The document summarizes the history and current state of mental health research and services in India. It discusses how the Indian Council of Medical Research (ICMR) has supported mental health research since the 1950s through epidemiological studies and other initiatives. It outlines the ICMR's role in providing research foundations for expanding national mental health services programs. Going forward, it proposes four strategies for the ICMR: (1) providing research support for mental health services, (2) generating new knowledge on mental disorders, (3) developing mental health indicators, and (4) building research capacity. The challenges facing mental health in India are also summarized.

1. Indian J Med Res 120, August 2004, pp 63-66
Editorial
Mental Health in the new millennium: Research strategies for India
Early this year, the Ministry of Health and Family Community Mental Health at Bangalore, Mental Health
Welfare, Government of India, invited “research of Aged at Madurai, and Biological Psychiatry at
proposals for funding as part of the ongoing National Lucknow – all of which demonstrated how research
Mental Health Programme (NMHP) which aims at support can help develop mental health services. The
providing community based mental healthcare using the ICMR also supported research into the mental health
existing public health infrastructure. The proposed aspects of disasters like the Bhopal Disaster in the 1980s,
research should be relevant and translational in nature, the Marathwada earthquake in the 1990s and the most
i.e., it should conform to the aims/objectives of the recently Gujarat earthquake and the fire tragedy in Delhi.
NMHP and should translate into more effective/cost- It is largely the result of these efforts that following any
effective mental health interventions/service delivery”1. disaster in India, psychosocial support is readily provided
This Rs 10 crore (US$ 22.2 million) is an unprecedented to the survivors along with other services7.
research support to the NMHP for “phased
implementation of the District Mental Health Mental health care in India over the last 25 yr has
Programme, strengthening of medical college been an intense period of growth and innovation. Prior
departments of psychiatry, modernisation of mental to the formulation of the NMHP in 1982, the major
hospitals, focused IEC initiatives, research and training”. initiatives included setting up of mental hospitals during
1950s and early 1960s and general hospital psychiatric
Commencing with the first epidemiological studies at units in the 1960s and 1970s 8. Simultaneously,
Bangalore in the 1950s and at Agra in the early 1960s, involvement of the families in care of the mentally ill
the Indian Council of Medical Research (ICMR) has was also initiated in a number of centres. Another major
been in the forefront of mental health research2. The step in mental health care was to integrate mental health
other major studies include the multicentered research care with general health services. Followed by the initial
cum intervention project titled “Severe Mental Morbidity” demonstration projects at Chandigarh and Bangalore9-11,
in four centres3. The “Strategies for Mental Health in the last two decades, the pilot programmes of
Research”, based on six task forces that identified integration of mental health with primary health care were
research priorities in mental health in 1980 was a major initiated at several centres. The district model of mental
milestone. Two of these task force projects focused health (DMHP) care was developed by National Institute
on acute psychosis and course and outcome of of Mental Health and Neuro Sciences (NIMHANS),
schizophrenia4,6. Findings of the studies have not only Bangalore during the latter part of 1980s12. The next big
influenced mental health care in India, but contributed to step was extending of DMHP to 25 centres around the
the inclusion of acute psychosis as a separate diagnostic country with central funding during the 9th Five Year
category in International Classification of Diseases (ICD) Plan13. Currently, during the 10th Plan period, the goal is
10th Edition, of the World Health Organisation. Other to cover 100 districts with about 150 million
studies were mental health care of the aged and child population14,15.
psychiatric problems. Many of the trainees who
participated in the community mental health training India enters the new millennium with many changes
programmes initiated their own community mental health in the social, political, and economic fields with an urgent
projects. These initiatives demonstrated both the need need for reorganization of policies and programmes.
for research support to the developing NMHP The mental health scene in India, in recent times, reflects
(formulated in 1982) as well as the willingness of the complexity of developing mental health policy in a
professionals to work as teams. The 1980s also saw developing country. There has been a critical examination
the Council set up Advanced Centers for Research on of the existing mental hospitals in the country by the
63

2. 64 INDIAN J MED RES, AUGUST 2004
National Human Rights Commission of India16. The document Neurological, psychiatric, and developmental
Supreme Court of India is continuously examining the disorders: meeting the challenges in the developing world,
wide variety of issues relating to mental health care, published by the Institute of Medicine in 2001 also
following the Erwadi Tragedy in which 28 mentally ill focusses on the research needed to support mental
persons were burned to death while chained to pillars. health programmes in developing countries21.
The National Health Policy17 clearly spells out the place
of mental health in the overall planning of health care. The scope of mental health in the new millennium
These developments have occurred against the over should include care of the mentally ill persons, prevention
25 yr of efforts to integrate mental health care with of mental disorders and promotion of mental health as
primary health care (from 1975), replacement of the outlined by Dr Govindaswamy, the first Director of All
Indian Lunacy Act 1912 by the Mental Health Act 1987, India Institute of Mental Health (now NIMHANS),
and the enactment of The Persons with Disabilities Act Bangalore22 over 50 yr back: “Mental health in India
1995 focusing on the equal opportunities, protection of has three objectives. One of these has to do with mentally
rights and full participation of disabled persons18. The ill persons. For them the objective is the restoration of
growth of voluntary action for mental health care in the health. A second has to do with these people who are
areas of suicide prevention, disaster mental health care, mentally healthy but who may become ill if they are not
setting up of community mental health care facilities, protected from conditions that are conducive to mental
movement of family members (care givers) of mentally illness which however are not the same for every
ill individuals, drug dependence, public interest litigation individual. The third objective has to do with the promotion
to address the human rights of the mentally ill; research of mental health with normal persons, quite apart from
in depression, schizophrenia and child psychiatric any question of disease or infirmity. This is positive mental
problems are other major developments19. The rapid health. It consists of the protection and development of
growth of private psychiatry with associated spread of all levels of human society of secure, affectionate and
services to peripheral cities and small towns and satisfying human relationships and in the reduction of
challenges of regulation is an another significant hostile tensions in the community.”
development of the last 10 yr.
The challenge for professionals working in India is
Against the above positive developments, the main the competing demand to provide services to large
challenges are the extremely limited number of mental numbers of persons with mental disorders and generation
health professionals (about 10,000 professionals of all of new knowledge through research. The research
categories for one billion population) and the very limited agenda for the Council could have the goals of
mental health service infrastructure (about 30,000 (i) reduction of the incidence, prevalence and burden of
psychiatric beds for over a billion population); limited mental and behavioural disorders; (ii) develop and
investment in health by the government (estimated public evaluate the mental health services so that they become
sector expenditure on health is only 17 % of total health available and accessible to the total population;
expenditure) and problems of poverty (about 30% of (iii) enhance the positive mental health of the population;
population live below poverty line) and low literacy with and (iv) create structures to promote long-term mental
associated stigma and discrimination for persons with health research and dissemination of mental health
mental disorders. information.
At the International level, the World Health Report The following four strategies can be used by the ICMR
2001 on Mental Health has been a landmark in the to achieve the above goals: (i) provide research and
development of policies and programmes relating to evaluative foundation to the expanding national level
mental health in the world and specifically in developing mental health services, both as part of NMHP and in
countries 20. The Report provides a framework for the private sector psychiatry; (ii) help generate new
countries with different development levels to initiate knowledge about the nature, course and outcome of
actions appropriate to their resources. Already there is mental disorders; (iii) develop measures for monitoring
evidence of change in many countries. Another important of the mental health of the community; and (iv) build

3. MURTHY : MENTAL HEALTH IN THE NEW MILLENNIUM: RESEARCH STRATEGIES FOR INDIA 65
capacity for mental health research and dissemination roles clearly cut out.
of mental health information among the public, policy
makers and professionals. Acknowledgment
Research in service development should focus as a I am thankful to Drs Somnath Chatterji and Shekhar Saxena of
priority, on areas like integration of mental health in WHO, Geneva for the technical inputs towards the development of
the goals, strategies and priority research areas during the year
primary care, early intervention in psychosis, use of family 2001 and Prof. N.K. Ganguly for initiating these discussions during
support, models of community long-term care, evaluation one of his visits to Geneva.
of suicide prevention initiatives and mental health in
schools. The topics for generation of new knowledge
R. Srinivasa Murthy
could focus on course and outcome of different mental
STP-Mental Health and Rehabilitation of
disorders; treatment by pharmacological and
Psychiatric Services
non-pharmacological methods of common mental
Regional Office for the Eastern Mediterranean
disorders; mental health of women; mental health of
W.H.O. Post Box 7608
adolescents; disaster mental health; health and behaviour,
Abdul Razak Al-Sanhouri Street
development of culturally appropriate assessment tools;
Naser City, Cairo-11371, Egypt
health system research; spirituality and health; and basic
e-mail: murthys@emro.who.int
biological studies of mental disorders. The development
of mental health indicators is an important strategy to
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