'Doctors advised to take medicines to remove these thoughts': the violence and violations in sexual mental health care in community mental health programmes in Kerala

Community mental health programmes (CMHPs) have proliferated in both governmental and non-governmental sectors in recent times in India. Although CMHPs are mandated to work in close collaboration with the community, the operationalization of community is fraught with exclusionary tendencies, particularly concerning non-cis-heteronormative sexual subjects. Mental health professionals trained in the mainstream western biopsychiatric paradigm are largely silent on the lesbian, gay, bisexual, transgender, queer, intersex and asexual identity discourses as they institute pathological and reductive conceptualization about sexualities, psychosocial disabilities and resultant sufferings. Drawing on ethnographic fieldwork carried out at two non-governmental and a governmental CMHP in Kerala, south India, I illustrate the lack of a human rights-based approach to sex and sexual orientation and gender identity, due to which pressing concerns of sexual life are mis/overdiagnosed as mental 'disorders' to be treated within a biomedical framework. The lack of an intersectional approach fails the marginalized sexual subjects to exert their agency, develop critical consciousness and recognize sexuality as a political issue-all vital for transformative social change. The consequence is a dehumanized mental health care system that fails to 'archive feelings' that are pivotal in making invisibilized worlds observable to tell 'unwelcome truths' that induce psychic pain. Collaborative alliances among other marginalised sections like Queer, Dalit, tribal and Crip (disability) groups are vital in resisting intra-individual prescriptions by increasingly commercializing mental health practice in a country beset by a host of social problems including poverty, discrimination and rising inequalities. It is crucial to understand systems of power (imbalance) that operate as major (social) determinants of (sexual) mental health.