Discrimination and Access to Mental Health Services in Rural India

This literature review investigates the impact of discrimination on access to mental health services in rural communities in India. It begins with a search strategy across databases like Google Scholar and Scopus, focusing on keywords like 'discrimination,' 'mental health,' and 'rural India.' The review identifies themes such as the stigma associated with mental health in rural areas, the role of social location in accessing care, and the limited effectiveness of government interventions. It adopts a critical social science research philosophy and proposes a mixed-methods approach, including ethnography and interviews, to explore these issues further. The study acknowledges limitations such as timeline constraints and the generalizability of findings from specific villages in Andhra Pradesh and Tamil Nadu. Ultimately, the review aims to contribute to a better understanding of how discrimination affects mental healthcare access and to inform more effective interventions.

Running head: IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
Name of the student:
Name of university:
Author note:

1IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
Abstract
The global economic burden on mental health has plagued people from all over the world and the
rural hinterlands of India are not far behind. It has been found that the stigma and lack of
awareness about mental health illness impedes people in the rural belt of the country from
accessing healthcare service. Mental healthcare service has become low for rural India, therefore
creating a gap for people with mental health illness. In this light, my paper aims to investigate
the impact of social discrimination in posing constraint to the access of mental healthcare. I aim
to argue that social location has bearing on the access of mental healthcare service in rural India.
I aim to adopt the critical social science research and adopt the mixed method approach for the
purpose of my study. I feel the study will be helpful in contributing to the vast wealth of
literature on mental health and social discrimination.

2IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
Table of Contents
1Introduction....................................................................................................................................3
Search strategy.............................................................................................................................3
Background of the study..............................................................................................................4
Statement of the problem.............................................................................................................5
Rationale of the research.............................................................................................................5
Research aims and objectives......................................................................................................6
Research questions.......................................................................................................................6
Research hypothesis.....................................................................................................................7
Literature review..............................................................................................................................7
Methodology....................................................................................................................................7
Research philosophy....................................................................................................................7
Research design...........................................................................................................................8
Sampling method and sampling size...........................................................................................8
Data analysis technique...............................................................................................................8
Research ethical consideration....................................................................................................8
Limitation of the study.................................................................................................................8
Proposed timeline of the study....................................................................................................9
Literature review............................................................................................................................10

3IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
References......................................................................................................................................14
Research proposal
“Investigating the impact of discrimination on access to mental health services in rural
communities in India”
Introduction
Search strategy
The database used for searching the relevant materials was Google Scholar, Scopus,
Proquest, PubMed, MEDLINE, Web of Science and Psychinfo. These are advanced search
engines comprise of high-quality peer-reviewed journals, and enabled me to look for the relevant
articles using the appropriate keywords.

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Name of databases Wave 1 Original
found
Wave 2 No. 1
(After applying
priori rules)
Wave 3
shortlisted
Wave 4 Final no.
(cited)
Google scholar 3 1 4 3
Scopus 185 56 24 2
Psycinfo 48 28 16 2
ProQuest 109 65 11 2
PubMed 56 20 16 2
MEDLINE 12 31 65 2
Web of science 5 12 4 1
Grey literature 1
total 418 173 140 15
Some of the keywords that were used to search the literature were discrimination, mental health
and rural India. I have consulted my friends who have studied on health sociology and teachers
who specialize on the area of stratification. Discrimination refers to exclusion and subjugation in
relation to access of resources, mobility and so on. Mental health refers to the condition of the
person about their emotional and psychological state. Rural India refers to village or countryside
regions of India. The timeframe of the search persisted for a period of one week as I found this
period enough to find the relevant documents for the research. The inclusion criterion for the
search was literature on mental health concerning rural India. The exclusion criterion was
keeping away articles that were not concerned with rural India or articles that did not discuss

5IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
about discrimination. I have obtained around 15 literatures for the purpose of the study that
discusses about the context of discrimination regarding mental health in rural India.
Inclusion criteria Exclusion critera
Journal (Peer-reviewed journal related to health,
psychiatry and social science)
Journals that are not related to this topic
Date ( 2012-2018) Anything before that
Keywords mental health, rural Indi and
discrimination
Urban India, mental health in the west and related
keywords
The process that I used to identify the themes emerged from the research questions and
objectives of the research. These themes are impact in accessing healthcare service, role and
degree of social location and role of government bodies in disseminating healthcare services in
India.
Background of the study
Mental health illness is a serious issue that has plagued countries across the world. India
features in the list of countries have a bad reputation of dealing with mental health disorder.
Kumar (2012) have found that the delivery of mental healthcare services in rural India is quite
poor. This is due to the lack of a robust approach by the government, civil society institutions

6IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
and the policymakers. The National Mental Health Programme had attempted to usher in
transformation in the rural areas but this without much result. There is an overall absence of
community based interventions in minimizing the effects of stress in the rural areas (Thornicroft
et al. 2016). At the village level, the non-trained service providers mostly provide mental health
services in rural India. According to Das et l. (2012), the service delivery in mental health has
become low for the rural India, thus creating a gap in access to health. Studies have demonstrated
that stigma precludes people in the hinterlands of rural India from the pursuit of healthcare
service.
Statement of the problem
Mental health illness has become an issue of great concern for the India. It has been
reported that around 14 per cent of the global burden of illness in the world is related to
neuropsychiatric disorders (Firstpost 2018). Mental health awareness have yielded positive
impact, however that is insufficient considering the persistence and stigma that continue
circumscribe around discussions on mental health services in India. This leads to the silencing of
people with mental health disorder and posits further obstacles in their access to mental health
care service in rural India. This has motivated me to intervene into the issue of discrimination
that impacts on the access to healthcare service in India.
Rationale of the research
In the context of increasing incidents of mental health disorder, there is no corresponding
initiatives to espouse and implement mental health literacy (Patel et al. 2016). The term mental
health literacy alludes to the ability of a community or an individual to understand their plight,

7IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
access healthcare service and tap the information in the promotion of good health. The WHO
have recognized that the rate of suicide in India as a consequence of severe mental health
disorder is higher than the global average (Semrau et al 2015). There is a gap in the treatment of
mental health disorder. In the light of existing research on mental health, I purport to conduct a
study to understand the impact of discrimination in accessing healthcare service in rural India.. I
feel that the large wealth of literature have not addressed the issue of social location of the
person that may exacerbate their plight in reaching out to the adequate service providers,
professionals and institutions in access to healthcare.
Research aims and objectives
The aim of this research is to study the impact of discrimination on people with mental
healthcare service in accessing healthcare. The objective of the research would be to
To examine the role and degree to which the social location of an individual or the position of a
community determines their chance in accessing healthcare in rural India.
To investigate whether there is presence of any community-based intervention to address the
issue.
To examine the role of government bodies in disseminating healthcare service in rural India and
the attitude of the service providers.
Research questions
RQ1. What is the role and degree to which the social location of an individual or the position of a
community determines their chance in accessing healthcare in rural India?

8IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
RQ2. Is there is presence of any community-based intervention to address the issue and what
have been their contributions so far?
RQ3. What is the role of government bodies in disseminating healthcare service in rural India
and the attitude of the service providers?
Research hypothesis
The research hypothesis is that there is a strong impact of discrimination in accessing
mental healthcare service in rural India.
Literature review
An elaborate discussion on literature review have been done in the second part of the
assignment.
Theme Identification
Based on the critical review of literature I found that the key themes that emerged in the
study were that there is stigmatization of mental health patients are common in the rural
hinterlands of India. Secondly, it was found that this fesr being labelled and stigmatization
pushes prevents the mental health patients in India in accessing healthcare services. Thirdly, it
was found that mental health patients are subjected to discrimination and this discrimination is
exacerbated by their gender identity. However, there is a silence on the caste identity and mental
health discrimination in context of modern India that I found quite startling considering caste
violence an important aspect of the Indian society. Fourthly, it has been found that there has been
interventions from the government at the grassroot level. However, those interventions fail to

9IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
grasp the complexity of the multiple dimensions that subject mental health patient to greater
discrimination. There has been no discussion on the training of health care service providers
operating at the grassroot level to alleviate the ordeals of the mental health patients and help
them to come out of the closet of stigma. This review of the literature enabled me to identify the
themes based on the keywords of each of the articles and also enabled me to identify the lacuna
in literature and scope of further research in this domain.
Methodology
Research philosophy
According to Neuman, (2014), research philosophy or epistemology can be defined as the
foundational premise of knowledge that would influence the methodological framework.
Keeping in consideration the temperament of the research, I feel critical social research theory
would be appropriate. The aim of critical social research is to generate knowledge that would
catalyse a social transformation through praxis. Through my research, I intend to explore the
range, ramifications and nuances of discriminatory practises that impedes patients with mental
health in accessing mental healthcare service.
Research design
Since the research aims to generate awareness and contribute to the existing wealth of
knowledge about the discrimination associated with mental health, I feel the action research
design would serve the purpose (McKenney 2014).

10IMPACT OF DISCRIMINATION ON ACCESS TO MENTAL HEALTH SERVICES
Sampling method and sampling size
My universe of study will be two villages in India (Andhra Pradesh and Tamil Nadu). I
would employ the purpose sampling technique and approach my respondents through the
snowball sampling technique. The sample size would be 30 people in each of these villages.
Data analysis technique
I would employ mixed methods to collect data. These methods would include
ethnography, participant observation, focussed group discussion and in-depth qualitative
interviewing. I would also conduct archival research through the analysis of the government
documents to examine the timeline of initiatives of the government
Research ethical consideration
Some of the ethical considerations for the research will be marinating the confidentiality
of the patients and respect their privacy. The second ethical consideration would be not to
interfere with daily activities of the people in the village through my research. I would take
special care not to lacerate the sentiments of the people in village especially the ones suffering
from mental health disorder.
Limitation of the study
Limitations are common in any research despite the accurate planning involved in
research. One major limitation of the study would be the timeline for the study. The second
limitation of the study would be the lack of availability of resources. The third limitation of the
study may be that since it is concerned with one village each in the states of Andhra Pradesh and
Tamil Nadu it will be difficult to generalize the data for the rest part of the country.

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Proposed timeline of the study
Activities 1st
to 3rd
Week
4th
to 10th
week
11t
h to
13th
Week
14th
to 17th
Week
18th
to 21st
Week
22n
d to
23rd
Week
24th
Week
Selection of the topic 
Data collection from
secondary sources
 
Creating layout 
Literature review   
Analysis and
interpretation of the
collected data
  
Findings of the data  
Conclusion of the
study

Formation of draft  
Submission of final
work

Fig: Gantt Chart
(Source: As created by the author)