The Mariwala Health Initiative: Reforming Women’s Mental Health

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SEATTLE, Washington — According to the World Health Organization, women worldwide predominantly have common mental health disorders (CMDs) such as anxiety, depression and post-traumatic stress disorder. Women in India are more likely to develop CMDs due to socio-cultural institutions like caste systems and dowry practices that inhibit agency and perpetuate gender inequality. The Mariwala Health Initiative (MHI) is a nonprofit organization based in Mumbai, India that improves Indian women’s mental health by combating gender discrimination and systemic oppression.

Women in India are significantly more at risk to develop CMDs due to:

  • Increased vulnerability to domestic violence and sexual abuse
  • Limited accessibility to education and employment opportunities
  • Restricted autonomy and support in decision making

The Borgen Project spoke with Raj Mariwala, the director of MHI, to receive insight into the nonprofit organization’s current efforts to improve women’s mental health in India.

Interview With MHI Director Raj Mariwala

The Borgen Project: What community-based approaches does the Mariwala Health Initiative take to provide treatment, services, promote mental health care and destigmatize mental illness?

Mariwala: “At MHI, we believe in a psychosocial approach to mental health—that mental health is a spectrum, and that we must situate lived experience at the core of any capacity, building work or intervention. We fund initiatives that are user-survivor-centered, shifting mental health dialogue from the old welfare-based model to a [human]rights-based one.

In our view, a paradigm shift in the conversation is called for, from prescriptive and paternalistic to perspective-oriented and intersectional. To this end, we work with our partners to create and nurture a mental health ecosystem with multiple stakeholders—individuals, communities, organizations and policymakers and government.

The initiatives we tend to support are those with a strong focus on community-based grassroots interventions, where services and support are provided not just by experts but also by trained individuals from within the community. In addition to foregrounding community voices and participation, this approach also acknowledges how systemic barriers and marginalization, specific to their particular context, affect an individual’s well-being. We believe that the only path to a holistic, universally accessible mental health ecosystem is through challenging structural inequalities.

[At the MHI,] we believe that strong linkages need to be forged between mental health service providers and allied services concerned with livelihood, health, gender, sexuality, education, legal support, as well as government welfare schemes. This boils down to our belief that mental health is a development issue. Thus, mental health issues cannot be considered in isolation from other areas of development, such as education, employment, emergency responses and human rights capacity.”

TBP: How does the Mariwala Health Initiative make mental health resources more accessible to women?

Mariwala: “MHI follows a psychosocial, rights-based, intersectional approach which makes concerted efforts to keep the rights and agency of individuals at its center. We work with partners who have demonstrated their perspective and ability to work with women in a rights-based manner. Furthermore, in terms of on-the-ground work, the majority of outreach, advocacy and service provision is implemented by women.

For MHI, the idea of a woman itself cannot be anchored in the gender binary. There are many people and communities that are not part of the question—women with disabilities, women marginalized by caste, trans women, LGBT communities, women from minority religions, female farmers, homeless women, sex workers and more. So, our mandate foregrounds these realities in our work towards making mental health resources accessible.”

TBP: How does agency and empowerment improve the mental health of women in India?

Mariwala: “It is very important to consider agency and empowerment when talking of the mental health of women. […] Unless we consider agency and empowerment, mental health services may not be accessible for women— in terms of not just accessibility to care due to restrictions on mobility, but also affordability. Apart from having control on women’s movements, social norms may [restrict]access to a confidential space with a mental health practitioner.

Women are also subject to Gender-Based Violence (GBV) that, in turn, impacts their mental health.
Additionally, looking at mental health institutions, we see mental health being weaponized against women who may not have been compliant with family wishes—whether natal or married family. This has been done with collusion from mental health professionals.”

The Impact of COVID-19 on Women’s Mental Health in India

The COVID-19 pandemic also poses a significant threat to women’s mental health in India. A drastic surge in domestic violence complaints issued at the beginning of the nation-wide lockdown points to an increased risk of CMDs among Indian women. In addition to domestic and sexual abuse, women in the workforce face financial instability due to workplace closings.

Looking Ahead

The MHI alleviates the prevalence of mental illnesses among Indian women by funding resources such as service providers, activists and researchers that provide inclusive and community-based approaches to women’s mental health care. The intersectional approach of the MHI considers socio-cultural factors that increase the risk of mental illness and aim to assist women who suffer from gender inequality and oppression. With organizations like the Mariwala Health Initiative, countries worldwide are taking one step closer to a world that values equality and inclusivity.

-Madeline Zuzevich 
Photo: Flickr

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