Care as Disability Justice: Reimagining Dignity in Mental Health

Behind every statistic on mental illness or suicide lies a life story that numbers cannot hold. A man who grew up eating leftovers and still drifts through life; a woman who now sees her trauma as “thoosi” (dust) after homelessness and violence; a person chained in a ward, forced to drink from a washroom tap because they were labelled “unmanageable”. These are not outliers. They expose how our mental health systems often respond to distress with control, containment and labels, rather than care, context and dignity. The piece argues that true disability justice in mental health means reimagining care as a long, relational practice of standing beside people in suffering — not merely integrating them back into an unchanged, unequal society.

The problem with the current mental health lens

1. Deficit thinking and “normalcy”

Dominant approaches to psychosocial disability still:

• View people primarily through a deficit lens — as lacking functioning, productivity or “normal” behaviour.

• Aim for “integration” into communities that themselves hold narrow ideas of the normal and “productive living”.

• Leave untouched the social order that generates distress: exploitation, exclusion, stigma and structural violence.

This pushes responsibility almost entirely onto the individual: you must adjust, adapt, be resilient; the world around you is rarely asked to change.

2. Huge treatment gaps, shallow questions

Despite newer medications and evidence-based therapies, treatment gaps remain 70–90% globally, and are especially stark in low- and middle-income countries. Access is one issue; the deeper issue is what kind of care is being offered.

The system keeps asking:

• “How do we reduce symptoms and stabilise behaviour?”

But not enough:

• “What kind of world is producing this suffering?”

• “What does this person need to live a life they find meaningful?”
  

  Distress is not just “in the brain”

  The article emphasises that multiple explanations for distress coexist:

  • Biological – neurotransmitter changes, inflammation, genetics.

  • Psychological – learned patterns, inner narratives, coping styles.

  • Social – isolation, economic precarity, discrimination.

  • Cultural – erosion of meaning systems, stigma, silence.

  • Political – oppressive structures, dismantled welfare, lack of safety nets.

  • Historical – intergenerational trauma, caste oppression, colonial legacies.

  These are not competing stories; they are layers of the same reality, intersecting with caste, class, gender, sexuality and disability.

  A disability justice lens insists that care must:

  • Hold these layers together,

  • Ask how injustice has shaped the person’s suffering,

  • And not reduce everything to either “brain chemistry” or “bad environment”.
    

    Suffering, shame and the social context

    The article points to NCRB data showing that a third of suicides in India are attributed to “family problems” and another significant share to relationship breakdowns. But even this is an under-reading:

    • Underneath are shame, rejection, alienation, abandonment.

    • People lack language and safe spaces to express this psychic pain.

    • Services often “fix patterns” labelled maladaptive, placing the blame for broken relationships and withdrawal entirely on the person.

    By not engaging deeply with relational and structural harm — violence in families, caste humiliation, gender-based abuse, homophobia, homelessness, chronic poverty — mental health services risk becoming a thin layer of symptom management on top of ongoing injustice.
    

    What does “care as disability justice” look like?

    The author proposes a radical reimagining:

    Mental health care should be the primary pursuit of dignity and disability justice, centred on equity, inclusion and diversity.

    This means:

    1. Staying with people through suffering

       • Care as a long, often messy process of walking alongside someone through material, relational and existential crises.

       • Accepting non-linear progress, relapses, and slow changes as part of the journey.

    2. Individual meaning-making

       • Care plans must support people to grapple with questions of meaning, purpose, identity, vulnerability and coherence.

       • Housing and income matter, but cannot alone heal disconnection from self and world.

    3. Relational work, not only individual “resilience”

       • Building and repairing relationships, trust, belonging and community ties.

       • Looking at how families, neighbourhoods, workplaces and institutions also need to change.

    4. Justice, not just access

       • Asking: Are we addressing the injustices that created this suffering?

       • Can we really call it “care” if we ignore caste violence, gender-based violence, economic dispossession or institutional abuse?
         
         

    Practice implications: how would services change?

    If we took this seriously, mental health practice would:

    • Combine medication, therapy, housing, income support with:

      • Dialogic spaces where people can speak about shame, grief, anger, and hope.

      • Community-based support that rebuilds connection and agency.

      • Recognition of spiritual, cultural and personal resources (faith, art, activism, peer support) as legitimate pillars of recovery.

    • Shift the core question from:

      “How do we treat this disorder?”
      to
      “What does this person need to live the life they want?”

    • Accept community and lived-experience practitioners as legitimate care providers, not just “non-specialists”.

      • Pay and train them fairly.

      • Place their contextual wisdom on par with professionally trained experts.

    • Treat trust and continuity as central outcomes:

      • Many people disengage from services due to disrespect, coercion, or feeling unheard.

      • Rebuilding trust requires honesty, shared decision-making, and patience with non-linear outcomes.

    Rethinking education and research

    To sustain this shift, three deeper transformations are needed:

    1. Education

       • Train mental health workers to sit with uncertainty and discomfort.

       • Teach them to navigate complex social worlds, celebrate small wins, and stay open to plural approaches (clinical, social, cultural, spiritual).

    2. Research

       • Move beyond only large, generalisable clinical trials.

       • Invest in studying the granular processes of care: what helps, for whom, under what conditions, in real-world settings.

       • Use implementation science and transdisciplinary methods to connect theory with practice.

    3. Ethics and justice frameworks

       • Drawing on thinkers like Michael Sandel, justice is not just fair distribution of services; it is recognising what we owe each other and the moral ties that make a society.

       • For mental health, this means asking if our systems genuinely centre dignity, acknowledge past harms, and aim at liberation rather than mere adjustment.

    Why this matters for India and policy debates

    For India, with:

    • A huge treatment gap,

    • Deep structural inequalities (caste, gender, poverty),

    • And rising concern about suicide, homelessness and substance use,

    this framework directly connects to:

    • GS2 & GS3 themes – health, social justice, vulnerable groups, welfare policies, mental health legislation.

    • Implementation of the Mental Healthcare Act, disability rights framework, and community-based care models.

    It invites policymakers, practitioners and communities to see mental health not as a narrow medical speciality, but as a mirror of how just or unjust our society is.

    Closing thought

    If we reframe care as disability justice, we stop asking people to fit themselves into a world that harmed them, and start asking how the world must change so that they can live with dignity. That shift — from “fixing people” to transforming relationships, structures and narratives — is where genuine liberation in mental health begins.