The Mental Health System in India: History, Current System, and Prospects

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Introduction

While policies and services for persons with mental illnesses in India are increasingly progressive and humane, the formal mental health infrastructure is minimal at best. The Mental Health Act (1987) represents an attempt to introduce the latest thinking in the field of mental health services, but the political will and the required resources to implement the legislation are lacking. Prodded by the courts, media attention, and a growing public awareness of issues related to mental illnesses, new services are emerging. Voluntary organizations, which provide crisis intervention, counseling, and rehabilitation services, are growing in urban areas. The National Institute of Mental Health and Neurosciences has evolved from a lunatic asylum established in the latter part of the 19th century to a premier service, training, and research institute. But the successes remain spotty and scattered, emblematic of what could be done with more consistency and commitment throughout of the country. Legislation and regulations—reflecting the underlying philosophy—are enlightened by any standard. The challenge is to implement these policies and ideas in a meaningful way.

Section snippets

Administrative and Health Infrastructure

India, with a population of approximately 900 million persons, has 25 states, 6 union territories, and 1 national capital territory, ranging in population from 406,000 (Sikkim) to 139 million (Uttar Pradesh). Ten states have more than 40 million people.

The Indian constitution charges states with “raising of the level of nutrition and the standard of living of its people and the improvement of public health.” Central (or federal) government efforts at influencing public health have focused on

History

While traditional Indian medical systems, such as ayurved and unani, identified mental illnesses as distinct disorders and necessary treatments were provided by medical practitioners. There was no separate, distinct setting or provider system for mental illness. Only with European colonization were services for persons with mental illnesses provided separately. The introduction of lunatic asylums—segregated and removed from population centers—was a British innovation influenced by the ideas and

The National Mental Health Programmme

As the Government of India embarked on an ambitious national health policy that envisioned “health for all by the year 2000,” mental health was not adequately addressed. The National Mental Health Programme was a set of recommendations developed to ensure that mental health care was explicitly included.

Early drafts of the National Mental Health Programme were formulated by mental health professionals and then subsequently adopted by the Central Council of Health and Family Welfare, the highest

The Mental Health Act, 1987

Even prior to independence in 1947, there was recognition that many of the policies and provisions in the 1912 Lunacy Act were outmoded and had outlived their usefulness. Initial attempts by the Indian Psychiatric Society to bring about change were unsuccessful. In 1959–60, reforms were considered but no consensus was reached. In the 1980s, there was a resurgence of activity resulting in the passage of the Mental Health Act in 1987.

The rationale for the new legislation was that :it has become

The System of Care

As the review of the historical development of mental health care indicates, the rate of movement toward the implementation of a “care” paradigm is painfully glacial. The colonial asylum system persists but, in parallel, there has been a growth of care provided through the medical colleges and voluntary organizations have initiated activities in the major urban areas. Overall, the formal mental health sector is skeletal at best where traditional systems of care co-exist with more medically

Interventions by the Supreme Court

While many of the progress changes and innovations have occurred as a result of the initiatives of mental health professionals, a strong lobby of lawyers and social activists have taken on issues related to the mental health care system. Their public interest petitions have produced several judgements by the Supreme Court that have had a significant impact on mental health care reform.

These public interest petitions were related to issue, such as poor conditions in mental hospitals; the

Mental Health Manpower

At the time of independence, there was no recognized facility for training psychiatrists in the country. Currently, there are approximately 40 centers that provide training in psychiatry and diplomas in psychological medicine. It is estimated that over 150 psychiatrists qualify annually and that there are about 1,500 psychiatrists in the country.

Training facilities for clinical psychologists are available at Ranchi, Bihar, and Bangalore. There are 400 to 500 clinical psychologists in the

Future Prospects for Mental Health Care in India

Policies related to mental health care have made great strides to promote humanistic ideals and community care as a worthwhile goal. A major shift has occurred from the concept of custodial care to one that emphasizes care and treatment. The Supreme Court, in its judgements, has supported this shift.

But a huge gap remains between the rhetoric of this new policy and its implementation. For example, though the government issued orders for the introduction of the Mental Health Act (1987) with

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