From institutions, to clinics to community: Development of community mental health in the last 50 years and looking to the future

Abstract

The developments in the location of mental health care from mental hospitals to the general hospital psychiatric units and to the community are a revolution in the thinking of professionals and people. This change has resulted in a completely different view of persons with mental disorders, the rights of ill persons, the role of the professionals and paraprofessionals and, most importantly, the increase in the numbers receiving care. The community mental health movement in India can be attributed to (i) advances in psychiatric epidemiology; (ii) advances in psychopharmacology; (iii) newer methods of psychosocial interventions; (iv) increasing number of psychiatrists trained within India; (v) formulation of the National Mental Health Programme of India in 1982, and (vi) human rights movements. Indian mental health services development fortuitously occurred around the time of these revolutionary changes in mental health care. Building on the wave of the above developments, professionals rapidly moved out of the outmoded mental hospitals to general hospital psychiatric units(GHPU) (1960s), to community mental health programmes (1970s onwards). In the recent years, the movement has moved further to empower persons with mental disorders. The Department of Psychiatry at PGIMER, Chandigarh has been a leader in all of these developments. The chapter will comprehensively and critically review the developments. The concluding section will present the challenges and opportunities for the future in the field of community psychiatry in India.