NEET, systemic discrimination and mental health: Tales of disadvantaged students

Prarthana Sonawani is hopeful of getting into a good medical college after her third attempt at NEET this year, which she believes went well. “It was difficult to convince my parents to let me attempt the exam a third time,” the 20-year-old from Lonavala, Maharashtra, admits. “Our family has no background of doctors, or of allowing girls to attempt an exam multiple times. After my first attempt in 2019, my father was supportive and let me try again. But after 2020, it took me two months to convince him and my mother.”

Prarthana is one of the many students from socially and economically marginalised communities who availed the free coaching for NEET at Lift for Upliftment (LFU), an NGO in Pune. For many weeks, she travelled three hours by train to and fro between Lonavala and Pune. “I would only reach home by 11 pm. I couldn’t relax during the commute or nap in the train. There was a constant fear of safety as there were barely any people on the train at that time. I remember being thankful every day that I reached home safely.”

Later, though she got a government hostel accommodation in Pune, she spent seven months trying to get permission to come back beyond the curfew time of 7.30 pm, as her coaching went on till 9 pm. “Every day, the warden would scold me, question me. People looked at me differently. The food would be over by 8.30 pm, and I wouldn’t get any unless some of my friends saved some for me. I couldn’t risk protesting because the accommodation was free, and I don’t have anywhere else to go,” says Prarthana. After all of this, she would only be able to begin studying by 10.30 pm every day.

Prarthana, who comes from a Scheduled Caste community, has a younger brother who studies in class 8. Her father works at a bag shop, and her mother is a homemaker. They could not afford coaching for Prarthana. She knows all too well what it’s like to have all the determination and put in the hard work for her academics, but feel helpless because of her socio-economic background. When asked about the recent NEET-related suicides in Tamil Nadu, Prarthana says she can imagine why the students felt compelled to take the drastic step. “When I failed NEET in 2019, I was very dejected and felt mentally unstable. It took me over a month to come to terms with the result. The one thing that motivated me was thinking that all that I have gone through shouldn’t be for naught,” Prarthana says.

It is known that suicide is closely linked to mental health, and is rarely an act of impulse or escape. However, the discourse often fails to adequately acknowledge the extent of impact of socio-economic marginalisation and systemic discrimination on mental health. When celebrities and leaders ask students not to take drastic measures like suicide, their messages, while important, do not take into account why systemic oppression and discrimination – furthered by exams like NEET – put students on unequal footing, and thus, makes those from marginalised communities more vulnerable to mental health issues.

Ever since NEET was introduced in 2017, Tamil Nadu has witnessed the suicides of many students who were unable to clear the exam. Recently, three students took their own lives in mid-September 2021, within a week of the NEET exam, and all victims were from marginalised communities. Seventeen-year-old Soudharya’s parents were daily wage earners and belonged to an OBC community. Kanimozhi, another 17-year-old, and 20-year-old Dhanush also came from Most Backward Caste (MBC) communities. All of them feared failing NEET; Dhanush, a third time. A week later, a report by the Justice AK Rajan Committee was released, and showed that NEET hinders students from rural and poor backgrounds as well as government schools from securing medical seats. Students educated in Tamil-medium and state board schools as well as first-generation learners are also at a disadvantage.

“A lot of times, the message becomes about encouraging people to be ‘mentally strong’ against all odds, saying ‘life is beyond these issues’. But this shifts the blame to the individual by implying that suicide happens because people are not mentally strong enough. That’s the messaging that young people and students are getting too,” points out Ahla Matra, senior counselor and head of academy and training at The Alternative Story. “Mental health is created and maintained by and connected to one’s context. Financial instability, poverty, and economic deprivation are going to show up in your mental health as well.”

“For people like us, when we dream of becoming doctors, the family and society’s expectations are also added on to ours. They are hopeful that once we get through, the family will have stability,” says Prarthana. She adds that her ambition to become a doctor stems not only from the desire to help alleviate others’ pain, but also because for someone like her, who has battled social discrimination and economic instability all her life, it is a path to security. “I want to earn well for myself, do something for my family. I need to have a stable income to do what I want. On one hand there are these aspirations, and on the other, if you fail, you don’t see anyone who can help, you just see NEET and your marks. There is no safety net…those students must have taken such a drastic measure when they saw no other hope. It doesn’t mean what they did was right, but they really must have felt there is no other alternative,” Prarthana says.

NEET is not a ‘common’ entrance test

Aathirai believes NEET should never be called a common entrance test. “Call it a Savarna entrance test or medical entrance for the moneyed. Even better – place a disclaimer which says ‘only for CBSE students’. Because the rest of us know that we never stood a chance,” she tells TNM.

It was 2017. Aathirai had just completed her class 12 from Christ King Government Girls Higher Secondary School, an aided school in Tambaram, Chennai, the same year that the NEET was made mandatory across medical institutes in India. Unaware then about the information inequality in her academic ecosystem, Aathirai decided to take NEET coaching. She and her classmates in the government aided school had no clue that NEET unfairly favoured the English medium educated, and CBSE students – a problem not uncommon to most common entrance tests in India.

Aathirai went to a small NEET coaching centre near her residence in the suburban neighbourhood of Tambaram in Chennai. The man running the centre had one question for her — “What board?” “If you’re state board educated, then you’re practically written off as ineligible for the exam. The man said I won’t be able to clear the exam and I’ll have to go to a coaching class. So, I signed up with a bigger coaching class,” she says.

But many cannot afford the coaching fee. The AK Rajan report also highlighted the mushrooming of money making coaching centres, propagating further inequality. Medical entrance coaching has grown into a Rs 5,750-crore industry in Tamil Nadu, with over 400 big centres since 2016. Each centre earns about Rs 13 crore per year, the report pointed out.

So, where does that leave those who cannot afford the tuition fee?

“Without a chance to secure a medical seat,” Aathirai answers. Her family couldn’t afford the in-person classes offered by the coaching centre. So, she opted for online classes and got her books from a friend who had also attempted the exam. “I simply couldn’t follow the classes and the syllabus in the books. I gave my exam knowing I will not clear it,” she adds.

A broken, biased system

Vinisha, a 20-year-old medical aspirant from Erode explains that in order to understand student suicides, it’s important to consider the multiple trigger points within India’s competitive exam ecosystem. “Most times, a student’s decision to end his or her life arises from multiple factors affecting their mental health. It must not be over-simplified to the student failing an exam,” Vinisha, who studied in a government Tamil medium school and who attempted NEET for the second time in 2021 tells TNM.

In the context of suicides in Tamil Nadu’s rural or urban poor households, she says that many candidates are first-generation learners whose parents are engaged in farm labour, construction labour, or middle-class jobs which consume their time. “When they see their son or daughter scoring well, they have aspirations for him or her to become a doctor. But information disparity between the rich and poor ensures that in many households and government schools, parents and teachers are not aware or do not educate students on alternate career options in related fields in the event of said student not clearing NEET,” Vinisha says.

Prarthana also points out that the education system does not prepare students for failure. “In schools and colleges, you are taught in class, given assignments, and write exams. When you pass or score well, everyone knows the drill to share the news and celebrate. But no one tells you how to deal with failure. When you fail, you only see your fault, and are left feeling completely alone.”

For this very reason, Vinisha’s first unsuccessful attempt at NEET came as a shock to her. “Although I wanted to be a teacher, my father began convincing me to try for MBBS. There was a fair amount of brainwashing and emotional manipulation and somewhere down the line, MBBS also became my dream,” she recounts. Having always stood first in all her classes, failing NEET in her first attempt in 2018 felt shattering for her. “I couldn’t fathom ever failing in an exam. But it happened,” she says. However, following this Vinisha’s family did not put undue pressure on her to become a doctor – and that made all the difference, she says.

The focus on academic excellence above all else, and at the cost of all else is to blame too. “The system is such that if you’re preparing for any competitive exam, you’re supposed to study for 14-16 hours a day, not spend time on leisure or entertainment or socialising. This is a recipe for disaster, a breeding ground for bad mental health,” explains Ahla. “All this adds to the pressure, and combines with the lack of coping mechanisms, which is exacerbated when there is discrimination on the basis of caste, class, gender or sexuality.”

The result? An emotionally charged candidate who places all of their dreams and a high level of self-worth on clearing a competitive exam. The situation is worse for medicine aspirants because NEET is the only entry point into the profession. “The system is set up in a way that it’s going to fail you, but what gets internalised is that it is your fault. You start seeing failure as an individual flaw, instead of seeing that the system is favouring students from a particular background,” Ahla notes.

Marginalised persons cannot take basics for granted

Much literature exists on how marginalised people – such as those who face racial and ethnic discrimination – have a higher vulnerability as well as incidence of mental health issues. This is because beyond the challenges that a privileged person faces during, say competitive exams, people from marginalised communities also expend significant time and energy battling other structures, fearing violence, and figuring out basic amenities.

When Prarthana finally managed to convince her parents to let her attempt NEET a third time, it came with a condition – that she remain at home and not live in Pune. So, Prarthana prepared for the exam in her one-room-kitchen apartment, often taking to sitting on the stairs outside her house to study. “I could manage analytical subjects like physics and chemistry inside the house. But for biology, where you need peace and quiet to aid memorising, it was impossible in the 1 RK house. So, I would sit outside on the stairs. Though when it would rain, water would come there,” she recalls.

Ahla points out that the trauma that marginalised persons grapple with is much greater. “For many, there is a threat of violence lurking around the corner. They fear that if they step out of line, ask for their human rights, then they are going to be met with oppression and violence, further depriving them of opportunities. There is little material and psychological safety. And new incidents of oppression can often trigger emotional flashbacks, depression, anxiety and so on,” she explains.

Access to conversations about mental health – let alone services like therapy – is a far cry for many. “Even if someone was talking to me about it, where are the psychologists? Where are the free services? My family wouldn’t have accepted it if I asked them for money to pay for therapy after my first failed NEET attempt,” Prarthana says.

What needs to be done?

For Prarthana, what helped immensely was the mentorship programme at LFU. Each student was assigned mentors who would talk to them about their problems, and since the students all came from marginalised backgrounds, they found companionship and a sympathetic ear in each other as well. “Sometimes, when they hadn’t heard from me for a few days, the mentors would call me up and ask me if I was okay,” Prarthana says. Ahla adds that having sensitive counsellors and mental health practitioners at coaching and educational institutions is a must too. “And they should be aware and receptive to the students’ issues, and not just focused on pushing the institutions’ agenda,” she says.

Both Athirai and Vinisha say that it is important to educate students, teachers and parents about alternatives, so that they don’t put disproportionate worth on one option. Aathirai, who is now pursuing a masters in Psychology, says, “Back then, if not MBBS, what else — was never a question that many of my classmates had asked. Perhaps if they had, it would have alleviated a bit of the pressure they put themselves through.” Vinisha, who is now pursuing naturopathy, says, “I am now in my second year, and my family says it doesn’t matter that I am not an MBBS doctor. But I want to clear NEET and switch to studying MBBS, although there is zero pressure to do so.”

However, this does not compensate for state action, which should ensure equal opportunity to all. “Suicide prevention is also assuring people have access to equal opportunities, housing, economic safety,” says Ahla. Indeed, a move towards the same in Brazil is something that has proven to prevent suicides. In this piece from April 2021, mental health journalist Tanmoy Goswami wrote about the Brazilian Cash Transfer programme — a conditional cash transfer scheme. A study of the scheme over 12 years assessed its impact on suicide outcomes. Under the scheme, Brazil’s poorest families received BRL89 or $17 per month, or $140 if they had a child, adolescent or woman in the family. Beneficiaries would have to ensure that the children in the family have at least 85% attendance at school, and that they and the women keep up with healthcare appointments and vaccination schedules. The study found suicide risk reduced by 61% among benefeciaries of the scheme, compared to non-beneficiaries.

Mental health practitioners have often pointed out that they approach suicide prevention needs to be multidisciplinary. Ahla argues that suicide is not just a mental health issue, but a public health issue. “There isn’t enough discourse about what are the circumstances causing distress. Yes, there is a connection between depression, anxiety and suicide, but what is causing depression and anxiety? Are systemic forces responsible? Every death by suicide is failure of the system to protect and serve its people. Removing barriers to accessing quality education and healthcare are mental health interventions too,” she states.