Mental health for women

Mala, a lawyer, grapples with anxiety and low self-esteem. Some days the anxiety is so overwhelming that she prefers staying in bed all day and giving in to her food cravings.

Sunita struggles to concentrate on her studies and finds her college classes boring. Constant parental criticism triggers rage, leading to self-harm episodes.

Priya, a new mother, relocated to the city post-marriage. With no support and a small baby to manage, she finds herself sad all the time and is convinced that she is an incompetent mother.

Maya, a domestic helper, faced many childhood hardships, including abuse and poverty. She continues to face violence in her family. Feeling burdened and exhausted, she started drinking to overcome her problems. 

Seema has been withdrawn, irritable, and sleepless for several months but refuses to go to the hospital. Her family has been taking her to various temples, as someone said she is possessed.

These glimpses showcase how mental health issues affect women’s lives. Gender plays a major role in the way mental health problems manifest. Women have much higher rates of anxiety and depression compared to men and also face the consequences of repeated trauma in their lives. Classic symptoms of depression are often masked, and women have more physical symptoms like fatigue and pain. This prevents them from recognising that it might be depression that needs help. Attention deficit disorder in women presents more commonly with procrastination, clumsiness, and laziness than the classic symptoms of over-activity and distractibility.

Research indicates adverse childhood experiences (ACEs) impact mental health in adulthood. Women are known to have more adverse experiences (especially sexual trauma and gender discrimination), which makes them especially vulnerable. Social determinants like poverty, discrimination, food insecurity, poor housing, and living in unsafe neighbourhoods and conflict zones all add to vulnerability.

Another major risk is relationship stress and intimate partner violence. It is important to remember that emotional violence in the form of criticism, ridicule, and humiliation has as much consequence for mental health as physical violence. Coercive control in relationships is extremely damaging to a woman’s mental health—when a woman is kept isolated from her friends and family, her phone calls and emails monitored, access to finances denied, and her decisions and independence thwarted. Coercive control is also manifesting in online relationships, particularly when the perpetrator has access to intimate photos or conversations. 

Caregiving is an emotionally exhausting activity, and most carers are women. Women in their later years often find themselves providing care for spouses or parents, which is also a time that they might need emotional support for themselves.

Seeking help for mental health problems is not easy for anyone, and it is even more difficult for women. Women do not want to be saddled with a mental health diagnosis, as it makes them even more vulnerable. They may not have an independent income to afford transport or consultation fees, and they may not even be able to take time out from their responsibilities. The situation gets more complex if she has a serious mental health problem like bipolar disorder or psychosis—conditions often labelled as problem behaviours rather than illnesses.

Unfortunately, mental health services are not designed to be gender-sensitive. Women would prefer access to treatment that is near their homes, in non-institutional settings that offer onsite childcare, shorter waiting times, and professionals who are gender sensitive and trauma informed. The NIMHANS Centre for Well-Being, with a dedicated women’s mental health clinic, is an example.

There are many touchpoints where psychological distress can be identified. Most women will reach a physician or a gynaecologist (as a patient or a carer) much before they see a mental health professional. Ideally, therefore, all medical professionals should routinely ask women two simple questions to enable early identification: How are you feeling, and how are you coping? Trained counsellors and trained police professionals play an important role in providing services for women facing gender-based violence, and there is a need for non-stigmatising services for persons identifying as LGBTQI+. Women in workplaces are also more likely to access counselling support if there is an environment that is non-judgemental and confidential. We need certified peer counsellors in universities, digital access for women to be able to use resources, and participatory groups set up in non-stigmatising community spaces in both rural and urban settings. Safe and affordable housing is needed for women with mental illnesses who cannot live independently. For creative and co-designed solutions, more conversations are needed between different stakeholders, which includes women with a lived experience of mental illness.

(The writer is senior professor of psychiatry and Dean of Behavioural Sciences, NIMHANS)