Community psychiatry – Transcontinental lessons of the last quarter century

Abstract

Fueled by the discovery of effective medications and the debilitative effects of psychiatric institutionalization and driven by the social winds of change, community psychiatry took shape all over the world. The gradual closure of asylums and the move to community signified not only a geographical shift, but also led to the development of a whole new raft of practices in delivering services in the community. Many of these have become mainstream practices elsewhere. After a promising start, initiatives in community psychiatry have stalled in India, with the lack of resources being the most obvious cause. For various reasons, the field of social psychiatry has also not been in the limelight as psychiatry shifted its focus to the possibilities held out by biological psychiatry. This is unfortunate because the need for broader models is never more relevant than now, as social inequities continue to grow. Therefore, the time is ripe to look back over the developments in community psychiatry of the last quarter century and search for relevance in the light of our current realities. What are the main developments and more importantly, can these be implemented in a cost-effective manner in India? This article is a reflective attempt to argue for the feasibility of models using those principles but adapted for our social and economic realities.

Keywords

• Community
• culture
• mental health care
• models
• social