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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

Medical and Psychiatric Services

India is a welfare state and medical services are available for free or at a very low cost through governmental infrastructure. Unfortunately, the huge population burden, poor resources and high level of illiteracy in the populace render these governmental medical and psychiatric services rather inadequate, leading to low penetration and accessibility. The National Mental Health Program of India has been criticized as a policy that remains constrained by the existing structures of the health delivery system, occupying only a peripheral position within the total program (Jain and Jadhav 2008; Kapur 2004). It retains all the paraphernalia as well as the loopholes of the public health sector. Moreover, the conceptual frameworks informing the program conform to the simple and basic bio-medical model only and the illnesses prioritized are the ones that can be easily identified and brought under control by the primary health care staff through drug dispensing (Jain and Jadhav 2009). The National Mental Health Program does not aspire to incorporate local concerns, practices and concepts while framing a community care and support system (Kapur 2004; Jain and Jadhav 2009; Sarin and Jain 2013). The National Mental Health Program of 1982 did not include any special provision for homeless persons with mental illness. The more recent policy has tried to overcome some of these earlier loopholes, but the impact is yet to be seen. Studies undertaking critical evaluation of the National Mental Health Program and District Mental Health Program have highlighted the limitations of these programs and have tried to identify the reasons for their success or failure in specific aspects (Kapur 2004; Jain and Jadhav 2008; Jain and Jadhav 2009; Jacob 2011; Sarin and Jain 2013; van Ginneken et al 2014).

Current mental health policy in India depends heavily on the family to initiate and maintain health service utilization. Service is, as a rule, dispensed from specified centers, be they primary health centers in rural settings, larger district hospitals or big urban general hospitals. There is hardly any attempt at outreach to patients beyond these locales (Jain and Jadhav 2008; Kapur 2004). The underlying assumption is that patients will themselves access service from these centers. In most cases, if not all, psychiatric services get translated into simple disbursal of some medicines and advice on how and when to administer them (Jain and Jadhav 2009). Naturally, for psychiatric patients, family is expected to access the service, to administer medicines and to come for follow-up care. Psychiatric in-patient services are theoretically available at district hospital level, but not all district hospitals have yet acquired these facilities. In-patient services are not available at primary health care centres.

Homeless persons with mental illness, not having family to take charge, and themselves having poor insight into their clinical conditions can hardly ever seek services from these centres. In the current scenario, the homeless are mostly left to the mercy of the police and judiciary. The combined ineptitude and heavy workload of these sectors leave the needy in a very poor state indeed. Moreover, these approaches render uprooting and forced institutionalization of these people inevitable, under acts like The Bengal Vagrancy Act (1943). Our colonized history brings special nuances to the situation. Health services in India, as currently available, did not evolve in our cultural milieu but are imports from Britain. Whatever indigenous resources that were there were systematically ignored and alienated and an alien service concept and theoretical model was imposed on the native population. Not surprisingly, an uneasy truce has existed since and is still palpable after more than half a century of independence. Modern medicine is viewed as a necessary evil by a large part of our populace, viewed with suspicion as ‘outsider’, potentially harmful and only the last resort. Traditional healing, ayurveda, unani, homeopathy (despite the last two being equally as foreign as modern medicine), among other treatments, occupy many people’s imagination as the ‘insiders’. The colonial legacy leaves in place the categories it created, giving rise to an East-West dichotomy where the urban elite of the Indian population equates and identifies with the ‘West’ and chooses ‘Western’ or ‘modern’ medicine while the masses identifies with the ‘East’ and chooses ‘alternate’ medicines, often because these are cheaper and perceived to have fewer side effects. The clash between long-held cultural ideas around mental illness and modern medical and civic awareness needs in-depth and sustained dialogue to reach a consensus, and such dialogues will facilitate policy-making endeavors.

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