["Movement for Global Mental Health"]
 
January 2020 Issue
 
Movement for Global Mental Health
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Note from the Secretariat
 
It gives us immense pleasure to release this edition newsletter from The Banyan Academy, which will host the Movement for Global Mental Health from 2020-2022. The Banyan Academy is a sister concern of The Banyan, a not-for-profit organisation based in India offering comprehensive outreach, emergency, continued care services and inclusive living options for over two and a half decades for persons entrenched in structural inequalities, and who, as a result are rendered homeless, trapped in a cycle of abuse, abandonment and intergenerational trauma. Our services are geared to create a space for healing, coursing individual paths towards personal recovery and actualising valued social roles. The Academy works in conjunction with The Banyan to build a cadre of human service professionals who seek to bridge the treatment and care gap, employ evidence-based mental health services in low-resource settings and drive progressive policy change[1].

We would like to begin by thanking Ms. Charlene Sunkel, our predecessor for all her support and creative inputs in the past 6 months. Charlene, you are a formidable presence in the mental health sector, and what you have brought to the movement has changed its course permanently, and for the better. We’re very grateful for your continued engagement.

We would also like to thank Prof. Vikram Patel for encouraging us to take on this very exciting assignment and his invaluable inputs to bring more diverse voices into the global mental health discourse.

We take this opportunity to introduce the Movement’s advisory committee for 2020-2022[2]. Thank you once again for coming on board. Your contributions are critical to meeting our vision to reach out to more individuals and communities living on the margins, with numerous learnings to share.

The secretariat will continue to focus on the movement’s founding commitment to scientific evidence and human rights. During our tenure, we aim to bring new voices from the Global South that will further contribute to the diversity and richness in the narrative, foster collaborations for transdisciplinary action, and build support networks that will help traverse systemic challenges towards building inclusive ecosystems for persons with psychosocial needs.

[1] For more information, please reach out to me at mrinalini@thebanyan.org
[2] Final list of names will be released in the next edition of the newsletter
 
 
 
 
Our first newsletter is centered around user perspectives on services and public policy with a plethora of contributors that include academicians, service-users, students and care providers. The theme of our February newsletter is ‘Work & Mental Health’.
 
Advisory Member Speak :
Ms. Charlene Sunkel
 
My career in global mental health emerged from my own journey with a severe mental disorder. I received a diagnosis of schizophrenia at the age of 19 years and the first 11 years that followed was like a tsunami causing devastation to everything in its way. The worst impact was not so much the symptoms of schizophrenia as it was the social impact that left me isolated and helpless – relationships got damaged, I was dismissed from work, and I lost everything that gave me independence, autonomy and a sense of purpose.
 
I ended up spending 4 years in total in psychiatric hospitals (mostly involuntary), 2 years in a psychosocial rehabilitation centre, and 9 years of trial and error of a range of different medications.
 
My experiences within and outside of the mental health system in South Africa, especially the human rights violations in psychiatric hospitals at the time and stigma and discrimination, was a wakeup call. I became determined to change the way people with mental health conditions were perceived and how societal systems often lead to human rights violations – and how this in itself is the greatest obstacle for anyone’s recovery journey.
 
In 2003 I started volunteering in the mental health field where I focussed my time on raising public awareness through visual and performing arts (writing and producing theatre plays). In 2006 I was offered full time employment with a provincially based mental health organisation – at the time, people in my life discouraged me from accepting the position, saying that “don’t bother, you won’t last 3 months”. This response made me even more determined and I accepted – I worked more than 8 years for this organisation, starting up and managing a provincial lived experience advocacy group. Later I moved on to a national mental health organisation, where I managed a national lived experience organisation for more than 4 years. Over the years through my advocacy work, I was given the opportunity to get involved at an international level, serving on various boards and committees and participating at various engagement platforms and projects.
 
In 2017 I was appointed Principal Coordinator of the Movement for Global Mental Health (MGMH) for the term 2017-2019, which enhanced my involvement in global mental health. My vision for the MGMH during my tenure was to strengthen lived experience voices globally and encourage partnerships between persons with lived experience and professionals, researchers, policymakers, and other stakeholders and like minded individuals. The idea for the establishment of the Global Mental Health Peer Network (GMHPN) developed from this – where the MGMH provided a solid foundation from which the GMHPN was launched in 2018 at the MGMH’s 5th Global Mental Health Summit held in South Africa. The partnership between the MGMH and the GMHPN creates a more extensive, globally diverse mental health community and cadre of leadership to enhance the value of sharing initiatives and experiences.
 
The GMHPN (www.gmhpn.org) became an independent registered non-profit international lived experience organisation that underpins all of its work through the promotion of international treaties and human rights instruments, and accountability measures under domestic laws, to emphasize the importance of protecting and respecting the rights of persons with lived experience. The GMHPN is built on the premise of an integrated and holistic response to mental health care and services. It incorporates medical, social and human rights models to advocate and promote knowledge on mental health conditions that affect individuals in all aspects of their lives and at all stages of life. This approach critically emphasizes the multidimensional aspects of mental health conditions and societal challenges that cannot be addressed in isolation as a medical problem. The GMHPN strongly supports and advocates for a person-centered and recovery approach to mental health care and services. It is challenging the paradigm of medical traditions and institutional care models that have subjected individuals with mental health conditions to severe human rights violations, developed structures of societal segregation, and denied the inherent human dignity and voice of this community. Since the GMHPN's establishment in 2018, the focus of its work has involved the building of a sustainable structure to serve two main purposes: 1) to develop a global leadership of lived experience; and 2) to create a sophisticated communication platform where the lived experience community can share their views, opinions, perceptions and experiences.
 
Looking back during the difficult times following my diagnosis, when I was told that I will never be able to work again or achieve at anything in life, I am so grateful to the few people who believed in me and gave me opportunities that helped me to rebuild my life and build a career in mental health where my journey can inspire change and prove that people with mental health conditions are able to contribute value to society and have successful roles in the workplace.
 
Unemployment among people with lived experience with mental health conditions is a result of a critical failure of society who often denies people with lived experience the opportunity to develop their full potential, add their skills and experience and unique perspectives to the workplace. At the same time, it is often the workplace environment that is unhealthy – not only for employees with a mental health condition, but for the mental health of all employees. Employment and a healthy working environment is the one aspect of any person’s life that can be the change in everything – alleviate poverty, improve overall health outcomes, achieving recovery from a mental health condition and having a purpose in life with dignity.
 
Charlene Sunkel (Founder/CEO: Global Mental Health Peer Network)
 
 

Carrying on: On working with depression
By Meera Vishavanatha
 
I’ve lived with depression for many years but never truly understood it. I’ve studied mental health and psychology for over five years but when it came to my own, it was incomprehensible. I was still in university and productive. But I’d come home feeling exhausted and numb. I’d lost many months of sleep and more than 10 kgs in the following months. I kept convincing myself I was fine because I was being so productive but when constant thoughts of suicide came in, I knew I’d reached my tipping point. I had turned down family and friends who tried to help during that time. I was in denial. I thought I knew my mental health because I had studied to become a professional but I was wrong. I finally decided to come out of the shell and seek therapy.
 
A few months later, I was confronted with the need for medication. I was in constant denial and refused to take it for months. I realized I had internalized pill shaming and viewed my illness with shame and disgust. Around the same time, I was completing my master’s degree to become a mental health professional. Working in the mental health space was part of the agenda since I began my college education.
 
However, I was unable to fathom working in a space that consistently incentivised productivity. As someone who had internalised the need to be valued based on performance at home, school, and college, I wanted to break away from that pattern. I took a break of six months to analyze the areas I would best fit in and attempted to work on understanding my own self-worth.
 

I’ve lost many months to depression. It has made me slip into a black hole of self-hate, constant doubt and thoughts of suicide. However, after a year of medication and therapy, I understand my patterns better. From a professional lens, being a patient has been a revelatory experience. It’s taught me how difficult it can be to verbalize what you’re feeling. And it’s taught me the power of denial. A lot of what I know about mental health, I learned by getting through it.
 
Contradiction
I’ve often wondered how I’m such a contradiction because I chose to be a mental health professional while living with depression. It did not happen together intentionally. Nobody wants to be depressed. Working in this field while also battling depression has given me significant obstacles to fight. Sometimes it’s like living in two parallel worlds. When it’s my mental health, my ability to cope is always different and often difficult from when I am someone’s therapist. When I’m working, I emphasize on human connection and back myself with knowledge. It has always been easier for me to do healthy emotional labor for others than for myself. This is why I’m in two worlds when I’m with myself and when I’m working. These worlds don’t collide and I make sure they don’t. However, it doesn’t remove the fact that I’m very much the same individual with my own barriers.
 
Depression gives me obstacles to battle and each time, different from the other. When I was studying, I took on multiple roles both at university and at home. There was a lot of illness at my home. My mother had just begun her treatment for cancer and my father had a stroke while traveling. The situation warranted that I extended myself as a caregiver. I kept taking on more work. I couldn’t always keep up my grades, I delayed my submissions and barely attended my classes. It was difficult and I couldn’t focus. I was always lost and felt constantly overwhelmed. Most days it seemed like I was chained to a boulder and just getting up sometimes was a win.

Coping

I recently decided to move cities for a job and found myself having to battle all of my difficulties while also learning to live a new kind of life. This meant learning to live with depression. This journey has come with learning to understand my body.

A hard pill to digest was learning to say no and taking my time off from work. Most workplaces have structural disadvantages for those with mental health issues. I’ve (slowly) made peace with the fact that this may cost me a few opportunities but I’ve realized how important it is to give time to recuperate.

I decided to give fitness an attempt a few months ago, while it was impossible to get myself out of bed, once I did, it changed how I felt about myself. It has taught me dedication and has given me a healthy coping mechanism. To be honest, I still struggle to maintain a routine but I have found that moving my body and working out can be a game-changer for my health.

I still don’t have it all figured out and I still grapple with understanding my own depression but I do know that everything I know of mental health, I learned by going through it. There have been moments when my abilities were questioned because of my diagnosis but I know that my approach to work, empathy, and care has been significantly shaped by my experience with mental illness. Because being a patient has been a revelatory experience. It’s taught me how difficult it can be to verbalize what you’re feeling. So now, when I have clients of my own, I know what it feels like to be on that side.

A part of taking on the growth curve has also been about accepting depression with all that it comes with. So it has included sharing truths about my mental health with my family, friends, and colleagues. Once I did, things were at ease. It helps to have people who know what you’re going through. I know that keeping things hidden can never turn out well. I know that the systems we are a part of will only give us endless barriers and by not challenging it, I only aid my oppression. As Audre Lorde said, ‘Your silence will not protect you.’ You deserve your own love directed towards you.”
 
 
Citizenship Rights
By K Malarvizhi
 
According to a survey conducted in 2016 by the National Institute of Mental Health and Neuro Sciences, 150 million Indians suffer from various mental illnesses. There exists a big treatment gap and it is doubtful whether a majority of Indians get access to the help they need. However, this does not discount their political acuity, clarity, and their awareness about the existing social landscape.

The Indian Mental Healthcare Act 2017 stipulates that only the court has the power to determine whether a person is suffering from mental illness. The names of persons with mental illnesses will remain in the voters’ list until the court states that the person suffers from mental illness and will not be in a position to vote, after which their names may be removed from the voter’s ballot. The current scenario however, discounts altogether voting rights of people with mental health issues, especially those living in institutions as the norm, only making exceptions on a case to case basis. We have been facing exclusion from the voting process due to the nature of our illness, despite constitutional guarantee of equality before the law.

There are cascading disadvantages to this systematic disenfranchisement of a significant proportion of the population.

Fundamental principles of democracy guarantee citizens a say in shaping polity, and intentional exclusion is tantamount to human rights violation. We deserve a say in who we get to choose to represent us. Our agenda will be taken seriously only when we are accepted as part of the electorate, with elements in manifestos dedicated to our welfare. Who represents our needs now? Who are our key stakeholders, and what are they saying for us, instead of with us? In addition to being left out of contributing to the discourse, millions of us are sadly unaware that such a discourse even exists.

Mental illness is indifferent to the socio-economic statuses of persons and affects everyone, but people from middle and low income groups face additional tribulations. With their interests represented effectively, they can claim access to entitlements which can arrest a vicious cycle of deprivation, and help achieve a minimum quality of life. In addition, the low voter turnout among women worsens multifold when some of us with disabilities are cast away from the process, almost undoing the hard-won victories of suffragettes 70 years ago.

How are you defining democracy? Where do we feature in it? When will persons with mental illnesses get to exercise their rights on par with others who can take this right for granted? Apart from voting rights, what answer does the government have for people who have mental illness, on our right to education, livelihood, health, marriage? Will the government ever take the disability agenda seriously?

It’s our collective duty to provide fellow human beings a right to life, dignity and participation.

Health, wealth, production, happiness and security are the five ornaments which give a country its beauty (translated from a Tamil proverb).
 
 
A New Decade: Love & Depression in Workplaces
By Enoch Li
 
"Our intelligence, however lucid, cannot perceive the elements that compose it and remain unsuspected so long as, from the volatile state in which they generally exist, a phenomenon capable of isolating them has not subjected them to the first stages of solidification. I had been mistaken in thinking that I could see clearly into my own heart..."
~First and Last Notebooks, Simone Weil~

I had been mistaken in thinking that I could know clearly my own mind.

It was tough three months at the end of 2019, and it was hard to celebrate the festive season. Much energy was spent on keeping myself sane, and breathing. I had been contemplating about depression, death, and love and the similarities between them - the torments, the melancholy, the creativity and dance, the passion overflow, the stricken with exhaustion, the delicious self-deception, the sweet confusion, and the inevitable transformation.

In our work with leaders, and employees, we educate them about mental wellbeing and equip them with tools and techniques to face stress and become resilient. We advise managers and organizations reorient their company culture so it is conducive to being a mentally healthy workplace.

More times than not, I find that our work boils down to one core -- helping every individual find the love within themselves, for themselves, for each other, and for the work they do and lives they live.

Because, without the self-awareness of who they are, and how they are doing emotionally, they will not be able to know whether they need support, whether they are stressed out, whether others need some sympathy. And in the self-awareness, slowly they discover the 720 degrees of themselves, and more, especially some elements they do not want to know. They come to some realization that pain is unavoidable -- but perhaps suffering is. They come to understand that sadness, anger, resentment, lethargy, are all part of normal human lives, and that they can take off the mask of smiling faces that burden them.

Counterintuitive perhaps, in preventing burnout, but pain, is one key element that has kept me alive. Simone Weil talks about pain, and the pain in love. The same volatility exists in depression. The same isolation. End of 2019, my mind and heart was so painful to the extent I came to the conclusion that there would be no hope, and thus my life, however meaningful, was needless to prolong.

"... But this knowledge, which the shrewdest perceptions of the mind would not have given me, had now been brought to me, hard, glittering, strange, like a crystallised salt, by the abrupt reaction of pain."
-First and Last Notebooks, Simone Weil~

With some scolding, some cajoling, some comforting, some support from people who strangely cares about me, I managed to pull through and come to a space now where I can engage with my thoughts and transition. Letting go of the old is painful, it is like tearing the skin off and exposing the raw flesh, as there is not yet the new layer. Yet, this is where creativity lies, the play that is possible, to design the new, to feel the bare air on my soul, and to let the sadness sink in.

I used to think that the sadness I felt in a depressive episode made me insane, but like Julie Reshe wrote recently, the sadness and pain are what makes us sane. I think it is what makes us human, and expands our capacities to understand others, so that when we find our colleagues' behaviour drastically changes from energetic to hiding away on his/her own, we can be sensitive to give them space to talk, instead of unsolicited advice to "Don't feel like that!" due to our own anxieties around sadness. We embark into a new decade. We continue to advise organizations on workplace mental health and support executives in managing their emotions and stress.

I would like to emphasize though, that it is not just employers' who need to take action, but perhaps even more so, it is employees' individual responsibilities to seek, to explore, to reflect, to learn, and to allow themselves to feel, because mental wellbeing is their's.

If we want to change the world, we must start with ourselves.
It is up to us to take care of our own minds, and hearts.

I hope everyone finds the space to know their own minds in 2020, and as Rumi would enlighten us, to seek the barriers we have built within ourselves against love, and then maybe, we would be less depressed, less anxious, less sad, and less exhausted.
Thank you for the support towards Bearapy's mission, living with us through the successes and disappointments.
To a loving and mentally well new decade, and a healthy, prosperous Year of the Rat.

Enoch Li (Managing Director, Bearapy)

Original article link:
https://mailchi.mp/bd7221f3f9a8/a-new-decade-love-and-depression-in-workplaces
 
 
The Pop Corn-er: Modern Love
By Suma Perumal
 
“Who am I? I’m… I’m hard to describe,” begins Episode 3 of Amazon Prime’s Modern Love, an adaptation of the New York Times column “Take Me As I Am, Whoever I Am,” written by Terri Cheney. The episode sets its premise with the protagonist, Lexi (Anne Hathaway) trying to explain about the “little thing” about her that makes it harder to describe about herself, embarking the journey of what it is to be her, a person with bipolar disorder.
 
Just as we are introduced to this chirpy young woman docked up in a glittery sequin dress going out to the supermarket to satiate her “crazy, crazy craving” for peaches and comes home with a date (Gary Carr) who finds her “crazy energized”, the next frame takes us to her room where she crawls into her bed with a heavy pang of sadness, so much that she’s not able to move for the next couple of days. We are then taken on a ride through a disastrous date during a depressive episode, her internal tensions of never being able to find true love because of her condition, her trying to make up for the dates that went bad, balancing work and finally opening up about her illness.

While mental illnesses have been used as insults over the decades in popular media, this episode is a fair attempt to start the process of de-stigmatization of mental illness through entertainment. The swift screenplay of the storyline coupled with the powerful acting of Anne Hathaway moves us through different emotions at varying intensities throughout the show, without portraying the character as piteous. Another notable aspect of the show was its ability to capture the protagonist’s mind through the background. For instance, be it the super-energized people around her who were seen dancing mindlessly during her elevated mood or the stillness of silence that covers her for days altogether during her episodes of depression.

Another credit that could be given to the screenplay is the subtle detailing provided throughout the show, silently questioning our own realities. One such example could be given from the scenes where Lexi doesn’t think twice to give excuses such as having an irritable bowel syndrome or flu when she couldn’t make to work or a date, instead of talking about her own mental illness which happened to be the reason for her absence. It also reminds us of how despite both physical and mental health being important for one’s functioning, we are more prone to accepting physical illnesses way more than even acknowledging our own mental health.

Though the show does a good job in the screenplay, it lags in its representation of the manic episodes experienced by the protagonist, portraying it in a highly romanticized manner. In fact it leaves the audience with an impression that manic episodes brings with it endless happiness, optimism and success, ignoring the consequences that may tag along. Leaving behind the ways daily functioning may be affected by manic episodes, the show merely makes us wait for another manic episode that brings more joy to the protagonist. Another debatable aspect of the show is the clinical ambiguity that it stirs up amongst its audience. For instance, the protagonist has been diagnosed with a condition called ultradian/ultra ultra rapid bipolar disorder characterized by shifts in mood (between mania and depression) within a span of 24 hours. This, however, is a rare form of bipolar disorder with characteristics that may not apply to the majority of the people diagnosed with bipolar disorder. While it’s not expected of shows meant for entertainment to become preachy, makers must it take upon themselves the responsibility to provide clarity to avoid misinformation.

Overall, the show is definitely a powerful medium that emphasizes self de-stigmatization. It shows how Lexi went from not talking about her mental illness to her date saying, “The man did not even like his peaches bruised. What would he think of my damaged psyche?” to calling up her exes, colleagues and others to talk about her mental illness. It beautifully brings out how ventilating her feelings regarding her mental illness to a work friend and the subsequent positive affirmation from her did the magic. Ultimately, the story doesn’t force itself to give us a happy romantic ending, but definitely does its bit to give us a smile at the end!
 
 
 
 
Artist: Shriya Mangla
 
“Many people think that the worst part of insomnia is the daytime grogginess. But like that pastor, I suffered most in the dark hours after midnight, when my desire for sleep, my raging thirst for it, would drive me into temporary insanity. On the worst nights, my mind would turn into a mad dog that snapped and gnawed itself. That is when my therapist recommended me to start sketching on a regular basis during these wakeful hours of the night. Art did not cure my insomnia, but transformed it into a manageable condition. I started dreaming of how a good night’s sleep would feel like which made me draw these self-portraits depicting my mental health. Insomnia could be a disease of existential loneliness. In the dark hours, when we’re wandering in the wilderness of thought, sometimes we just need to feel that someone, even a digital someone, is watching over us.” - Shriya Mangla
 
 
 
Artist: Kamya Kiran
 
“This art is a representation of LGBTQAI solidarity, particularly that of trans and intersex communities. The piece comments about emancipation of the community through empathy for each other, which in turn would help us fight against internalised misogyny and patriarchal gatekeeping. This piece comments on the how the patriarchal state is forcing us to change our bodies to conform to its idea of gender. Together we can fight this oppression, be true to ourselves, however we want to be.With love and power to all.” - Kamya Kiran
 
UPCOMING EVENTS
 
The Movement for Global Mental Health Summit - Peer Enabled Mental Health Care

Peer-led services have found an indelible space in mainstream mental healthcare as a result of their effectiveness in improving in patient outcomes, even in the case of mental disorders[1]. The unique strengths in peer-led care have been adopted and protocolised in developing countries, but peer providers in developing countries have yet to carve a distinct identity, their engagement often emerging out of tokenism and packaged into routine service provider roles. This may be hypothesised as an outcome of a hegemony of normalcy where alternate perspectives are discounted by Northern, ableist epistemologies. What constitutes knowledge and evidence is determined by a dominant apparatus that seeks to perpetuate power structures and existing carer-receiver dyads[2]. There have been repeated assertions on the significance of cultural humility[3] in building theory and practice, but this may be impossible without cognitive justice, which recognizes “the right of different forms of knowledge to co-exist, but adds that this plurality needs to go beyond tolerance or liberalism to an active recognition of the need for diversity”[4]. Users' and caregivers’ voices, especially from LAMI countries and/or indigenous communities contribute significantly in enabling cognitive justice, which is fundamental to the establishment of adaptive mental health systems.

We invite users, caregivers and other professionals engaged in peer-led service provision, research and advocacy to participate in this conversation. Do write to us on admin@globalmentalhealth.org should you wish to attend, to present at the summit. We will send a formal invitation with a call for abstracts shortly.

[1] Druss, B. G., Zhao, L., Silke, A., Bona, J. R., Fricks, L., Jenkins-Tucker, S., ... & Lorig, K. (2010). The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophrenia research, 118(1-3), 264-270.
[2] Swerdfager, T. (2016). Theorizing resistance: Foucault, cross-cultural psychiatry, and the user/survivor movement. Philosophy, Psychiatry, & Psychology, 23(3), 289-299.
[3] Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34(2), 165-181.
[4] https://www.india-seminar.com/2009/597/597_shiv_visvanathan.htm
 
 
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KEEP THE DATES OPEN FOR THE 6TH GLOBAL MENTAL HEALTH SUMMIT
4-5 December 2020, Chennai, India
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