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There is almost universal agreement that community-based care for individuals with mental health problems is preferable to institution-based treatment. In India, the Central Government’s National Mental Health Programme established the goal of providing community-based care for individuals with mental health problems. There is, however, anecdotal evidence that law and public policy actually present barriers to the provision of community-based mental health care in India. The purpose of this study is to determine whether these barriers exist, and, if they do, to recommend ways the barriers can be overcome or eliminated. In sum, the goal of the study is to determine whether India’s community-based mental health services are being inhibited by law and public policy. This goal was achieved by analyzing community-based mental health services and the laws governing their operations. Insights have also been drawn, where appropriate, from the laws regulating mental health services in other countries. This study concludes that there are currently a number of significant barriers to the provision of community-based mental health services in India. As a result, this study is of potential interest to a wide range of readers, including: During this study, I visited forty-four mental health facilities in four states or regions within India: Karnataka, Maharashtra, Tamil Nadu, and the Delhi Region. This study is focused primarily on two types of mental health facilities: rehabilitation centers (RCs) and general hospital psychiatric units (GHPUs). In order to understand the functioning of these facilities, I documented the following aspects of their operations: infrastructure, including spatial arrangements and layout; admission/discharge procedures and the legal authority for such procedures; relationships with governmental authorities, including police officials, the judiciary, and public mental hospitals; ward access policies, including whether closed ward systems are used; and inpatient/outpatient services, including whether rehabilitation services are offered. I then examined this data to determine whether there are any legal or public policy barriers that interfere with the provision of community-based mental health care by RCs and GHPUs. Part II of this study examines mental health policy, law, and services in India. With regard to the law, this study focuses on the Mental Health Act of 1987 but also discusses four other laws that affect the provision of mental health services: The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999, The Rehabilitation Council of India Act, 1992, and The Protection of Women from Domestic Violence Act, 2005. This study also examines the Convention on the Rights of Persons with Disabilities, which India has recently signed and ratified. Part III of this study describes the methodology that I employed. Part IV of this study includes the findings from my field visits to forty-four mental health facilities. This part of the study begins with a profile of each of the providers whose mental health facilities I visited. The following aspects of the functioning of these providers are then discussed: details of the services provided, including cost, the most common diagnoses treated, staffing patterns, the types of therapy employed, the use of ECT, and the use of physical restraint; the admission and discharge procedures and the average length of stay; the providers’ experiences with licensing and monitoring; and insights the providers offered based on their experiences with the relevant laws and public policies. Part V of this study contains the analysis of the findings that are set forth in Part IV. The analysis focuses on five dimensions of community mental health care facilities: origins and funding; infrastructure; services offered; admission and discharge; and licensing and monitoring. In addition to the collected data, this part of the study draws on literature on mental health policy, law, and services in India and other countries. Part VI sets forth conclusions that I have drawn from this study. Based on these conclusions, I also suggest recommendations that could be used to overcome or eliminate barriers to community-based mental health services. This study concludes with suggestions for additional research. Kevin M Cremin
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