Care as disability justice, dignity in mental health

Why in the News?

A recent opinion piece by Vandana Gopikumar of The Banyan and Banyan Academy of Leadership in Mental Health argues for a radical reimagining of mental health care in India and globally. It frames mental health not merely as clinical treatment, but as an issue of disability justice, dignity, and relational care, questioning dominant biomedical and deficit-based approaches amid persistent treatment gaps and rising psychosocial distress.

Background

• Mental health systems worldwide continue to be dominated by biomedical and deficit-oriented frameworks, focusing on diagnosis, symptom reduction, and “integration” into socially prescribed norms of productivity.
• Despite advances in third-generation psychotropic drugs and evidence-based therapies, 70–90% of people globally lack access to adequate mental health care.
• In India, distress is deeply shaped by poverty, homelessness, family breakdown, caste and gender hierarchies, and institutional violence, yet these contexts are often marginalised in care planning.
• Data such as NCRB suicide statistics highlight relational and family problems as major triggers, but administrative categorisation fails to capture lived suffering, meaning, and trauma.

Feature

Care as Disability Justice

• Mental health care should aim at dignity, equity, inclusion, and justice, not mere clinical recovery or social conformity.
• Disability justice recognises diverse ways of living, healing, and making meaning, rather than forcing individuals to adapt to an unequal social order.

Centrality of Lived Experience

• Personal narratives of neglect, abuse, homelessness, and institutional violence reveal dimensions of suffering that quantitative indicators fail to capture.
• Healing is non-linear and deeply influenced by beliefs, histories, and social locations.

Multidimensional Nature of Distress

• Mental distress arises from overlapping causes:
  • Biological
  • Psychological
  • Social
  • Cultura
  • Political
  • Historical
• These factors intersect with caste, class, gender, sexuality, and disability, shaping both suffering and access to care.

Relational and Contextual Care

• Care is defined as staying with people through uncertainty, addressing material deprivation, relational breakdown, and existential pain.
  
• It emphasises meaning-making, safety, relationships, and everyday dignity, not just symptom control.

Critique of Reductionism

• Over-reliance on labels such as “maladaptive behaviour” places responsibility solely on individuals, ignoring broken social systems.
• Integration into “normalcy” risks erasing difference rather than addressing injustice.

Challenge

Persistent Treatment Gaps

• Severe shortages in access to comprehensive mental health care persist despite policy advances.

Over-medicalisation

• Dominant frameworks obscure existential, relational, and moral dimensions of distress.

Social and Institutional Violence

• Experiences of abuse within psychiatric institutions undermine trust and continuity of care.

Loss of Engagement and Continuity

• Many service users disengage due to alienation, lack of trust, and rigid systems, leading to cycles of homelessness and despair.

Inadequate Research and Training Models

• Research prioritises generalisable outcomes over granular, real-world care processes.
• Training insufficiently prepares practitioners to handle uncertainty, complexity, and diversity.

Way Forward

Re-centre Care Around Dignity and Justice

• Shift from “treatment” to asking: What does this person need to live the life they value?

Integrate Material and Relational Interventions

• Combine medications, housing, income security, and social protection with:
  • Relational work
  • Community connection
  • Spiritual and cultural supports

Strengthen Longitudinal and Community-Based Care

• Invest in continuous, trust-based engagement, accepting non-linear recovery paths.

Reform Mental Health Education

• Train professionals to:
  • Sit with discomfort and uncertainty
  • Engage with social contexts
  • Celebrate small, lived wins

Reorient Research Priorities

• Focus on implementation science, lived experience, and transdisciplinary methods linking practice and theory.

Value Lived Experience and Community Practitioners

• Recognise and compensate non-specialists and persons with lived experience as legitimate practitioners bringing contextual wisdom.

Conclusion

Mental health care cannot be separated from the social, moral, and relational worlds that shape human suffering. Reimagining care as a pursuit of disability justice and dignity moves the discourse beyond narrow clinical fixes toward solidarity, equity, and hope.