In response to global initiatives, India established the National Mental Health Programme (NMHP) in the late 1970s, emphasising accessibility, primary healthcare integration, and community engagement. The goal was advanced through the District Mental Health Programme (DMHP), which prioritised basic services and integration into general healthcare. The 2017 Mental Healthcare Act (MHCA) highlighted a paradigm change towards prioritising autonomy and respect for people with mental diseases.
Integration Challenges in the Legal Framework
While the NMHP welcomed community participation, the DMHP's implementation followed a biomedical approach with a focus on psychotropic drugs. The DMHP has been criticised for its administration, finance, and dominance by one organisation, which stifles creativity and the incorporation of different approaches. A remarkable analysis of oral histories from persons engaged in the formation of the NMHP and the DMHP suggests that the NMHP was overambitious and became unduly dominated by one institution, NIMHANS. This can inhibit creativity and the integration of alternative models, such as those developed by non-governmental organisations (NGOs).
The Facade of Progress
International frameworks, including the Sustainable Development Goals (SDGs), the Movement for Global Mental Health (MGMH), and the World Health Organization's (WHO) Mental Health Action Plan have all had a significant impact on Indian mental health policy. These frameworks emphasise the link between mental health and overall developmental goals. Nonetheless, while the link between issues such as poverty, gender justice and mental health is emphasised, the solutions generated by these frameworks have no practical applicability in the process of planning, establishing goals, and allocating money. The Mental Global Mental Health (MGMH) framework's assumptions, as demonstrated in Indian mental health programmes, prioritise pharmacological therapy for mental diseases and highlight a substantial lack of treatment access in low- and middle-income countries (LMICs). Critics challenge the term "treatment gap" and advocate substituting "treatment difference" or "care gap" to encompass a broader spectrum of mental health resources. The "task-shifting" strategy, which entails offering specialised training to primary workers, is considered a potential solution. However, there are concerns about the possible pressure it may have on workers, particularly marginalised women, as well as the strengthening of biological dominance. There is also a concern that these 'trained' volunteers may eclipse local understandings and relationships in mental health because biomedical psychiatry sometimes regards traditional mental health interpretations as superstitions or impediments to treatment.
The National Tele-Mental Health Programme has adopted technology, which has been emphasised throughout the pandemic. This has resulted in benefits such as increased reach, but it has also created challenges, like the creation of a digital divide. The current paradigm, which is heavily inspired by biological psychiatry, ignores other forms of knowledge and practices, thereby marginalising non-biomedical perspectives. While mental health is receiving a lot of attention in India, the community-level approach, which is mostly focused on biomedical treatments, fails to recognise the significant insights that other points of view may provide. The National Mental Health Policy's efficacy in reconciling opposing viewpoints and providing advice remains dubious, as its rights-based approach has not been fully implemented since its introduction in 2014.