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9 November 2017

 

Reflections on Stress Management, Burnout Prevention, and Self-Care

Context

Mental illness is a growing area of interest in India, where about 60 million people are estimated to struggle with some form of mental illness.[1] In spite of such numbers there exists an overwhelming treatment gap; funds allocated to treat mental health problems in national health budgets are disproportionately small in relation to the serious health consequences they pose: the WHO estimates that for every 100,000 people in India, there are only 0.3 psychiatrists, 0.12 nurses, 0.07 psychologists, and 0.07 social workers.[2] With such numbers, the current reality of the situation regarding mental health care services in India is dire. Services and access are limited not only by the scarcity of resources but also by the prohibitive cost. The existing services, particularly in terms of regular psychotherapy and not just prescriptions, are usually only available in urban areas to those who can afford them.

       Such services are not only self selective of an urban, upper middle class clientele, but are also heavily bound by heteronormative norms. Mental health care and mental health care practitioners in India are largely unaware of the intersectionality of the field in terms of catering specifically to minority and historically oppressed populations. In the case of the population marginalized on the basis of gender identity and sexual orientation, members of the queer community face significant familial, societal, and legal discrimination on the basis of their identity in addition to the stresses brought on by everyday life such as work, relationships, and peer pressure. Homophobia, transphobia, staying in the closet (i.e., concealing one’s identity), and coming out are only a few examples of stressors that take a heavy toll on mental health. Mental wellbeing is severely impacted by the intersection of gender, sexuality, caste, socioeconomic status, and other identities, and it is important that this is recognized and addressed in an appropriate manner.

 

Nazariya and Our Response

        Nazariya is a New Delhi based queer feminist resource group that was formed in October 2014 by a group of queer feminist activists. It was started to sensitize the work and culture of groups and individuals working on issues of gender based violence, livelihoods, education, and health from a queer perspective through research & evaluations, capacity building, and advocacy. We use the word “queer” for people who have diverse gender identities and sexual orientations. A queer perspective helps build links between issues of people marginalized on the basis of gender and sexuality, and the existing work on violence, livelihoods, education, and health in order to impact the discourse on pleasure, desire, rights, and entitlements.

       Over the last three months, Nazariya has been engaging with the concept of mental healthcare as a process that extends far beyond clinical diagnoses or prescriptions. Various factors in our personal and professional lives can lead to chronic and acute stress, anxiety, fatigue, burnout, tension headaches, and other issues. Mental health is a vital component of our overall well being, and it is therefore important to develop and learn healthy coping styles for the different stressors that impact us. Given the paucity of resources in our country, it is imperative for us to build community initiatives that focus on mental well-being.

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           So far, we have hosted two stress management and burnout prevention workshops in partnership with Talking About Reproductive and Sexual Health Issues (TARSHI): a non-residential 4-day workshop for the LBT*FAB (Lesbian, Bisexual and Queer women and Trans*[3]  individuals assigned female at birth) community in New Delhi and a residential 2-day workshop human rights defenders/activists working on issues of gender and violence across North India.

          Our first workshop was restricted to the LBT*FAB community within the overall queer spectrum of identities in order to provide an intentional space that recognized the additional stress that arises out of the intersection of gender identity and sexual orientation. As the only LBT*FAB organization in North India, Nazariya wanted to highlight the needs of the AFAB (assigned gender female at birth)  and transmen community which are largely ignored, even within the queer movement.

      Our second workshop focused on human rights defenders, social workers, activists, and educationists who work within the issues of gender, sexuality, and gender based violence. Individuals within this field are often subject to a great deal of stress and burnout. A part of this sector ourselves, this could be a result of the unjust environment that we work in, criticism that we face from others for the work we do, the emergency situations we handle, and not fulfilling expectations and achieving standard that we set for ourselves. When work revolves around the care and welfare of others in such an environment, self-care is often compromised.

           As a response to these issues and needs, both workshops functioned on a non-medical model with an emphasis on simple stress management techniques that can be practiced individually without any additional equipment/resources necessary.

 

Reflections from the Workshop

       In both the workshops, our discussions often focused on the importance of self-care as we responded to participants’ expectations of the workshop and their reasons for participating. LBT*FAB participants reported struggling with self acceptance, fears of rejection based on their identity, and isolation. The activists and human rights defenders mostly reported wanting to learn how to better manage their stress and work/life balance. Overwhelmingly, however, the participants of this workshop also mentioned their interest in the workshop because they wanted to carry forth their learning into their casework/fieldwork and improve their counselling skills with their clients. This focus on the care and welfare for others even within a workshop meant to focus on the individual demonstrated to us the need for conversations on self-care.

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        All participants, LBT*FAB and activists, were quick to agree that self-care is a feminist issue because it calls on women and individuals serving the community to consciously and deliberately take the time to focus on themselves. This is often at odds with societal expectations of women, who are expected to take care of and nurture others, and caseworkers/activists, who are expected to be on call 24/7. As feminists, as activists, and as individuals, we are aware of the importance of self-care and advocate for it but have a hard time committing to it ourselves. Many participants admitted to feeling guilt or shame when they took time out for themselves because there is always the thought that they could be “doing something useful” with this time.

         Participants in both workshops also were unanimous in their opinion that there is a lack of community space and support to be able to speak and reflect openly on such unique stressors and experiences. LBT*FAB participants spoke about feeling invisible or silenced within larger queer spaces and the activists/caseworkers reported a complete lack of avenues speak about their experiences, especially when boundaries between work and life are constantly blurred. It is therefore imperative to keep creating spaces where people can share their experiences, speak out about the stressors they battle, and have a support system that understands that self-care is not a luxury, but a necessity.

 

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Notes

[1] http://www.indiaspend.com/cover-story/nearly-60-million-indians-suffer-from-mental-disorders-68507

[2] http://www.searo.who.int/india/topics/mental_health/about_mentalhealth/en/

[3] Trans* is an umbrella term for transgender people, genderqueer people, or people who do not conform to notions of gender assigned to them at birth.

[4] All pictures courtesy of Nazariya.

[5] This piece is published on the occasion of #OneDayOneStruggle 2017, as part of the campaign for sexual and bodily rights as human rights, coordinated by CSBR.

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For more information on Nazariya, see: https://nazariyaqfrg.wordpress.com/