"Initially, medicines will be given, and then we need to study the case": Medicalized perspectives about chronicity and mental health care in Kerala.

In response to the global call to upscale mental health services in low--income countries, mental health non-governmental organisations (MHNGOs) have sprung up in Kerala to address mental health needs by partnering with pre-existing locally grown, bottom-up, community-led pain and palliative clinics (PPCs) to increase access to mental health care through task-shifting. The MHNGOs mandate filtering only patients with 'severe mental disorders' from low socioeconomic backgrounds for their free services. This eligibility criterion mandated by the MHNGO is ruffling feathers within the palliative clinics that oppose such -classifications. They believe that suffering cuts across all divisions and should not be discriminated against based on economic background and severity of illnesses. When chronicity and suffering are held universal by the MHNGO and palliative care, respectively, it brings to the fore the enactment of two perspectives of care. Drawing on observations of clinical interactions between patients, MHNGO staff and mental health professionals and interviews with community volunteers of palliative care clinics in Kerala, this paper demonstrates how chronicity narrative promoted by MHNGOs based on biopsychiatric model gains hegemony, whereas the community care model loses traction progressively. The state, caught between these two narratives, frontstages development by submitting its health machinery to the MHNGOs flouting basic medical safety laws in its services to marginalised people like the tribal population. This paper argues that the rising dominance of chronicity narrative in community mental health clinics as well as in popular media discourses evolves out of power relations between the MHNGOs and the palliative clinics.

Evolving jurisprudence on conversion therapy: Reconsidering ethics in mental health systems.

Since the Delhi High Court judgement (2009), reading down IPC 377 that criminalised homosexuality, the Indian judiciary has been at the forefront of invoking constitutional morality to uphold LGBTQIA+ rights. In contrast, the mainstream mental health systems have failed to uphold human rights and protect LGBTQIA+ people ethically, except for a few position statements. Though the Supreme Court directed the mental health fraternity to exercise utmost sensitivity to LGBTQIA+ issues, they have not risen to the occasion. The absence of gender affirmative guidelines and failure to put in place punitive action against those practising conversion therapies set apart Indian mental health systems, in stark contrast to international mental health associations. Here, we review landmark judgments and the actions of professional mental health bodies regarding LGBTQIA+ rights in India, from 2009 to 2022 - especially those regarding conversion therapies and the discriminatory medical curriculum - to examine the deepening crisis of public health ethics.

LGBTQIA+ rights, mental health systems, and curative violence in India.

This commentary examines the space-attitude-administrative complex of mainstream mental health systems with regard to its responses to decriminalisation of non-heteronormative sexual identities. Even though the Supreme Court, in its 2018 order, instructed governments to disseminate its judgment widely, there has been no such attempt till date. None of the government-run mental health institutions has initiated an LGBTQIA+ rights-based awareness campaign on the judgment, considering that lack of awareness about sexualities in itself remains a critical factor for a non-inclusive environment that forces queer individuals to end their lives. That the State did not come up with any awareness campaign as mandated in the landmark judgment reflects an attitude of queerphobia in the State. Drawing on the concept of "biocommunicability", analysing the public interfaces of state-run mental health institutions, and the responses of mental health systems to the death by suicide of a queer student, I illustrate how mental health institutions function to further anti-LGBTQIA+ sentiments of the state by churning out customer-patients out of structural violence and systemic inequalities, benefitting the mental health economy at the cost of queer citizens on whom curative violence is practised.

Fractured narratives of psy disciplines and the LGBTQIA+ rights movement in India: A critical examination.

In 2018, a day before the Supreme Court of India commenced hearing the curative petition on Section 377 of the Indian Penal Code (which criminalised carnal intercourse against the order of nature), the Indian Psychiatric Society (IPS) issued an official statement that homosexuality is not a mental pathology. In 2014, a year after the top court recriminalised homosexuality, the then IPS president had termed it as a pathology requiring treatment. By examining articles on LGBTQIA+ rights published in two flagship Indian journals in psychiatry and clinical psychology, position statements by professional bodies, and international and national developments in human rights mechanisms, we argue that psychiatry's voice for human rights protection of the marginalised has been akin to whispering sweet nothings in tune with the juridico-penal system. In turn, clinical psychology appears to huddle with biomedical psychiatry without raising its voice against coercive and traumatising practices within mainstream technocratic psychiatry. We seek to explore the troubled relationship between mainstream psy disciplines and LGBTQIA+ persons characterised by psychological evasion: failure of mainstream psy disciplines to take up sensitive, socio-political issues like same sex love in a broader human rights framework leading to individualisation- pathologisation complex which further side-lines persons living on the margins of society.