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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 163-170

History of psychiatric rehabilitation in India

1 Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
2 Department of Psychiatry, YENCOURAGE, Mangalore, Karnataka, India

Date of Submission24-May-2021
Date of Decision25-May-2021
Date of Acceptance26-May-2021
Date of Web Publication26-Jun-2021

Correspondence Address:
Dr. Rajesh Mithur
Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_127_21

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Psychiatric rehabilitation is a therapeutic approach in the management of mental illness which encourages people to recover from the illness and achieve their fullest potential through learning and environmental support. The method involves adapting the patient to his environment or modifies the environment to meet the patient's needs. The concept of psychiatric rehabilitation has a long history in India. In its difficult journey from colonial ages to post independence it has come across many hurdles. With the hard work of few pioneers, institutes and government reforms we have reached a significant stage today. We will discuss psychiatric rehabilitation from the Vedic period, ancient India, British rule, post-independence to the current status. Also covering the laws related to the field, achievements, people and Institutions involved. People say past is where we learn lesson and future is where we apply them. After this long fascinating journey through development of psychiatric rehabilitation in India, we can find that the development in this field is still inadequate. With multiple deficiencies in funding, infrastructure and work force this unique multidisciplinary field has a long way to go in this country..

Keywords: History, psychiatry, rehabilitation

How to cite this article:
Kakunje A, Mithur R, Puthran S, Joy A, Shetty S. History of psychiatric rehabilitation in India. Arch Med Health Sci 2021;9:163-70

How to cite this URL:
Kakunje A, Mithur R, Puthran S, Joy A, Shetty S. History of psychiatric rehabilitation in India. Arch Med Health Sci [serial online] 2021 [cited 2021 Dec 8];9:163-70. Available from: https://www.amhsjournal.org/text.asp?2021/9/1/163/319379

  Introduction Top

Psychiatric rehabilitation is a therapeutic approach in the management of mental illness which encourages people to recover from the illness and achieve their fullest potential through learning and environmental support. The method involves adapting the patient to his environment or modifies the environment to meet the patient's needs.[1] The rehabilitation process is thus extremely positive in its approach and works in building competency. Rehabilitation services can be classified under four main models of intervention – recovery, respite, rescue, and retention. The recovery model helps persons who have recovered from the illness to function optimally at a social level. Respite model is for who have residual symptoms. Rescue model is for the homeless and wandering mentally ill, and finally retention model is for people who have resistant illnesses or difficult to be managed at home.[2]

  Psychiatric Rehabilitation in Ancient India Top

The concept of psychiatric rehabilitation has a long history in India. In its difficult journey from colonial ages to postindependence, it has come across many hurdles. With the hard work of few pioneers, institutes, and government reforms, we have reached a significant stage today. India is practicing the concepts of mental health since Vedic age. The earliest reference to the description and treatment of mental illness is found in Charaka samhitha and Sushrutha samhitha. The treatment methods then were crude and consisted of multiple herbal extracts. However, in spite of no developments in medical care, they were able to give some relief to their patients. Raghavan et al. in their paper described the presence of stay in facility for mentally ill in the Chola period.[3] The 11th century epigraph gives evidence to the presence of Veera cholesvara hospital in the premises of Janatha mandapam of a temple in Thirumukkudal. The hospital was established by Veera Rajendra Deva (1063AD–1069AD), the then king of Chola Empire. The epigraph in the temple describes the presence of a 15-bedded hospital and also gives the details of staff strength. The list of drugs administered to the patients has been inscribed with no much detail of their indications. The detailed indication and uses of these drugs can be found in the Charaka samhitha and Sidha system of medicines. For chronic patients, stay was arranged in the remote areas of the temple premises. This crude form of rehabilitation can be described as the earliest form of stay in facility for mentally ill in India. It is interesting to note that this asylum for mentally ill was setup before the famous Bethlem hospital in England. Another epigraph of Chola period in the Vedaranyeswara temple describes the asylum for the fearful (anjuvan pugalidam) which was a place for accommodating the fearful or mentally ill.[3]

Firuz Shah Tughlaq (1309–1388), the successor of Mohammed Bin Tughlaq, is known to have constructed several hospitals in Delhi where the mentally ill were chained and locked up. Evidences from the 15th century show the presence of asylum for the treatment of mentally ill during the period of Mohammad khilji (1436AD–1469AD). Certain evidences also mention about a physician named Maulana Fazulur Hakim who worked in a mental hospital at Dhar near Mandu in Madhya Pradesh.

Until the beginning of 17th century, the practice of psychiatric rehabilitation was nonspecific, unsystematic, and crude. Most of the mentally ill were either found roaming in open public places or confined to some locations due to belief of them being possessed. The system of separation of mentally ill in an asylum was a western idea introduced only in the 17th century. This system was practiced only with the idea of protecting the general public and with no intention of curing the mentally ill.[4] Racial discrimination prevailed. People were treated according to their social status and often poor Indians were confined to crowded compartments, while Europeans enjoyed multiple benefits.

  Establishment of Asylums Top

The idea of establishing a lunatic asylum was first brought to India by the British East India Company. These asylums were then constructed for segregating the mentally ill British officers and Indian soldiers working for the East India Company. The evidences show that the first mental health asylum in India was constructed at Bombay in 1745. However, its full-fledged construction and functioning at Colaba started much later in 1806.[5] The first lunatic asylum was built in India at Calcutta by surgeon named Dr. George M Kenderline in 1787.[6] However, this asylum failed to get medical board approval as Kenderline got dismissed from his service due to neglect of duty. Later, another lunatic asylum was built by private owner in Calcutta which passed medical board's approval and started to function under William Dick. At the same time, a new asylum was built in Monghyr in Bihar in 1795, the remnant of which is now called “Paghla Ghar building.”[7] The first lunatic asylum for the state of Madras in south India was approved around the same time in 1793.[4] The asylum was completed and opened under the charge of Dr. Valentine Connolly in 1794; a 20 bed asylum in Chennai.[8] Treatment then was offered in the form of opium, hot bath, and music to calm own the patients.

  Lunacy Act 1858 Top

This was the act which laid down the rules and regulations for rehabilitating the mentally ill. The act defined the concept of lunacy or unsoundness of mind and stated that if a lunatic cannot take care of himself, then it is the responsibility of the crown to take care of. The act also stated that it was the responsibility of the court to decide if the person is lunatic.[9] The handling of the property of a lunatic was decided in the law. The act was mainly passed as the transportation of mentally ill to England was expensive. Although the act came for the benefits of the East India Company, it laid down the foundation for rehabilitation process in India.[10]

An experiment with the “Geel sytem” (Boarders got family care system) was conducted at the Dacca asylum in 1860s where the mentally ill were offered boarding at homes of the reputed or educated normal people.[5] This plan was a success which reduced overcrowding in the asylums. The doctors regularly visited the homes and checked on the mentally ill. However, the system had short comings as the residents who cared were held responsible if the mentally ill escaped. Thus, this system slowly faded away.

  Occupation Therapy in India Top

In the initial days of the development of asylums, the Indian inmates were forced into hard labor. The patients or inmates were discriminated based on color and lost basic human rights. Those days the inmates only worked for the greed of the British owners.[11] Earliest found records show evidences of lunatics subjected to work.[12] Aurthur Payne who was superintendent of asylums of presidency in 1862 documented that the death rate was high among nonworking lunatics.[13] Hence, the inmates were forced to work in asylum voluntarily which was called “Lunatic labor.” Thus, the concept of “Asylum industries” prevailed.[10] This job included castor oil manufacturing, gardening, mat weaving, wheat grinding, or road making. These jobs generated income for the asylums.

However, the Mysore lunatic asylum changed the course of rehabilitation when they first used the concept of “Work therapy” for their patients.[14] The patients were mostly involved in agricultural activities as a part of therapy. Records show that the concept of occupation therapy in India was thought for the first time by Dr. W R Rice of Indian medical service in 1895.[14] After thorough survey of the mental asylums in India, they found that occupation therapy would benefit the patients when provided as a part of mental health care. Hence, the occupation therapy departments were created in most of the asylums in India. Occupational therapy as a service was provided to persons at the All India Institute of Mental Health (Current NIMHANS) [Figure 1]. The department of occupational therapy, retraining, and rehabilitation was started in 1954.
Figure 1: Earlier All India Institute of Mental Health; current NIMHANS

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  European Mental Health Asylum, Ranchi Top

The “European mental health asylum” now called Central Institute of Psychiatry, Ranchi [Figure 2], was built in 1918 solely for the treatment of European and American patients.[15] Lt. Colonel Owen Berkeley-Hill became the superintendent of hospital in 1919 and brought many important developments in the hospital.[6] In 1920 after repeated requests to the government, he changed the name of “lunatic asylum” to “mental hospital” in India.[16] The Ranchi mental hospital considered mentally ill people as patients and offered the most advanced available treatment and rehabilitation during those days. It treated patients with necessary drugs after performing the basic investigations. This hospital was a pioneer in various rehabilitation methods in India.[17] The asylum provided the patients with a very nutritious diet. They allowed the male and female patients to dine together in the restaurants which helped them to interact more and believed that it had positive benefits in rehabilitation. The hospital had regular exercise regimen for patients in admission. Male patients were allowed to play football, cricket, hockey, badminton, and tennis.[18] “Habit formation chart” similar to token economy technique was started in 1920.[16] The hospital used the “Swedish drill regimen” for patients to improve their mind–body coordination by suggestion, imitation, and command. The asylum also promoted the indoor activities for recreation such as reading, writing, cards, chess, and dominoes. Music was played using gramophones, and patients had weekly concerts and dance programs. The asylum had its own brass band of 22 male attendants with an expert band master who used to entertain the staff and train the patients. The patients were also taken for weekly drives for relaxation and were offered paroles with written consent whenever they were fit to go out. The Central institute of psychiatry Ranchi established the first occupation therapy ward in India in 1922.[15] Every patient getting admission was given an occupation prescription where they were allotted a certain job. However, when describing the asylum in his article Owen Berkeley says that certain jobs were of tougher grade and needed lot of technical expertise. This kind of jobs was of not much use as patients with cognitive difficulties could not bring out anything productive and they could not make any use of it. Hence, the jobs were divided into grades and allotted to patients. The payment for their job was also made in suitable form, and this service helped them in rehabilitation. The hospital also started hydrotherapy center for the patients in 1923.[16] Cottages were built outside the campus for the family members to stay for family therapy.[16] Thus, the asylum showed the new direction in psychiatric rehabilitation.
Figure 2: Central Institute of Psychiatry, Ranchi now

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  Kilpauk Mental Hospital Top

The asylum also called “Government mental hospital, Madras” or “Madras lunatic asylum [Figure 3]” which is now called Institute of Mental Health, Chennai has made a significant contribution to psychiatric rehabilitation.[8] The hospital had special wards for various psychiatry patients with comorbid illness such as tuberculosis, diarrhea, leprosy, and criminal lunatics. The mentally retarded children had special wards, and also a special school was also started during the time of Dr. Venkatasubba Rao.
Figure 3: Kilpauk Mental Hospital

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Occupation therapy here was introduced in 1949. The hospital had various recreation activities for the patients in the form of group activities, dramas, and games. The patients were provided with prayer halls and radio sets for recreation in wards.[8] Celebration of Pongal, Christmas, etc., was conducted regularly at the hospital. Sports days and picnics were conducted for recreation. It offered weaving, book binding, gardening, poultry farming, cleaning, and carpentry. A guinea pig farm was specially created for criminal patients during the tenure of Dr Rajaiah D Paul. Industrial therapy center or ITC was constructed in 1970 from the various donations offered and provided rehabilitation activities.[8] The center was the pioneer in ITC which offered toy manufacturing, bag making, incense stick making, paper cover making unit, and flour grinding units.[19] Patients prepared and offered good food at cafeteria at the hospital. Patients were paid nominal amount for the work they had done. Thus, the institute had great contribution to the rehabilitation process in the country.

  Indian Lunacy Act 1912 Top

The Indian lunacy act 1912 was an important step laid down by the legal authority to safeguard the rights of the mentally ill and rehabilitate them.[20] The lunacy act specifically laid down the rules for the reception and detention of the mentally ill at the asylum.[21] In terms of rehabilitation, the act made provisions for the appointment of the manager for the estate of the mentally ill. Specific rules were laid down to prevent any sort of abuse of the patient. However, this law favored custodial treatment and partially went against patient rights.

  Mapother Report 1938 Top

The report mainly compared the state of mental hospitals and services in London and India and gave various suggestions.[22] Multiple suggestions were provided to improve hospital, beds, admission procedures, and staff. In terms of rehabilitation, the report suggested to increase the number of social workers in all the hospitals and also recommended suitable occupation for the patients.

  Bhore Committee 1946 Top

The Bhore committee report was a health survey conducted by the colonial government to give important recommendations for the development of health care in India.[23] The committee found severe inadequacy of psychiatry workforce in the field and hence recommended training of more staff in the field. The Bhore committee after survey found that the staffs in the department of social work, occupation, and recreation therapy were not given any attention in this country. The Bhore committee made very important recommendations in the development of the field of psychiatric rehabilitation. The committee recommended the training of occupation therapists, psychiatric social workers, and nursing staffs in the field of psychiatry. The asylums in Bombay and Calcutta were also instructed to develop their centers for training the personnel in the field of rehabilitation and occupation therapy. The establishment of Child guidance clinic for the correction of unsatisfactory behaviors in children was suggested. The report also recommended starting specific national programs to develop cultural activities, hobbies, and education for self-development.[23]

The recommendation of Bhore committee [Figure 4] led to the establishment of All India Institute of Mental Health in 1954. This institute was renamed as NIMHANS in 1974 and has become one of the top institutes in the field of psychiatric rehabilitation today.
Figure 4: Sir Joseph William Bhore who was the chairman of the famous Bhore Committee

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  Alcohol Anonymous Top

The rehabilitation technique called alcoholic anonymous first started in India only in 1957. The first recorded meeting of alcohol anonymous (AA) took place in Mumbai.[24] Harold was the first person in India to undergo AA therapy and achieve sobriety. Later, multiple centers emerged in various parts of India sponsoring the alcoholic anonymous therapy for patients.

  Special School for Psychiatric Patients Top

In the past, the cases of mental illness and intellectual disability were treated at homes. This shifted to the asylum setup of management in the 17th century. However, separate treatment by segregation of mental retardation cases started first in Madras Lunatic asylum (now Institute of Mental Health Chennai).[4] The first special school for the intellectually disabled in India was started in 1918 at Kurseong in Eastern India. Other documents show that the first residential home for the management of children with mental retardation was started in Mumbai in 1941. In due course, a special school was also established for managing the special children in 1944. However, the education for the intellectually disabled continued to be with the normal children until 1947. However, after the independence, the segregation of the disabled improved.

Another major step was laid by the Indian education commission 1964–1966. The education commission then suggested that the aim of providing special education is not only humanitarian but also it should be targeted to make the intellectually disabled into productive citizens.[24] The aim was to provide special education to at least 5% of intellectually disabled by 1986. The government established the National Institute for the Mentally Handicapped (NIMH) at Secunderabad in 1985 to promote research and education in the field. Reports showed that the number of special schools was only 237 in 1966, but the number increased to more than 3000 by 2007.[25]

National policy on education was passed in 1986. This policy helped consider intellectually disabled as equal to general population and helped them integrate well in the population. The policy made significant recommendations in the areas of Integrated Education, Special Schools, Vocational Training, Teacher Training, and Voluntary Organization. Early childhood care and education has been integrated with ICDS and district primary education program to offer disability education for mental retardation. The Rehabilitation Council of India (RCI) act which was passed in 1992 has then made a significant contribution to educate the special children.[25]

  Autism Top

The condition called autism appeared in Indian literature only in 1959.[25] However, the knowledge of autism and rehabilitation methods attained significance only in 1980s. It was only in 1991 a group of like-minded parents came together to form a group called “Action for Autism.” In 1994, a specialist school to train autistic children called “Open Door” was started in India. In the year 1994, the Action for Autism created a new full time teacher training course in Delhi. In 2003, the RCI came forward to start a course called Diploma in special education (Autism spectrum Disorder) to train the teachers in handling the autistic children.

  Day Care Therapy Top

The 1st day care center for the treatment of psychiatric patients in India was started in All India Institute of Mental Health (now NIMHANS) in Bangalore in 1960. Different forms of vocational activities in the form of carpentry, weaving where conducted for the patients. Day hospital for mentally ill was started at the Institute of Mental Health Chennai in 1962 with similar facilities.[14] Another milestone in a history of day care therapy was the founding of “T. T. Ranganathan Clinical Research Foundation” in 1980 at Chennai.[26] The center specialized in day care therapy of alcoholics through detoxification, intensive therapy, and regular Alcoholics' anonymous therapy. This was the first of its kind therapy center in India where day care was offered for minimum 21 days for alcohol deaddiction therapy. “Asha” in Tamil Nadu and “Ashadeep” in Assam are other day cares centers which are operated by patient's family members.[27] In due course, the day care therapy started in many other centers throughout the country.

  Yoga for Mental Health Top

The use of yoga in psychological therapies is only a recent concept in India. In 1960s, several articles were published on the probable health benefits of yoga.[28] In 1971, the first study of psychological benefits of yoga was published in journal of yoga institute.[29] In the later years, several studies on yoga were published by Dr. Vahia and others. The government mental hospital Kilpauk (now Institute of mental health), Chennai was also a pioneer in building a separate yoga therapy department under Dr. R Ramadas.[30] Instead of chair, patients were made to sit in mats and relax and were taught yoga asana which helped in rehabilitation. The United Nation general assembly with the suggestion from India has decided to celebrate June 21 as yoga day to promote mental peace and physical health.

  Family Support and Family Participation in Rehabilitation Top

The participation of family member in the treatment of mentally ill is a newer concept in India. This unique method was first utilized in 1957 by Dr. Vidhyasagar in Amrithsar Mental Hospital.[31] Around 1960s, further experiments were also conducted on this method in Christian medical college Vellore.[32] Findings in Vellore hospital showed that family members were skillful in calming down the patients. They had good emotional connection and hence could help patients participate in occupation therapy and group therapy.[14] With the introduction of this technique, the success of psychiatric rehabilitation has increased significantly.

  Community-Based Rehabilitation Top

Child Guidance Clinic at Sir Dorabji Tata Graduate School of social work (now Known as Tata Institute of Social Sciences) in Mumbai was the pioneer in establishing the psychiatry social work department. They appointed the first psychiatric social worker in India. This led to the further development of training in the field of psychiatric social work.

  Mental Health Camps Top

The concept of mental health camps in India was first tried in Bagalkot in 1972. Camps were also reported from Karnataka in 1970s.[33] Substance-use disorder camps functioned in 1979 at Jodhpur and also at TTK Chennai. However, in due course, abstinence and increased retention rates grew to be a problem.

  Other Centers Top

The Schizophrenia Research Foundation (SCARF), a nongovernmental organization (NGO) in Chennai was founded in the year 1984. The organization was led by Dr. M. Sarada Menon, a psychiatrist, and currently by Dr. R. Thara. They have been conducting extensive research in the field of mental health and known for their work in schizophrenia and rehabilitation.[2]

Darul-Majanine meaning mental asylum was started at Chanchalguda central jail and shifted to Jalna in Maharashtra. The name of the institution changed from Darul-Majanine to hospital for Mental Diseases, Jalna. The Institute was shifted from Jalna to Hyderabad in 1953 and is currently known as Institute of Mental Health at Erragadda.

  Mental Health Nongovernmental Organizations Top

NGOs and voluntary agencies have made a significant contribution to psychiatric rehabilitation. Medicopastoral association and the Richmond Fellowship Society-India (RFS-I) branch were pioneers in the private rehabilitation services in our country since 1986. The above agencies offered half way home services for the psychiatric patients. “Vikas” was the brainchild of RFS which was created for men. In 1989, the RFS established “Accredited Social Health Activist (ASHA)” which catered to both men and women.[33] At the same time, Dr. Bharat Vatwani established rehabilitation center for mentally ill patients in 1988 called “Shraddha.” The center made significant contribution, for which Dr. Bharat won Magsaysay award for his service to mankind.[34] In 1992, Dr. Joyce Sirimoni established Paripurnata which was a half way home exclusively working for mentally ill women.[35] This organization mainly worked for mentally ill women detained in prisons. Dr. Ramasubramaniam in 1992 founded the “Chellamuthu trust and research foundation.” They promoted mental health awareness and literacy.[2] Around 1993 Vandana Gopikumar and Vaishnavi Jayakumar established “The Banyan” a halfway home for mentally ill homeless women in Chennai. The banyan since then has worked for many homeless women with mental illness. The Chittadhama trust offers rehabilitation for homeless mentally ill since 2010 at HD Kote in Mysore.[2]

  National Mental Health Program Top

”Bellary model” of treatment was the method of integrating the mental health services at primary health care. In this model of treatment, the primary health-care staff and primary health physicians were trained in managing the basic mental disorders and observed for changes in the mental health system. This method of health management led to the development of “National mental health program” in 1982. In due course in 1996, the government also launched the “District mental health program” for benefit of the people.[36]

  Mental Health Act 1987 Top

The mental health act (MHA) 1987 was passed on May 22, 1987. This act laid down regulations for admission and care of mentally ill people in India. The rules and regulations for establishing and running a mental hospital were specifically framed in this act which improved the level of care available for the psychiatric patients.

However, the MHA does not prescribe any law on the rehabilitation procedures. A major drawback of this law was the concept of involuntary admission which was arbitrary and partially went against the rights of mentally ill patient'.[37]

  Rehabilitation Council of India Act Top

The RCI act was passed in 1992 which paved way for the constitution of RCI. RCI act mainly concentrated on training the professionals and in maintaining a central rehabilitation register. The standard of education necessary and the professional misconduct were well defined in the act. Thus, the act was mainly passed for streamlining the education and building standard rehabilitation technique in India.[25]

  Persons with Disability Act Top

Persons with disability (PWD) act was passed in 1995 to promote full participation of the disabled and to bring about equality among all the people. This was the first time where mental illness was included as disability. The act constituted various committees and distributed powers to manage rehabilitation activities. Prevention and early detection of disability were given more importance in the act. The act helped bring the intellectually disabled to main stream by preventing exploitation and promoted equality. The act suggested establishment of special schools, vocational training, part time classes, and special classes for functional literacy and nonformal education for children with different disability of specific age groups. Text books were offered free with revised subjects, free scholarships, and free transport facilities were offered to encourage disabled children to get educated. Government offered reservation not <3% for the disabled. Income tax benefit of 75,000, concession in train, free travel on road, and disability benefits were available. Government offered special schemes for building homes, starting business, and building recreation center for disabled. Social security in the form of financial assistance and insurance schemes was offered for the disabled. Thus, PWD act played a key role in improving the rehabilitation services for the people of this country.[38]

  Disability Certificate Top

In the past, there was no tool to officially assess and certify anyone as suffering from disability.[39] In order to rectify the problem, “Indian Disability Evaluation and assessment Scale” commonly referred to as the “IDEAS” was framed. IDEAS was gazetted by the Government of India, Ministry of Social Justice and Empowerment, in February 2002.

  Erwadi Tragedy Top

Erwadi tragedy was a fire accident that took place on August 6, 2001, which killed 26 chained mentally ill people.[40] The incident drew lot of media attention to the mental health state of the Indians. The National Human Rights Commission and Supreme Court went through the report on incident that brought about some reforms. The National Human Rights Commission in 2001 asked all States and Union Territories to release the patients in captivity. Thus, the rule helped to unchain the mentally ill patients who were treated like prisoners.

  United Nations Convention on the Rights of Persons with Disability Top

One of the recent developments in the rehabilitation process of mentally ill is United Nations Convention on the Rights of Persons with Disability (UNCRPD). India signed and ratified the UNCRPD on October 1, 2007. The convention is aimed at promoting and protecting the rights of mentally ill people with disability. Respecting human rights, reducing stigma, improving human resources for mental health, and managing financial allocation are some of the important objectives of this policy.[41]

  National Mental Health Policy 2014 Top

Another recent development in psychiatric rehabilitation in India is the National Mental Health policy. This policy was developed with the intent of promoting mental health and preventing mental disorders. Reducing stigma, providing social care, and socioeconomic support were also included in the vision.[42]

  Mental Health Act 2017 Top

The MHA 2017 was passed on April 7, 2017.[38] The act gave unique opportunity to a mentally ill to prepare an “Advanced directive.” Any one above 18 years can prepare a written document to inform how he wished to be cared and also by a person of his choice who is called as nominated representative. The new MHA made provision to establish half way homes, sheltered accommodations, and home-based rehabilitation. Child and old age mental health services were also established. Any destitute or homeless was supposed to be treated free of cost at mental health establishments or funded by government.

According to this act, the rights of a mentally ill were well defined to safeguard them in any mental health establishment. Safety, hygiene, sanitation, leisure, recreation, education, dignity, privacy, and personal clothes have to be provided. The mentally ill are also to be safe guarded from all physical and sexual abuse. Various laws were laid down in running mental health establishments and thus the act made a significant change in the treatment of psychiatric patients in India.

  Psychiatry Rehabilitation in Medical College Departments and Private Sector Top

Several psychiatry rehabilitation centers started in association with Medical college psychiatry units. Since the last couple decades, there has been a phenomenonal increase in psychiatry rehabilitation centers by the private sector.

  Current Scenario Top

Psychiatric rehabilitation is gaining increasing importance and getting integrated with routine treatment. Awareness among the public and health professionals, increase in mental workforce and infrastructure has led to tertiary care services in psychiatry and people looking forward to functional recovery from the earlier symptomatic recovery. Courses and chapters on psychiatric rehabilitation are taught to all working in the field of mental health. The Biopsychosocial model is gaining strength. There is an active Indian Association of Psychosocial Rehabilitation society, a branch of World Association of Psychosocial Rehabilitation (WAPR). Dr. Murali Thyloth became the first Indian and the first person from South East Asian region to become the President of WAPR.

  Conclusion Top

People say past is where we learn lesson and future is where we apply them. After this long fascinating journey through development of psychiatric rehabilitation in India, we can find that the development in this field is still inadequate. With multiple deficiencies in funding, infrastructure, and workforce, this unique multidisciplinary field has a long way to go in this country.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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Lunacy Act 1858
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Indian Lunacy Ac...
Mapother Report 1938
Bhore Committee 1946
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