Academic journal article Indian Journal of Psychiatry

Mental Hospitals in India: Reforms for the Future

Academic journal article Indian Journal of Psychiatry

Mental Hospitals in India: Reforms for the Future

Article excerpt

Byline: Muktesh. Daund, Sushma. Sonavane, Amresh. Shrivastava, Avinash. Desousa, Sanjay. Kumawat

Mental hospitals are an integral part of mental health services in India. It is an interesting story how mental hospitals have responded to the challenges of contemporary period they were built in. It is beyond doubt that it is a progressive journey along with advances in mental health both in India and internationally. As in other countries, mental hospitals in India have responded to the social challenges, disparities, and poor resources of workforce and fiscal investment. Historically, there have been changes and three major reforms are needed, namely attempt to facilitate discharge and placing patients back into the family, introducing teaching and research in mental hospitals, and accountability to civil rights as per the requirements of the National Human Rights Commission. In this review, we explore the brief history of mental hospitals in India and examine the reforms in the clinical, administrative, and psychosocial areas of these hospitals and progress in teaching and research. We finally summarize and conclude the necessity and the relevance of mental hospitals in India akin to modern psychiatric practice. We believe that mental hospitals have an important and perhaps a central role in mental health services in India. Its modernization to address issues of long-term stay, burden on caregivers, stigma, research and teaching including undergraduate and postgraduate training, new curriculum, and training for nonpsychiatric professionals and primary care physicians are necessary components of the role of mental hospitals and responsibilities of both government and nongovernmental sectors. Last but not the least, it is obligatory for mental hospitals to ensure that evidence-based treatments are implemented and that the standard of care and respect of civil and human rights of the patients and families are provided while involving the people's participation in its functioning.

Introduction

Mental hospitals have been an integral part of psychiatric services in India over the years and for the past century. Mental hospitals stemmed in India from the era of lunatic asylums - a concept that was British and European in its conception. The whole purpose of the concept of a mental hospital was to segregate the mentally ill from the community and not treat them as normal but rather detention away from the community. Most mental hospitals in India were built in the British and pre-British eras when the emphasis was never on community-based treatments and in that era psychiatric patients were viewed as a danger and menace to the society. The present article aims to present a history of the development of mental hospitals in India and their role in mental health care, first in the past, and the manner in which they can influence and contribute to community mental health care in the present era. The article draws a plan wherein with judicious use of the infrastructure of a mental hospital, there can be an incremental rise in psychiatric services in cities where these hospitals exist and they can serve as a means to re-integrate the mentally ill rather than segregate them. The authors here propose a few ideas, some far-fetched yet attainable, while most of the suggestions in this article are highly implementable and will add to the already grim mental health infrastructure in our country.

Certain Historical Aspects

The establishment of mental hospitals has played a significant role in the evolution of psychiatry to its present status. The prime objective of establishing mental asylums was to protect the community and not the insane and as a result, they were constructed away from cities, with high enclosures and often in military barracks from where escape was not possible. These mental asylums served as a means to isolate mentally ill persons from the society at large and provide treatments that were prevalent at that time. …

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