Reimagining Mental Health Care

Context

A national debate on transforming mental health care has intensified as personal narratives reveal deep gaps in dignity, access, and social understanding. India continues to face high distress, low service engagement, and weak systemic support for people with psychosocial disabilities.

What is the core problem in mental health care in India?

1. Mental health systems remain dominated by a deficit-based, biomedical approach.
2. Lived experiences of trauma, abandonment, and discrimination are poorly understood or ignored.
3. Treatment gaps globally and in India remain 70–90%, showing inadequate reach.
4. Care often focuses on “normalising” individuals rather than addressing structural inequality and social context.
5. People frequently disengage from services due to lack of trust, stigma, and inadequate support systems.

Why does reimagining mental health care matter?

1. Human suffering is shaped by abuse, poverty, social exclusion, and stigma, which medical models alone cannot address.
2. NCRB suicide data shows major distress linked to family conflict and relational breakdown, reflecting deeper emotional pain.
3. Distress is influenced by intertwined biological, psychological, cultural, political, and historical factors.
4. Ignoring caste, class, gender, and queer identities limits effective care.
5. Without a justice-based approach, mental health care risks becoming ineffective, discriminatory, and inaccessible.

How should mental health care be redesigned?

1. Centre mental health care around dignity, disability justice, equity, and inclusion.
2. Provide support that stays with individuals through material hardship and relational suffering.
3. Combine medicines and tangible support with relational work, meaning-making, and emotional coherence.
4. Recognise and integrate community knowledge and lived-experience practitioners into mental health systems.
5. Treat care as enabling people to ask: “What do I need to live a meaningful life?”

Mental Health as a Public Health and Governance Challenge

1. Mental health impacts productivity, social cohesion, crime, homelessness, and poverty cycles.
2. India faces one of the world’s largest treatment gaps (70–90%), making it a structural governance issue.
3. Weak public health infrastructure limits long-term psychosocial care.
4. Mental health is deeply linked to SDGs (3, 5, 10, 11, 16).

The Justice-Based Approach to Mental Health

1. Goes beyond clinical treatment: focuses on dignity, equality, and lived experience.
2. Recognises mental health problems as outcomes of violence, exclusion, discrimination, deprivation, not merely biology.
3. Aligns with constitutional values (Articles 14, 15, 21) and the Rights of Persons with Disabilities Act, 2016.

Social Determinants and Intersecting Inequalities

1. Mental health struggles emerge from poverty, caste hierarchy, gender violence, job insecurity, and housing instability.
2. NCRB data linking suicides to family problems, relational breakdowns, and economic distress shows the social nature of suffering.
3. Historical trauma (displacement, caste violence, migration) affects community mental health patterns.

Current Mental Health Frameworks in India

1. Legal Frameworks
   1. Mental Healthcare Act, 2017 (MHCA 2017) — The main law replacing the older 1987 Act. It guarantees the “right to access mental healthcare”, protects the rights of persons with mental illness (non-discrimination, confidentiality, informed consent, humane treatment, community living, advance directives, legal aid).
   2. MHCA aligns Indian law with international standards, especially obligations under UN Convention on Rights of Persons with Disabilities (UNCRPD).
   3. Establishments offering mental health services must be registered under MHCA, ensuring minimum standards of care and regulation.
2. Policy Frameworks
   1. National Mental Health Policy, 2014 — Provides the broad vision and guiding principles for mental health in India. Focuses on decentralised community care, inclusion, access to services, and addressing social determinants.
   2. National Health Policy, 2017 — Recognised mental health as a priority and reiterated the commitment to integrate mental health services into primary health care, strengthen human resources, and expand access across the country.
3. Programme-level Frameworks
   1. Tele-MANAS / National Tele Mental Health Programme (launched 2022) — A digital initiative offering 24×7 toll-free helpline and tele-counselling, integrated with National Mental Health Programme (NMHP). Helps expand access especially in remote or underserved regions.
4. Institutional & Regulatory Mechanisms
   1. Mental Health Establishments Registration & Regulation — Under MHCA 2017 and associated rules, all public or private establishments providing mental health services must register. This ensures regulation, quality standards, and accountability.
   2. Mental Health Review Boards & Legal Safeguards — MHCA provides for review boards and legal provisions to protect patient rights: confidentiality, informed consent, safeguards against inhuman treatment, capacity assessment, advance directives, and complaint redressal.

Implications of Transforming Mental Health Care

1. A dignity-based system can reduce stigma and disengagement.
2. Community-based support can prevent homelessness, isolation, and crisis escalation.
3. Recognising lived-experience workers can bridge treatment gaps in underserved areas.
4. Relational and contextual care encourages long-term healing and trust-building.
5. A justice-oriented model aligns mental health reforms with rights-based governance.

Challenges and Way Forward

Conclusion

India’s mental health landscape requires a fundamental shift from deficit-based models to systems rooted in dignity, justice, and lived experience. Effective care must address structural inequality, relational suffering, and the need for personal meaning. A transformative, inclusive, community-anchored approach is essential for building a compassionate mental health ecosystem.