Mental Hospitals in India: Current Status and Role in Mental Health Care

This book is based on the proceedings of a World Health Organization workshop on the future role of mental hospitals in mental health care in India, held in Delhi in December 1995. The book gives a factual and statistical account of the government-run psychiatric hospitals, known as mental hospitals, which have functioned as asylums and recently have seen increased emphasis on treatment and rehabilitation.

The authors describe the evolution and history of these hospitals under British rule and independent India and mention the growth of general hospital psychiatric units and private psychiatric hospitals. They report recommendations to correct many of the shortcomings of the mental hospitals, which result mainly from low budgets: poor structure, insufficient numbers of trained psychiatric staff, and limited formulary and laboratory facilities. In addition, the authors recommend changing the nomenclature to less stigmatizing terminology, use of modified electroconvulsive therapy exclusively, and increases in outpatient and 24-hour emergency services.

The authors also note the change in the role of these institutions from asylums to providers of care for treatment-refractory, chronically mentally ill, criminal, or dangerous patients who cannot be treated in the general hospital units or cannot be permanently rehabilitated; a continued need for these psychiatric hospitals is evident. Provisions for more accommodation for families to encourage their continuing involvement and participation are suggested.

The book touches on reforms introduced by the Supreme Court of India that ensure that the fundamental rights of mentally ill institutionalized patients are not violated and that change the way courts deal with patients who attempt suicide. The rules and regulations pertaining to mental health care under the Indian Lunacy Act of 1912 and the Mental Health Act of 1987, implemented April 1993, are described. The authors describe the difficulties in passing the Mental Health Act and the continued use of the Lunacy Act by some courts and psychiatric hospitals.

The authors are eminent psychiatrists, and they meet their objective of presenting comprehensive information about the Indian government-run psychiatric institutions, including their history, architectural requirements, quality assurances, and specific problems, and the recommendations of the WHO workshop. Although the style of the book is very dry, the extensive information is of value to any persons interested in the practice of psychiatry in India. However, the reader must remember that a vast number of mentally ill patients are treated in general hospital psychiatric units and private psychiatric institutions, which have access to most of the modern psychotropic medications and modified ECT and which are not the focus of this book.

Dr. Phadke is assistant professor of psychiatry at the University of Massachusetts Medical Center in Worcester and staff psychiatrist at Worcester State Hospital.