritiman Ray

According to the World Health Organization (WHO), nearly one billion people suffer from some form of mental disorder globally. In recent years, significant progress has been made in prioritising mental health in global health policy and it is now included in the UN’s Sustainable Development Goals. Despite this progress, in some countries mental health services are limited, psychological health professionals are scarce, and people with mental health conditions face human rights violation, stigma, and discrimination.

India has one of the highest prevalence of mental illnesses globally. It is estimated that approximately 150 million Indians need mental health care services. Unfortunately, less than 30 million take up these services due to lack of access, stigma associated with mental health, and a lack of awareness of available resources.

 Commonwealth Alumnus Dhritiman Ray is a mental health counsellor and consultant. Since 2019, he has managed a private counselling therapy practice in New Delhi where he provides in-person therapy services and virtual therapy sessions across India. Through his work, he strives to spread awareness about mental health to marginalised groups, including members of the queer community and people living in low-income communities.

Building a network in India

One of Dhritiman’s main goals through his practice, alongside treating patients, is to strengthen the network of mental health professionals in India, including psychiatrists, social workers, activists, health workers, and community workers. He cites the growing mental health crisis in India as a key factor in wanting to lead this change.

“We do have a public health system in India. Unfortunately, that did not prioritise mental health that much, until very recently. Even though we have psychiatrists and other mental health professionals, it’s one the worst [patient-doctor] ratios in the world. And now we are the most populous country in the world with very high rates of depression, anxiety, and trauma.”

Dhritiman is passionate about working with communities to raise awareness of mental health care, and believes it is essential to form strong alliances with mental health practitioners to improve services for vulnerable young adults, especially those from marginalised communities.

Challenging stigma

Prior to his Commonwealth Scholarship, Dhritiman volunteered at Sangath, an NGO aimed at addressing psychological and social needs of people through comprehensive interventions. During this time, he provided counselling services to high school students from under-resourced government schools and was first exposed to the stigma and discrimination faced by young individuals trying to understand their gender identity and its impact on mental health.

Recounting his experience at Sangath, his first client was referred by a teacher for not wearing the correct uniform, a referral he notes as being strange as it did not seem to require counselling support. Dhritiman soon learnt, however, that the student was being bullied by the school principal for being queer and that the referral about school uniform was a cover to enable the student to access counselling.

In India, although historical literacy depicts homosexuality was prevalent in ancient times, being queer still holds a lot of stigma due to religious and cultural beliefs. Same sex relationships and queer identities are often termed as illegal and unlawful, disrupting the Indian culture.

Reflecting on his experiences, Dhritiman shares that queer people must overcome additional challenges to access mental health support, such as addressing their fear of being queer and assumptions that the therapist will judge them on their identity. Dhritiman is a queer-affirmative mental health practitioner, and helps clients embrace their identity and sexual orientation, and ensures that his practice provides a safe space to both queer and non-queer clients.

“You need to be aware of what they [queer individuals] go through. You need to make them feel profoundly accepted. You can’t make someone feel authentically accepted if you [service providers] have stigma.”

To advance his knowledge and practice, in 2019 Dhritiman completed a Fellowship with Safe Access, a charity in Delhi bridging the gap between LGBTQ+ community and health care services. During this time, he developed an online directory for the LGBTQ+ community to find queer-friendly health practitioners in Delhi.

This work led to a further fellowship with the Unsound Project, an initiative to create mental health awareness through an intersectional lens by looking at mental health beyond religion, gender, caste, and economic status. Through this exposure, Dhritiman realised that to provide services to the queer community, service providers must be unbiased and aware of the challenges faced by the community.

The importance of a multi-disciplinary team

Having worked with marginalised groups, Dhritiman was keen to advance his skills in mental health therapy to better support the psychosocial needs of his clients. He notes that existing research in psychology in the global south is dominated by studies and publications from researchers in the global north and therefore not directly applicable to the Indian context. To address this gap, in 2020 he pursued a Masters in Global Mental Health at the University of Glasgow through a Commonwealth Scholarship.

The Master’s course provided Dhritiman a systematic approach to understanding key factors and psychiatric models at play in mental healthcare. During his Commonwealth Scholarship, he undertook a placement at the National Health Service’s (NHS) Glasgow Trauma Centre (GTC). Here, he received first-hand experience of understanding the UK’s public health system and the role the NHS plays to address intense, long-term, psychological trauma.

The placement helped him understand the importance of a multi-disciplinary team for trauma intervention including art therapists, clinical psychologists, occupational therapists, counsellors, and psychiatrists. This experience empowered him to expand what he can do as a mental health practitioner to improve the well-being of traumatised communities outside individual therapy.

“The NHS placement just completely opened my mind because until then I was unconsciously approaching therapy in a very circumscribed way. In many ways, it was more like a sacred space that is only between two people. That placement experience made me realise it doesn’t need to be. There are more ways to go about it [therapy].”

Creating services that are available to all

On returning to India in 2021 following his Commonwealth Scholarship, Dhritiman has sought to bring together his previous work and Master’s studies to advance and improve his mental health practice. He shares that his biggest learning during this time was that there is no ‘standard’ approach to providing quality mental health care.

Whilst on placement at the NHS, he was introduced to the pluralistic therapy model, which gives authority to clients to decide their goals, tasks, and therapy process. Drawing on the best practices of this therapy model, he now offers tailored support to clients by involving them in the decision-making process in seeking mental health care.

Dhritiman strives to make mental health care services available to low income communities and marginalised groups by implementing a sliding scale model. Through this, clients from high-income backgrounds pay higher fees for his services, enabling him to provide pro-bono therapy services to those on low incomes.

He has also introduced online therapy to ensure individuals from regions with reduced mental health services can access therapy. Online therapy has been especially popular with people from the queer community as it offers a safe space to talk about trauma and stigma. Since 2022, more than 100 clients, including from the queer community, have accessed mental health therapy with Dhritiman in this way.

“Without the internet, I don’t think I would be able to work with the queer community in India. That is the main reason why I can have clients from the southern end of India who speak a different language, to the northeast, who live in conflict zones.”

Although online platforms have helped in reaching out to clients across India, Dhritiman admits that the lack of face-to-face sessions can greatly influence the therapeutic alliance. A physical space for therapy can give clients some respite from their home environments especially when it is invalidating, triggering, or dangerous.

Developing awareness

Dhritiman notes that the Commonwealth Scholarship helped him increase his understanding on mental health systems developed in different contexts, how the practice is influenced by power, resources, and cultural assumptions, and how therapy can be made more efficient and equitable. This allowed him to put theory into practice and modify his therapy services, especially for clients from marginalised groups.

To advance his career goals of improving mental health care in communities, he is now pursuing cross-cultural doctoral research on spreading awareness about complex trauma and intergenerational trauma with non-medicalised and culturally relevant narratives from the UK and in India.

“The Commonwealth Scholarship equipped me with advanced academic skills, introduced me to the academic circles in the UK, and informed me about the opportunities available to progress in my career.”

Dhritiman Ray is a 2020 Commonwealth Shared Scholar from India. He completed his Masters in Global Mental Health at the University of Glasgow.