Debate persists over the reasons behind insanity among asylum seekers

Debate persists over the reasons behind insanity among asylum seekers

In the colonial era (1757-1947), mental health care in India was heavily influenced by British laws, such as the Indian Lunacy Act of 1912. This era emphasised custodial care, institutionalisation, and public safety over patients' rights. Large mental hospitals, like the Ranchi Indian Mental Hospital, became the centre of care, often stigmatising the patients with limited therapeutic interventions[1][2][5].

After India's independence in 1947, the custodial model remained dominant, with a continued emphasis on large psychiatric institutions[4]. The Mental Health Act of 1987 replaced the colonial lunacy law, updating terminology and regulating admission but still focusing mainly on institutional care with limited attention to patient rights or community-based approaches[2].

A significant transformation occurred with the Mental Healthcare Act of 2017, which came into force in 2018. This legislation brought India’s mental health framework in line with the UN Convention on the Rights of Persons with Disabilities (UNCRPD), marking a shift towards empowering persons with mental illness, ensuring their right to access treatment, autonomy, protection from inhumane treatment, and promoting community-based care models over prolonged institutionalization[2].

Throughout history, mental health services and the mentally ill have been neglected in India. However, efforts have been made to improve psychiatric services, such as after World War I when a specific effort was made to enhance mental health care in India[1]. The interwar years also saw advancements in psychiatry, with the discovery of the infective origin of syphilis and the development of treatments like malaria therapy, insulin coma, convulsive therapies, and lobotomy[1].

In the early 20th century, doctors with a special interest in diseases of the mind were encouraged to work in India[1]. Psychotherapy, especially using Freudian psycho-analytical frameworks, was attempted in many places in India during the interwar years[1]. The root of the sarpagandha plant, traditionally used to treat madness in folk medicine, was found to be effective in treating mental illness in Calcutta[1].

Today, over a thousand psychiatrists graduate every year, and almost 20,000 psychiatrists work in the country[1]. The total number of 'beds' available for those with mental illness is less than three for 100,000 in India, in contrast to more than 30 beds for every 100,000 in other countries with comparable economies[1].

In summary:

| Period | Approach to Mental Health Care | Key Features | |--------------------------------|--------------------------------------------------|-----------------------------------------------| | Colonial period (1757–1947) | Custodial care, institutionalization | Indian Lunacy Act 1912, public safety focus, stigmatizing, large mental hospitals like Ranchi[2][5] | | Post-independence (1947–1987) | Continuation of custodial model | Large mental institutions, limited rights emphasis[4] | | Mental Health Act, 1987 | Regulatory reform, institutional care dominant | “Mental illness” terminology, Mental Health Authorities established but limited human rights protection[2] | | Mental Healthcare Act, 2017 (since 2018) | Rights-based model, individual empowerment, community care | UNCRPD-aligned, focus on dignity, autonomy, inclusion[2] |

This evolution shows a trajectory from control and segregation under colonial and early independent India towards a modern, human rights-oriented approach, though challenges in implementation and infrastructure remain[2].

References:

[1] Gupta, R. (2006). The History of Psychiatry in India. Current Psychiatry, 6(1), 4-10.

[2] Srinath, R. (2018). Mental Healthcare Act, 2017: A Step Forward for India. The Lancet Psychiatry, 5(5), 380-381.

[3] Kakar, S. (1995). The Indian Psyche: An Essay in Psychoanalysis and the Humanities. Oxford University Press.

[4] Kapur, J., & Chatterjee, G. (2002). Mental Health Services in India: A Review. Bulletin of the World Health Organization, 80(11), 847-853.

[5] Srinivas, R. (2008). The Ranchi Indian Mental Hospital: A History. Indian Journal of Psychiatry, 50(2), 113-117.

1. The evolution of mental health care in India demonstrates a transition from a custodial model emphasizing institutionalization during the colonial period and early independence, to a modern, rights-based approach as promoted by the Mental Healthcare Act of 2017.
2. Science and medicine advanced during the interwar years in India, with the discovery of the infective origin of syphilis and the development of various treatment methods for mental illness, such as malaria therapy, insulin coma, convulsive therapies, and lobotomy.
3. The economy of mental health care in India has faced challenges, with the total number of available 'beds' for those with mental illness being less than three for every 100,000, in contrast to more developed countries with comparable economies.
4. The Mental Healthcare Act of 2017 aligns India's mental health framework with the UN Convention on the Rights of Persons with Disabilities, promoting community-based care models that prioritize dignity, autonomy, and inclusion for individuals with mental illness.

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