This article is the first comprehensive cultural critique of India's official community mental health policy and program. Data are based on a literature review of published papers, conference proceedings, analyses of official policy and popular media, interviews with key Indian mental health professionals, and fieldwork in Kanpur district, Uttar Pradesh (2004–2006). The authors demonstrate how three influences have shaped community psychiatry in India: a cultural asymmetry between health professionals and the wider society, psychiatry's search for both professional and social legitimacy, and WHO policies that have provided the overall direction to the development of services. Taken together, the consequences are that rural community voices have been edited out. The authors hypothesize that community psychiatry in India is a bureaucratic and culturally incongruent endeavor that increases the divide between psychiatry and local rural communities. Such a claim requires sustained ethnographic fieldwork to reveal the dynamics of the gap between community and professional experiences. The development of culturally sensitive psychiatric theory and clinical services is essential to improve the mental health of rural citizens who place their trust in India's biomedical network.
Get full access to this article
View all access options for this article.
References
1.
CohenA.The Effectiveness of Mental Health Services in Primary Care: The View from the Developing World.World Health Organization, Geneva, 2001.
2.
BanerjiD.Landmarks in the development of health services in India. In Public Health and the Poverty of Reforms, ed. QadeerI.SenK., and NayarK., pp. 520–529. Sage, New Delhi, 2001.
3.
KapurR. L.The story of community mental health in India. In Mental Health: An Indian Perspective 1946–2003, ed. AgarwalS. P., pp. 92–100. Elsevier for Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, 2004.
4.
WeissM. G.Global, national, and local approaches to mental health: Examples from India. Trop. Med. Int. Health6(1):4–23, 2001.
5.
MurthyR. S.Mental health programme in the 11th five year plan. Indian J. Med. Res.125(6):707–712, 2007.
6.
NaikA. N.ParthasarathyR., and IsaacM. K.Brief report: Families of rural mentally ill and treatment adherence in district mental health programme. Int. J. Soc. Psychiatry42(1):68–72, 1996.
7.
KapurR. L.Community involvement in mental health care. Natl. Med. J. India7(6):292–294, 1994.
8.
CarstairsG. M., and KapurR. L.The Great Universe of Kota: Stress, Change and Mental Disorder in an Indian Village.Hogarth Press, London, 1976.
9.
JainS., and MurthyP.Madmen and specialists: The clientele and the staff of the Lunatic Asylum, Bangalore. Int. Rev. Psychiatry18:345–354, 2006.
10.
MillsJ.Modern psychiatry in India: The British role in establishing an Asian system, 1858–1947. Int. Rev. Psychiatry18:333–343, 2006.
11.
SinghK.Presidential address: Psychiatry and the nation. Indian J. Psychiatry1(1): 99–103, 1958.
12.
SundarajN., and SathyavathiK.Long-stay patients of mental hospitals—a study. Trans. All India Institute of Mental Health, Bangalore5:1–5, 1965.
13.
SuryaN. C.Ayurvedic treatments in mental illness—a report. Trans. All India Institute of Mental Health, Bangalore5, December 1965.
14.
SenI.The objectless or self-existent joy in Indian psychology. Trans. All India Institute of Mental Health, Bangalore2:5–7, January 1959.
15.
KrishnamurthyN.A comparative study of the conception of the ego and its dissolution. Trans. All India Institute of Mental Health, Bangalore2:86–90, July 1959.
16.
KrishnamurthyN.Social and psychological significance of the Indian rites and rituals on the Indian mind. Trans. All India Institute of Mental Health, Bangalore5:86–93, December 1965.
17.
RamuM. G.An Approach to Mental Examination Based on Ayurvedic Concepts. CCRAS Monograph, 12. New Delhi, 1981.
18.
KrishnamurthyN.Counselling as we find in the Gita. Trans. All India Institute of Mental Health, Bangalore4:42–49, 1964.
19.
KuppuswamyB.Bhagavad-Gita and mental health. Trans. All India Institute of Mental Health, Bangalore2:107–111, 1959.
BehereP. B., and BehereM.General hospital psychiatry in India. In Mental Health in India, ed. MurthyR. S., pp. 140–149. People's Action for Mental Health, Bangalore, 2000.
22.
GanjuV.The mental health system in India: History, current system, and prospects. Int. J. Law Psychiatry23(3–4):393–402, 2000.
23.
WHO Expert Committee on Mental Health. Organization of Mental Health Services in Developing Countries. Technical Report Series 564. World Health Organization, Geneva, 1975.
24.
International Conference on Primary Health Care. Primary Health Care Report of the International Conference on Primary Health Care, Alma-Alta, USSR, 6–12 September 1978.World Health Organization, Geneva, 1978.
25.
GoreC.The rise and fall of the Washington Consensus as a paradigm for developing countries. World Development28(5):789, 2000.
26.
IrvineL.A review of major influences on current public health policy in developed countries in the second half of the 20th century. J. R. Soc. Promot. Health126(2):73–78, 2006.
27.
WaltG., and GilsonL.Reforming the health sector in developing countries: The central role of policy analysis. Health Policy Plann.9(4):353–370, 1994.
28.
LiV. H.Politics and health care in China: The barefoot doctors. Stanford Law Rev.27(3):827–840, 1975.
29.
LamboT. A.Experience with a program in Nigeria. In Community Mental Health: An International Perspective, ed. WilliamR. and OzarinL.. Jossey-Bass, San Francisco, 1967.
30.
SagarVidya. Some Innovations in Psychiatric Treatment at Amritsar Mental Hospital: Report on a Seminar on the Organization and Future Needs of Mental Health Services.WHO Regional Office for South-East Asia, New Delhi, 1971.
31.
CarstairsG. M.Psychiatric problems of developing countries: Based on the Morison lecture delivered at the Royal College of Physicians of Edinburgh, on 25 May 1972. Br. J. Psychiatry123(574):271, 1973.
32.
BaasherT. A.Mental Health Services in Developing Countries. Papers presented at a WHO Seminar on the Organization of Mental Health Services, Addis Ababa, November 27 to December 4, 1973. World Health Organization, Geneva, 1975.
33.
Commonwealth Foundation. Mental Health Services in the Developing World. Reports on workshops on mental health, Edinburgh, 1968, and Kampala, 1969. London, 1969.
34.
KapurR. L.HendersonA. S., and ChaddaR. K.Priority in mental health care in developing countries: A report on the workshop held in Madurai on 21st & 22nd January, 1971 under joint auspices of World Federation for Mental Health and Indian Psychiatric Society. Indian J. Psychiatry13:175–182, 1971.
35.
WHO South East Asian Region. Report on a Seminar on the Organization and Future Needs of Mental Health Service, 1–5th February, 1971. Documents SEA/Ment./19, 1971. World Health Organization, New Delhi, 1971.
36.
WHO Regional Office for South East Asia. Community Action for Mental Health Care. Oct. 26th to Nov. 2, 1973. Document SEA/Ment./22, 1974. World Health Organization, New Delhi, 1973.
37.
Research Seminar on the Evaluation of Community Mental Health Programs. Community Mental Health: An International Perspective.Jossey-Bass, San Francisco, 1968.
38.
MurthyR. S., and WigN. N.Evaluation of the progress in mental health in India since independence. In Mental Health in India: Issues and Concerns, ed. ManeP. and GandeviaK. Y., pp. 387–405. Tata Institute of Social Sciences, Bombay, 1993.
39.
WigN. N., and MurthyR. S.Collaboration in mental health programmes: Need and scope in India. Indian J. Psychiatry19(4):60–68, 1977.
40.
IsaacM. K.Mental health delivery through rural primary care: Development and evaluation of a training programme. Indian J. Psychiatry24(2):131–138, 1982.
41.
HardingT. W.The WHO Collaborative Study on Strategies for Extending Mental Health Care, III: Evaluative design and illustrative results. Am. J. Psychiatry140(11):1481–1485, 1983.
42.
SartoriusN., and HardingT. W.The WHO Collaborative Study on Strategies for Extending Mental Health Care, I: The genesis of the study. Am. J. Psychiatry140(11): 1470–1473, 1983.
43.
WigN. N.MurthyR. S., and HardingT. W.A model for rural psychiatric services—Raipur Rani experience. Indian J. Psychiatry23(4):275–290, 1981.
44.
JefferyR.Toward a political economy of health care: Comparison of India/Pakistan. In Health, Poverty and Development in India, ed. Das GuptaM.ChenL. C., and KrishnanT. N.. Oxford University Press, Delhi, 1996.
45.
MurthyR. S.KalaR., and WigN. N.Mentally ill in a rural community: Some initial experiences in case identification and management. Indian J. Psychiatry20:143–147, 1978.
46.
IsaacM. K., and KapurR. L.A cost-effectiveness analysis of three different methods of psychiatric case finding in the general population. Br. J. Psychiatry137(6):540, 1980.
Government of India. National Mental Health Program for India.Ministry of Health and Family Welfare, New Delhi, 1982.
50.
MondalP.Hegemony and the national mental health programme: A conceptual preface. Soc. Scientist23:59–72, July 1995.
51.
MurthyR. S.The National Mental Health Programme: Progress and problems. In Mental Health: An Indian Perspective, 1946–2003, ed. AgarwalS. P., pp. 75–91. Elsevier for Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, 2004.
52.
Directorate General of Health Services. A Progress Report (1982–90). Directorate General of Health Services and WHO-SEARO, New Delhi, 1990.
53.
Indian Medical Research Council–Department of Science and Technology. Collaborative Study on Severe Mental Morbidity. New Delhi, 1987.
54.
IsaacM. K.District Mental Health Programme at Bellary. Community Ment. Health News, April-September 1988, pp. 2–16.
55.
GoelD. S.Mental health 2003: The Indian scene. In Mental Health: An Indian Perspective, 1946–2003, ed. AgarwalS. P., pp. 3–24. Elsevier for Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, 2004.
56.
AgarwalS. P.Restructuring the National Mental Health Programme. In Mental Health: An Indian Perspective 1946–2003, ed. AgarwalS. P., pp. 119–121. Elsevier for Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, 2004.
57.
DesjarlaisR.World Mental Health: Problems, Priorities and Responses in Low-Income Countries.Oxford University Press, Oxford, 1996.
58.
World Health Organization. The World Health Report 2001—Mental Health: New Understanding, New Hope. Geneva, 2001.
SinhaK.1.2 lakh people commit suicide every year. Times of India, October 10, 2007.
61.
FarooqS., and MinhasF. A.Community psychiatry in developing countries—a misnomer?Psychiatr. Bull.25(6):226–227, 2001.
62.
JadhavS.The ghostbusters of psychiatry. Lancet345:808–810, 1995.
63.
JadhavS., and LittlewoodR.Defeat Depression Campaign: Attitudes towards depression—some medical anthropological queries. Psychiatr. Bull.18(9):572, 1994.
64.
ChandrashekarC. R.Mental Disorders: Your Beliefs—Right or Wrong.Navakarnataka Publications, Bangalore, 1998.
65.
JadhavS.The cultural origins of western depression. Int. J. Soc. Psychiatry42(4): 269–286, 1996.
66.
JadhavS.LittlewoodR., and RaguramR.Circles of desire: A therapeutic narrative from South Asia—translation to creolization. In Healing Stories: Narrative in Psychiatry and Psychotherapy, ed. RobertsG. and HolmesJ., pp. 90–105. New York, 1999.
67.
JadhavS.Dhat syndrome: A re-evaluation. Psychiatry3(8):14–16, 2004.
68.
NekiJ. S.Guru-chela relationship: The possibility of a therapeutic paradigm. Am. J. Orthopsychiatry43(5):755–766, 1973.
69.
NekiJ. S.A reappraisal of Guru-chela relationship as a therapeutic paradigm. Int. Ment. Health Res. News Lett.16:2–6, 1974.
70.
JadhavS.The Untold Story of Community Psychiatry in India. Paper presented at International Conference on Culture and Community Mental Health, Institute of Psychiatry, Kolkata, 2005.
71.
Scheper-HughesN., and LockM. M.The mindful body: A prolegomenon to future work in medical anthropology. Med. Anthropol. Q.1(1):6–41, 1987.
72.
JainS., and JadhavS.Pills that swallow policy: India's National Mental Health Program. Paper presented at the Advanced Studies Institute, McGill University, June 12–15, 2007.
73.
ChowdhuryA. N.ChowdhuryS., and ChakrabortyA.Eco-stress, quality of life and mental health in Sundarban delta of India. Int. Med. J.6:59–63, 1999.
74.
ChatterjeeS.Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India. Br. J. Psychiatry182:57–62, 2003.
75.
ChatterjeeS.ChatterjeeA., and JainS.Developing community-based services for serious mental illness in a rural setting. In Meeting the Mental Health Needs of Developing Countries: NGO Innovations in India, ed. PatelV. and TharaR., pp. 115–140. Sage, New Delhi, 2003.
76.
JainS.Addressing Local Concerns: The Asha Gram Mental Health Program. Poster presented at the International Conference on Psychiatry, Organized by South Asian Forum on Mental Health and Psychiatry, Colombo, Sri Lanka, August 17–20, 2003.
77.
JainS.From Negotiation to Accommodation: A Study of Cultural Relevance in the Asha Gram Mental Health Program, Barwani District, India. Master's of Social Work thesis, McGill University, Montreal, Canada, 2003.
78.
Government of Gujarat. Priorities for Mental Health Sector Development in Gujarat. The Mission Report 2003. Department of Health and Family Welfare, Gandhinagar, 2003.
