“Asking what mental health services universities need or why young people seem to have poor mental health is the wrong question. We need to ask why students are in distress.”
Two years into her PhD in 2016, Siva Shakthi began throwing things around her room at the Indian Institute of Science Education and Research (IISER), Thiruvananthapuram. Her friends got worried and took her to see a doctor. She was soon diagnosed with bipolar disorder.
“In that episode, I was experiencing mania. With bipolar disorder, one can experience either extreme depression or extreme mania,” Shakthi, who will be wrapping up her PhD at IISER in a few months, said. She has already published 11 research papers.
She had to take time off to go to Puducherry for treatment and stay with her family there. When she got back to IISER a few months later, she said she started regularly seeing both the psychiatrist and psychologist on campus.
The university did not compromise on these doctors and, Shakthi said, she found them very qualified and professional in their work. “They really maintained confidentiality. The medications which my psychiatrist at IISER gave were acceptable to my other expert doctors at NIMHANS and JIPMER, who were also treating me. I felt confident about the doctors provided on campus.”
She also credits her guide, at the IISER’s school of physics, Ravi Pant. “He is really ambitious but also was flexible with my work on days I was unwell,” she said. “If not for that, I would have dropped out of my PhD.”
When Rohit Vemula, a PhD student at the Hyderabad Central University and a Dalit, took his life in 2016, one newspaper columnist asked whether this was a case of “depression or oppression”. But this binary is often meaningless, as many argued: depression can be a result of oppression.
Indeed, suicide is not the only marker of poor mental health, though it has come to dominate the narrative. With or without suicide, Indian students are spiralling in and out of their mental health conditions while simultaneously pushing through their coursework.
Why students are in distress
While Shakthi has had a positive experience dealing with her mental health from within a high-pressure academic environment, this hasn’t been the norm.
Vemula died by suicide days after the university suspended him and his friends and barred them from the hostel. More recently, Payal Tadvi, a gynaecologist and an adivasi, died by suicide in Maharashtra after letting people know she’d been the victim of caste-based harassment at the hands of her upper-caste seniors.
In the last three months, two students at the Indian Institute of Science (IISc), Bengaluru, have been found dead, possibly by suicide. Two medical students in Rajasthan have died by suicide in just one week.
Until recently, ragging was assumed to be a normal part of student life, in spite of the existence of anti-ragging laws and university policies. This is apart from targeted harassment along caste, class, gender and sexuality lines. Many students attend college under various socio-economic pressures, including from their families; so in addition to their implicit harm, ragging and harassment also exacerbate mental stress.
Thus, all together, India’s college and university campuses are hotbeds of mental distress, some of it leading to suicide. Whether universities like it or not, they now have a responsibility to ensure students have access to mental healthcare services. Officials are also expected to structure campus administration, teaching and coursework keeping in mind the mental wellbeing of their student population.
“Asking what mental health services universities need or why young people seem to have poor mental health is the wrong question,” Soumitra Pathare, a psychiatrist at the Centre for Mental Health Law and Policy, Pune, told The Wire. “We need to ask why students are in distress.”
Pathare – who works closely with the government to formulate law and policy – particularly disagrees with the depression/oppression binary. “Taking a medical approach to the issue and terming it a ‘mental health issue’ makes it seem like it’s the fault of the person with the ‘poor health’ and that the solutions are also their responsibility and that the solutions can be simple and biomedical,” rebutted. “This increases stigma and makes medical care dominant.”
According to him, there are lots of determinants of poor mental health and that mental illness is an outcome of a variety of these determinants.
“The medical and counselling approach tells students, ‘You have to solve yourself, the system is not wrong’. But we need to ask how we can reorganise the system to decrease distress, and not pin it on the individual alone.”
To this end, he contends that asking broader and more generic questions on the nature of distress could lead to a fuller understanding of what kind of solutions we could use instead of focusing on just “mental health”. In the same vein, he says we need a curative, and not preventive, approach that also thinks in terms of universal, selective and targeted solutions at once.
A universal approach would mean doing working to effect systemic changes, overhauling the rigid structures that contribute to oppressing students (many of whom may already be marginalised).
A selective approach would mean changing policies that affect students already from high-risk communities or who are already marginalised.
Finally, a targeted approach entails making services available to people who may already have a known problem, such as a diagnosed medical and mental-health condition.
Prateek Sharma, a student of clinical psychology and who writes on mental health issues, says approaches should target the individual, administrative and political levels. For example, at the individual level, “a psychologist must be like an investigator to find out the actual causes of distress: Is a student anxious just about the upcoming exams or maybe they don’t want to be studying that subject at all?”
At the institutional level, faculty and administration must think beyond yearly workshops and posters. “Are they trained to recognise early signs of anxiety or depression or do they dismiss students by telling them that they should just do yoga or try to relax?”
And at the political level, Sharma says it is not a coincidence that most suicides are reported from medical and engineering institutes. Aqseer Sodhi, a psychotherapist who runs Aaina, a peer-support initiative out of New Delhi, agrees. “Competitive residential colleges tend to be hyper-masculine, toxic spaces where empathy goes to die,” he told The Wire. “To address ragging, bullying, sexual harassment, depression and anxiety would mean working on campus culture and addressing complaints/incidents as they arise” (emphasis in the original).
Towards ‘acceptable’ ways forward
Pathare adds that there are clearly some determinants in the design of these institutes precipitating poor mental health. He also links the spate of complaints to wider superstructures, such as the economy outside the university, the employment crisis, the pressure to marry and start a family, etc.
So whatever intervention an institute tries needs to be “acceptable” to students: “Young people may not be interested to go to a room with a big signboard that says ‘counsellor.’ Peer counselling may be a smarter approach to try.”
Sodhi has been working on a peer-support model with a flat, non-hierarchical format in various colleges. “Most universities stop at hiring a campus counsellor that nobody is comfortable going to because the counsellors are ultimately answerable to the administration,” he said.
Aaina, the initiative Sodhi runs, has adapted a manual on peer-support training from the Trinity College, Dublin. Students are invited to apply for a two-day training workshop, with the organisers preferring those that other students in distress have reached out to. The workshop helps the selected candidates conduct “listening circles” that can identify different stages of mental illness among their peers.
“We don’t try to convert everyone on campus,” Sodhi says. “We empower the ones that already serve as agony aunts to their friends. We help them listen better, we create a space so they can unburden too, and we keep tabs on them so they don’t burnout listening to their peers.”
Some institutes, like IIT Delhi, have started outsourcing these services or have teamed up with companies like YourDost. Additionally, Aaina and others like it have been taking the peer-support model to the the Jindal Global Law School, Sonipat; the Institute of Law Nirma University, Ahmedabad; and the National Law School, Bengaluru, among others.
At IISER Pune, counsellors as well as faculty members have been assigned to every student to discuss academic as well as non-academic issues. other issues. IIT Kanpur offers a layered counselling service that is open 24/7 during exams. IIT Guwhati has a ‘Saathi club’ for counselling. Ashoka University, in Sonipat, has a centre for wellbeing with student counsellors trained by their psychologists.
Places like the Tata Institute of Social Sciences, the Ambedkar University, Delhi, and Manipal University have set up counselling cells. Some departments at IISc also have small committees in charge of general wellbeing at the workplace.