• A recent article co-linked with the M.S. Swaminathan Research Foundation (MSSRF) and practitioner accounts argues for reimagining mental health care in India as disability justice, centered on dignity, equity, and contextual understanding. This approach is in response to rising psychosocial distress, abuse within systems, and disengagement from existing mental health services.

Trends in Current Mental Health

• Rising psychosocial distress: Increased trauma, family conflict and economic strain drive mental ill-health; e.g., NCRB 2023 shows one-third suicides due to family problems.
• High treatment gaps: 70–90% mental-health treatment gap persists, especially in rural and marginalised groups.
• Over-medicalisation: Focus on symptoms and medication overshadows relational healing and trauma processing.
• Intersectional vulnerabilities: Women, Dalit communities, LGBTQIA+ individuals face layered discrimination; e.g., high suicide attempts among queer youth.
• Growing peer-support models: Recovery-led models like The Banyan’s inclusive housing show survivor-led approaches are gaining recognition.

Need for Strong Mental-Health Care

1. Human dignity: Survivors of homelessness and coercive care require systems that restore agency and basic rights. E.g. In 2023, the NHRC inspected the Gwalior Mansik Arogyashala and found patients living in “animal-like conditions” without beds or hygiene, prompting a Supreme Court inquiry into state-run facilities.
2. Disability justice: Psychosocial disability demands support centered on “legal capacity” rather than guardianship. E.g. In Ravindra Kumar vs. Union of India (2019), the Supreme Court ruled that a past diagnosis of mental illness cannot be a ground for disqualification from public employment, upholding rights under MHCA 2017.
3. Complex nature of distress: Distress is often situational (academic, financial) rather than purely biological. E.g. The Kota student suicide crisis (2023) saw 29 deaths linked primarily to academic pressure and isolation, forcing the administration to mandate “anti-suicide fans” rather than addressing the root psychosocial stress.
4. Prevention of chronic spirals: Community-based interventions prevent minor distress from becoming psychiatric disability. E.g. The ‘Atmiyata’ model in Gujarat trains community volunteers to identify distress early; an impact evaluation showed it significantly reduced depression and anxiety scores in rural Mehsana without hospitalisation.
5. Socio-economic productivity: Poor mental health drives massive economic loss through “presenteeism” (working while unwell). E.g. A Deloitte 2022 report estimates that poor employee mental health costs Indian companies ~₹1.1 lakh crore annually due to absenteeism and attrition.

Reimagining Care as Disability Justice

• The proposed model seeks to move beyond the "deficit lens"—which focuses solely on symptoms and productivity—toward a system centered on:
• Dignity and Equity: Prioritizing the person’s inherent worth and right to a meaningful life over clinical "recovery" or "normalcy".
• Contextual Understanding: Recognizing that mental health is shaped by intersecting vulnerabilities, including caste, class, gender, and queer identities.
• Relational Justice: Viewing care as a collective moral obligation. This involves "staying with" people through non-linear recovery and addressing the social conditions that create suffering.
• Transformed Education and Research: Reorienting training to help practitioners handle uncertainty and recognizing those with lived experience as expert practitioners who provide community wisdom.

Challenges Associated

1. Severe resource shortage: The gap in trained professionals forces reliance on general physicians who may lack specific training. E.g. A Parliamentary Standing Committee report (2023) highlighted a 96% shortage of clinical psychologists and psychiatric social workers in the government sector against the sanctioned strength.
2. Stigma and discrimination: Social prejudice leads to exclusion from family and community life E.g. The LiveLoveLaugh Foundation survey (2018) revealed that 47% of Indians believe that people with mental illnesses should not be given any responsibility.
3. Fragmented service ecosystem: “Cured” patients often remain stuck in hospitals because welfare and housing support are missing. E.g. In 2021, the Supreme Court pulled up the Maharashtra government for keeping hundreds of patients in mental hospitals for decades simply because the state lacked “Halfway Homes” for their rehabilitation.
4. Poor continuity of care: High costs and lack of follow-up mechanisms lead to massive treatment dropouts. E.g. The National Mental Health Survey (2016) identified a treatment gap of nearly 83% for mental disorders, largely because medication costs often exceed 15% of a poor household’s monthly income.
5. Under-addressed determinants: Economic precarity acts as a constant trigger for mental collapse. E.g. NCRB 2022 data showed that daily wage earners accounted for the largest share (26.4%) of total suicides, directly linking financial instability to fatal mental distress.

Initiatives Taken

1. Mental Healthcare Act (2017): Guarantees rights, bans inhuman practices like chaining, mandates community-based care.
2. National Mental Health Programme (NMHP): Expands services to districts; DMHP operational in 700+ districts.
3. Tele-MANAS (2022): 24×7 helpline offering psychological support; 5 million calls since launch (example of scale).
4. NGO-led models: The Banyan’s Home Again model offers supported housing for women recovering from distress.
5. WHO mhGAP framework: Helps integrate mental healthcare into primary health services.

Way Ahead

Scale community-based ecosystems:

• Supported housing, crisis response teams and peer-led fellowships ensure continuous, localised care and reduce dependence on institutional facilities.
• Models like Scotland’s Open Dialogue show that relational, family-inclusive interventions significantly cut relapse and hospitalisation rates.

Train multidisciplinary & non-specialist workforce:

• ASHAs, ANMs and social workers trained in trauma-informed and culturally attuned care can bridge India’s 70–90% treatment gap.
• Task-sharing evidence from the District Mental Health Programme (DMHP) shows frontline workers can deliver early detection and follow-up effectively.

Integrate social determinants into care:

• Mental health interventions must link with livelihood missions, SWAYAM, domestic-violence cells, housing schemes and disability pensions.
• Addressing unemployment, violence or homelessness improves long-term recovery far more than medication alone, especially for women and urban poor.

Promote real-world, implementation research:

• Implementation science can evaluate what works in PHCs, urban clinics and community shelters rather than relying on lab-style trials.
• This generates context-sensitive evidence needed to scale effective models across diverse socio-economic and cultural settings.

Institutionalise lived-experience leadership:

• Embedding trained peer navigators in PHCs and district hospitals improves trust, engagement and adherence to treatment plans.
• Global studies show peer-led support significantly increases continuity of care, especially for survivors of homelessness or addiction.

Ensure dignity, autonomy & rights-based care:

• Strict enforcement of MHCA 2017—consent, advance directives, least-restrictive care—prevents coercion and restores user trust.
• Prioritising dignity and relational support shifts focus from symptom control to enabling individuals to live meaningful, self-directed lives.

Conclusion

• India’s mental-health crisis cannot be solved through medicine alone — it requires confronting social injustice, trauma, and structural deprivation. Building a rights-based, relational, community-rooted system can restore dignity and trust. Care as disability justice is the pathway to a humane, inclusive mental-health future.