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Women's well-being: reframing mental health.

Women need to have control of their lives in order to be physically and mentally healthy. Poverty, gender power relations, gender discrimination and violence against women as the main social determinants of women's mental health have reduced this control and thus these factors need to be urgently addressed. Central to women's NGO work in Asia and the Pacific for the last two decades is the goal of improving women's mental health and well-being. Based on the experience of the women's movement and women NGOs' provision of crisis services for women, women NGOs know that women suffer extensive abuse, suffering and unhappiness. These problems are unfortunately not adequately captured through the conventional indicators of the prevalence of mental health disabilities and disorders or overcome through the medical approach of drugs (see Factfile pg. 12).

Now that the World Health Organisation (WHO) and governments had acknowledged in 2001 that mental health is a neglected but a priority public health problem, it is critical that women NGOs' perspectives and women's experiences are taken into account as key stakeholders' views in designing mental health policies and services. There is well-documented research evidence that women experience psychological distress and mental health problems such as depression and anxiety because of their subordinate social position and gender roles. Women affected by violence may face several forms of psychological distress simultaneously, for example depression, post-traumatic stress disorder and panic disorder as well as somatic or physical complaints.

Women comprise 70 per cent of the world's poor, head most single-parent families, have most responsibility for child rearing, suffer the consequent overwork, and experience more domestic violence and sexual abuse. Depression and anxiety are much more common in women than men. Women particularly at risk are those who are poor, migrant, indigenous, young, with pre-school children and are family caregivers. In addition, the treatment of women for mental health problems which they share with men have been shown to differ even when the symptoms are the same, due to gender bias in diagnosis and treatment within the health system. For example, women are known to be more commonly prescribed medication for stress and depression. Newer areas such as the effect of the denial of women's sexual and reproductive rights on their mental health have not yet been thoroughly studied. The psychological outcomes of forced sterilisation, abortion and marriage, sexual coercion and marital rape still need to be researched. What has not been clearly documented and analysed are the solutions. What is the most useful framework for health providers to use in designing mental health services for women? Why are some women more resilient and better able to cope with the same stressful life events and situations? To what extent have women NGOs' feminist counselling and support groups for women who have suffered abuse and violence against women increased their well-being? How have women NGOs mainstreamed their experiences and lessons in this area with the Ministries of Health and Women's Development? What can health and reproductive health services do now to improve women's well-being?

A framework for mental health policy and services for women has to begin with a socio-cultural approach including a gender analysis, identifying the determinants and risk factors for women and how economic and cultural forces interact to undermine women's social status. In the long term, progressive government policies on women's economic development, legal protection, violence against women, reproductive rights and gender equality in the family and society need to be in place in order to provide a macro policy framework aimed at improving women's well-being and mental health. The Beijing Platform For Action (BPFA), the Cairo Programme of Action, and the CEDAW Convention are essential guides to developing such policies. Psychiatrists, mental health nurses and primary health personnel require urgent orientation and training in this framework in order to reorient their medical approach. Immediately, health and reproductive health services can assess their services to ensure that women are encouraged to speak of their stress and psychological problems and the violence they experienced, and are listened to and referred for appropriate support. Improving the quality of health services for women in this way with greater respect, sensitivity and gender awareness will help to surface difficulties and help prevent them from becoming major mental health problems. This is not an easy task when health services in Asia and the Pacific are understaffed and underbudgeted but this is critical to prevent mental health problems. Specific mental health services need to expand creatively in a socio-cultural and gender framework, to move towards interventions which are not only drug-related but include counselling support groups, group work and self care instruction. Here, competent experienced women NGOs and other NGOs can be consulted on what has worked best. Support groups for survivors of incest, rape and domestic violence, for example, have shown that facilitated collective social intervention has greatly helped women to cope with related depression and anxiety, which increases when they are isolated, and therefore see their situation as an individual problem.

NGOs such as Women's Aid Organisation, Malaysia; Women's Crisis Centre, Philippines; the Fiji Women's Crisis Centre; China Women's Hotline; and others have much to share. They need to document, publish and disseminate their experiences and lessons learned so as to share them more effectively. Research on the outcomes and impact of these groups and feminist individual counselling is vital for better mainstreaming and effectiveness of their own work. Researching and analysing women's resilience to remain mentally healthy despite adverse circumstances are critical insights to share with the women themselves. Women's coping mechanisms and resources which aid self care, increase social support and lead to better quality health and social services need to be identified and promoted. Undoubtedly, it is essential that mental health services become more fully a part of primary health services as advocated by the BPFA and the WHO and are gender-sensitive. For women with serious mental health problems, increased access to and availability of such services will reduce their disability and suffering. However, this will not address the prevention of mental health problems for women. Some actions outside the mental health system may be as or more effective. For example, one of the best ways of reducing violence-related depression is to ensure that the violence stops and that the woman can live somewhere safely. As mental health disability is predicted by the WHO to become the second highest disability by 2020, efforts by health and reproductive health service providers to address women's well-being, the development of conducive state policies and close collaboration with women NGOs and the women's movement are essential.

* References:

Good, Mary-Jo Del Vecchio. 1998. "Women and mental health". [Discussion paper prepared for the] UN Expert Group Meeting on Women and Health: Mainstreaming the Gender Perspective into the Health Sector, Tunis, Tunisia 28 Sept.-2 Oct. 1998. <www.un.org/womenwatch/daw>.

WHO. 2001. Mental Health: New Understanding, New Hope. The World Health Report 2001. Geneva: WHO.

WHO. 2000. Women's Mental Health: An Evidence Based Review. Geneva: WHO.

* By Rashidah Abdullah, Executive Director, ARROW.
COPYRIGHT 2001 Asian-Pacific Resource & Research Centre for Women
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Author:Abdullah, Rashidah
Publication:Arrows For Change
Geographic Code:00WOR
Date:Dec 1, 2001
Words:1168
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