Indian Mental Health History
“Those who do not remember the past are condemned to repeat it” – said philosopher, George Santayana.
This is especially true when it comes to mental health. What we understand about mental health today has been through both breakthroughs and missteps. Hence, it is imperative to remember the past of psychology so that we do not repeat it in the future. As part of my psychology degree, I have been studying the history of mental health in the UK. I realised how little is known about the history of psychology in India and it’s a gap I feel I must address.
Even folks who have not learnt psychology would have heard of Sigmund Freud, folks who have learnt it will know of Wilhelm Wundt as the Father of Psychology, but how many will know who is the Father of Indian Psychology?
Spoiler alert! It’s Dr. Narendra Nath Sen Gupta! He founded India’s first-ever Department of Psychology at the University of Calcutta in 1916. He integrated centuries of philosophical concepts steeped into Indian culture with Western ideas of psychology to pave the way for India’s first integrated practice. He recognised that the roots of mental health go as far back as the Vedas and combined the Indian concept of ātmavidyā (knowledge of self) into the Western science of consciousness.
While the pre-colonial history of Indian psychology deserves its own deep dive, this article will focus on its journey from the late 18th century onward—an era marked by significant shifts and milestones in understanding mental health in India.
Mental Health in Colonial India
Mental health care in India had a drastic shift in the late 18th century and followed British methods closely. The British administration built mental asylums in Calcutta (1787), Kilpauk (1794) and Monghyr (1795) [1] mainly to treat British soldiers in India. Eventually, it was also opened to Indians, making it the first formal centre for mental health treatments.
Eventually, the very first Lunacy Act was created in 1858. Lord Ashley, who was crucial to this act, said,
“These unhappy persons (mentally ill) are outcasts from all the social and domestic affection of private life… and have no refuge, but in the laws.” [2]
The focus of this act was to provide a safe haven and treatment for these patients. Even though the intentions were good, the asylums became too crowded and the conditions pathetic, even downright dangerous for those in those places. People who were not mentally ill were admitted into these asylums as a way to, for lack of a better word ‘control and contain’ certain individuals.
Between 1886-89, changes were made to the act so that there was a clear process who could be admitted into the asylums. Illegal detention, like husbands getting their wives institutionalised and the poor or the rebellious forced into asylums to reduce dissent, all created an intense fear of being called ‘insane’ or ‘lunatic’. An editorial at that time said,
‘We are sure… that troublesome times are before those entrusted with the care of the insane’. [2]
Rather than improve conditions, these amendments ended up creating such a stigma about being termed as ‘mentally ill’ for more than a century and it lasts to this day!
As a measure to reduce such forceful detention of people, in 1912, the Indian Lunacy Act allowed people to voluntarily get themselves admitted. This is done so that it would reduce the number of people forced into asylums. The act also provided more oversight to courts and local authorities to monitor the situation within the asylums. Closely on its heels, in 1922, all ‘lunatic asylums’ were renamed to ‘mental hospitals’. Any further changes to the mental health situation after this period were foreshadowed by the Independence movement until 1946.
Bhore’s Committee Report
In 1946, Bhore’s committee [3] was given the task of evaluating the medical health situation in India. Their elaborate report highlighted the gargantuan gap in mental health services, personnel and poor conditions in all mental health institutions. It was phenomenal that even in 1946, the committee understood that
‘… physical and mental health of an individual are inter-related and no health programme can be considered complete without adequate provision for the treatment of mental ill-health and for the promotion of positive mental health’. [4]
The whole report still seems way waaaay ahead of its time!
The report provided a very clear distinction between mental health disorders and deficiency. The report called for immediate requirements to improve facilities in existing facilities and to create a separate Department of Mental Health, along with requests to
Form Mental Health Organisations to create awareness among the public
Improve treatment facilities with specific budgetary considerations
Train personnel both domestically and internationally
Promote positive mental health through integrative approaches
In many ways, this report was the precursor for everything that has been done towards mental health in independent India.
Mental Health in Post-Independence India – Before NMHP
In 1959, the Government of India created, what is now popularly known as ‘The Mudaliar Committee’ to review how the recommendations from Bhore’s committee have been implemented. The report highlighted a lack of statistics around mental health care, making it very difficult to understand the magnitude of concerns and the total lack of treatment when it comes to psychosomatic disorders such as stress-induced, pains, aches, inflammations etc. This committee was the first to recommend introducing mental health care into physical health hospitals and to set up psychiatric clinics in every Indian district. [5]
In 1976, the Srivastava Committee introduced the Community Health Volunteer program that would help in the timely identification of mental health concerns [6]. Additionally, as per WHO’s recommendation to all developing countries, India became one of the first countries to create its National Mental Health Program (NMHP) in 1982. The NMHP had a three-pronged approach – to prevent, treat and rehabilitate mental health disorders. NMHP also focused on reducing stigma around mental health by creating the Central Mental Health Authority and State Mental Health Authority for this purpose.
True change began to emerge when the District Mental Health Program was created in 1996, after a successful pilot in Karnataka, as the focus was on local approaches rather than a centralised one. In a country as vast as India, granular ground-level approaches like these work and it can be seen by the rapid increase in DMHPs. As of 2021 – 692 out of 797 districts had DMHPs.
Source: MoHFW Annual Reports
The National Mental Health policy introduced in 2014 created significant improvements for people with mental illness by providing them with constitutional rights. The most significant change happened when suicide was officially decriminalised in 2017.
Where we are today
Despite all the limitations, India is far ahead in the mental health care journey than other developing nations! There still are significant roadblocks to overcome though –
There is a lack of leadership and drive. Mental health care is still fragmented, with no policy establishing the quality of care. I could say, I will offer counseling services without any background in hands-on therapy and nobody can question it.
As of 2020, there is a gap of 67% to 96% in the availability of qualified professionals to help with mental health treatments [5]
Public-private partnerships for mental health are in their infancy and there are limited guidelines for promoting this.
Budgetary considerations are the biggest deterrent, with a shortfall of 87.5% severely limiting the ability to make any lasting impact. Even allocated funds are concentrated only towards Karnataka and Assam, making it difficult for other states to promote mental health programs.
If you reached this stage of this article – I applaud you. History can be dry like a day-old toast, but what have we learnt? That progress is happening, but only with consistent effort and an unwavering commitment. India is still at the start of its mental health journey, but we are definitely taking steps towards a better mental health future!
References
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6198594
[2] https://pmc.ncbi.nlm.nih.gov/articles/instance/3172424/pdf/IJPsy-29-3.pdf
[3] https://nihfw.ac.in/Doc/Reports/bhore%20Committee%20Report%20VOL-1%20.pdf
[4] https://nihfw.ac.in/Doc/Reports/Bhore%20Committee%20Report%20-%20Vol%20II.pdf
[5] https://www.ijcmph.com/index.php/ijcmph/article/view/197/197
