Care as disability justice, dignity in mental health

A 60-year-old recalls eating leftovers as a child, in the absence of his birth family, and, even today, is passively engaged with life. A survivor of childhood abuse says that she now views her problems as ‘thoosi (dust’), but only after being homeless and battling insurmountable trauma. Then there is a recollection by someone of stark abuse while under psychiatric care, who was chained and forced to drink water from a washroom because they were deemed ‘unmanageable’. These stories embody suffering in ways that numerical data fail to capture. These are stories that spotlight how different people are impacted and respond differently to distress and care, based on their contexts and beliefs. A lack of commitment to unpack these narratives risks shrinking the immersive exploration that is warranted. It may touch the surface of healing and venture a little beyond but will ultimately relegate the discourse that spotlights barriers, attitudes, social distances, and inadequate care systems to the margins. Yet, dominant approaches to psychosocial disability continue to view these experiences through a deficits lens, as they are focused on ‘integration’ into communities that hold stereotypical understandings of productive living, a reductionist imagination of ‘the normal’, and a social order that goes unquestioned. The gaps in mental health-care access continue to range from 70%-90% globally. While third generation medications promise fewer side-effects and evidence-based therapies proliferate, the fundamental questions remain. We argue that mental health care must be radically reimagined as the primary pursuit of dignity and disability justice that centres equity, inclusion, and diversity, highlighting complexities with all their nuances; as the practice of staying with people and persisting alongside them through suffering, whether that suffering is relational, material, or structural in nature. Care in this lens is a process of individual-level meaning-making, responding to adverse life events, relational disruptions and existential queries, while fulfilling needs for safety, relationships, everyday wins, and problem-solving. It is also a tussle between one’s context and one’s chosen path, complicating the narrative and the care plan. ## Related Stories • India needs a unified mental health response India needs a unified mental health response • India’s mental health crisis, the cries and scars India’s mental health crisis, the cries and scars • Why India’s public universities must embrace mental health education Why India’s public universities must embrace mental health education • Mental health care in India continues to remain out of reach for most who need it: expert Mental health care in India continues to remain out of reach for most who need it: expert • Why does mental health and disability support often end when you turn 18? Why does mental health and disability support often end when you turn 18? • Court’s nod to mental health as right Court’s nod to mental health as right • What has WHO highlighted on mental health? | Explainer What has WHO highlighted on mental health? | Explainer To untangle the knots between mental health and the social context we must start with asking what kind of world creates such suffering, and how can one standardise essential protocols while achieving personalisation at scale. Sustained material and relational deprivation, both as a cause and an outcome of mental ill health, often go unaddressed, resulting in a range of losses. An example is found in the National Crime Records Bureau (NCRB) data on suicides, which while reducing causes to monotonic categories as reported by police, shows that a third of suicides in India are due to family problems and another tenth due to relational ruptures. Feelings of shame, rejection, alienation and abandonment that underlie distress are rarely spoken about, limiting both the language and expression of psychic pain. Solutions often attempt to fix patterns (labelled ‘maladaptive’), placing the onus for broken relationships, social withdrawal and loss of vitality squarely on the person. Multiple explanations for distress may persist concurrently, ranging from biological (neurotransmitter alterations, inflammatory markers), psychological (learned patterns, cognitive frameworks), social (isolation, economic precarity, discrimination), cultural (loss of traditional meaning systems), political (oppressive structures, dismantled safety nets), and historical (intergenerational trauma, colonial legacies). These explanations do not exist in isolation. They are overlapping and intersect with caste, class, gender and queer identities in ways that shape both the experience of suffering and access to care. Rather than viewing these as competing frameworks, comprehensive care requires attention to diverse explanations and approaches simultaneously. #### On care practice People experiencing emotional and social crises or intense alienation require the space to grapple with these existential uncertainties. In contrast, dominant notions that locate these within biological or social determinants frameworks obscure these meaning-making dimensions of mental well-being. As much as living in extreme housing precarity may limit opportunities to pursue what is personally meaningful, having a stable house or income alone cannot diminish feelings of disconnection from self and the world. While privileging tangible interventions such as medication, housing or cash transfers and grit and resilience building (which is not exclusively individual dependent) must assume greater importance, equally, care planning must highlight the need for relational work that engages with questions around vulnerabilities and invulnerabilities, purpose and existential incoherence, located in social-ecological contexts. In these ideas lie the foundations of disability justice, that embodies the spirit of liberation and wholeness, and not mere integration into an unequal world. What if we thought critically, practised with solidarity, and pursued more longitudinal work that is real-world sensitive? Care would then be re-centred as the practice of relational justice and examine concerns that sustain distress and approaches that suffuse hope in complex scenarios. This could range from medications and economic security, to finding hope in spiritual practice, one’s goals and community connection. The focus shifts from treatment to ‘what does this person need to live the life they want?’, recognising that there are variegated and yet valid ways of understanding and responding to distress. A secondary yet important gain might address the one issue that affects all mental health work — engagement with a service and continuity of care. Many people who access a service are disillusioned and lose faith and trust for innumerable reasons. This disengagement could often result in a downward spiral into states of despair, loneliness and homelessness. Building trust involves honest collaborations, dialogic practice and acceptance of non-linear outcomes. Justice beyond fair distribution of resources or services, as espoused by Sandel, becomes central; as a process of recognising what we owe to one another and the moral threads holding our relationships and society. In mental health care, this means asking whether our systems centre dignity and account for the injustices that precipitated suffering, and, importantly, whether care can even be conceived without addressing the contexts that created harm in the first place. #### Transforming care, education and research Mental health education may need to prepare people to sit with discomfort and uncertainty, navigate the complexity of a person’s social world, celebrate small wins, and remain open to diverse approaches. Research priorities require reorientation toward capturing the granular aspects of care rather than only large-scale, generalisable findings. These actions require examining micro-level processes through implementation science and transdisciplinary methods that link practice and theory, enabling continuous learning about what works, for whom, and how. Most critically, those currently designated as non-specialists and those who bring lived experience need to be recognised and compensated as practitioners who bring community wisdom and contextual understanding that formal training cannot replicate, and receiving preparation and resources that enable them to engage with the same systemic support afforded to those with professional credentials. Vandana Gopikumar is with The Banyan and Banyan Academy of Leadership in Mental Health and is a mental health and social care practitioner and care systems researcher. Lakshmi Narasimhan is with The Banyan and Banyan Academy of Leadership in Mental Health, and is a mental health and social care practitioner and care systems researcher Published - December 10, 2025 12:16 am IST ### Related Topics mental health / psychiatry / psychiatry and counselling / social issue / health / suicide / education