Mapping Difficult Terrains: The Writing of Policy on Mental Health

Alok Sarin and Sanjeev Jain

In the last few years there have been a number of efforts to both review and rephrase mental health legislation in India, and to articulate a mental health policy as a set of principles to guide thinking about both legislation and practice, as well as the role of the State in mental health care delivery. In this chapter, the authors try to explore the historical antecedents of these efforts, the ways they have evolved and the nature and scope of the most recent efforts. Recent developments in Global Mental Health have meant that mental health policies are currently being, or have recently been, written for a number of countries that previously did not have them (WHO, 2014). It may therefore be opportune to explore the Indian experience, for what lessons it might hold for others.

Mental health legislation should reflect the contemporary social situation and derive from mental health policy. The way that society views mental health and illness, and the primacy it gives to privileging individual rights (as distinct from the rights of families or care givers, or, perhaps, those of communities) needs to be considered and articulated in both legislation and policy. Paradoxically, in India, while we have had both mental health legislation

A. Sarin (*)

Sitaram Bhartia Institute of Science and Research, New Delhi, India S. Jain

National Institute of Mental Health and Neurosciences,

Bengaluru, Karnataka, India © The Author(s) 2017

R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_33

and programmes that have been linked to plans, we have not had policy. The analogy of carts preceding horses seems apt here.

While much of this may seem painfully obvious, what is surprising is that no attempt at articulating a national policy has been made in the past. So while the country has had a National Mental Health Programme (NMHP) since 1982 (Director General of Health Services 1982) and a District Mental Health Plan since 1996 (Murthy 2011), it has had no mental health policy. This apparent confusion has been because short-term planning has perhaps had primacy over long-term vision.

In this chapter, we would like to address three issues:

  • • Historical antecedents to the articulation of a mental health policy,
  • • The possible reasons for the failures or successes of health planning, and the difficulties attendant on that assessment, and
  • • The modes of policy planning.

To begin with, it has often been felt that no systematic attempts at policy planning in the field of mental health have been made in India. This, however, is not strictly true.

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