Psychiatry in India: Historical roots, development as a discipline and contemporary context

The authors provide an overview of the development of psychiatric services in India. They track the early developments in ancient and medieval periods, and after Western medicine made its appearance. Lunatic Asylums were established in India by the East India Company, and extended to various parts of the country, under British rule. The spread of medical education and services was quite slow, and there were very few psychiatrists, and a small number of beds by mid-twentieth century. Publicly funded universal health care, planned on similar lines as the NHS at the eve of Independence, did not develop sufficiently in subsequent decades. Economic and social disruption, and low priority to spending on health care thwarted efforts at extending the services. The development of pharmacological treatments in the 1950s raised the possibility of general hospital-based psychiatric services, at least of severe mental illness. Importantly, efforts to understand the psychosocial causes and correlates of both common and severe mental disorders were slow to develop. There was unease expressed with ‘Western’ models of psychopathology and intervention, and there were attempts at incorporating indigenous ideas and philosophical traditions. These remained sporadic, however, and did not give rise to any pan-Indian approach to understanding psychiatric illness or its cure. Although epidemiologic rates for psychiatric disorders are lower than in high-income countries, the rates in India are higher compared to other average Asian prevalence rates. However, there have been few concerted efforts at understanding these differences and the local psychosocial factors producing psychiatric illness. Further, inadequate human resources to deal with the existing problems and serious operational problems with the National Mental Health Programme are ground realities. The growing number of private for-profit and not-for-profit mental health facilities is welcome as some have innovative mental health care reach-out strategies. However, they also remain a cause for concern due to their poor regulation and sometimes human rights violations. The new mental health policy hopefully provides a framework for better partnership, quantity and quality of care. With the re-emerging interest in global mental health and ‘universal’ treatment guidelines, it is an appropriate time for serious reflection on the way forward and to examine the relevance of local and sociocultural contexts in understanding and treating psychiatric illnesses.