Beyond pharmacological reductionism: Reframing community mental health in India
DOI:
https://doi.org/10.37506/jt83d473Keywords:
Mental Health, social determinants, primary health careAbstract
Mental health care in India continues to be shaped largely by a biomedical paradigm that prioritises diagnosis and pharmacological treatment while insufficiently addressing the social and structural determinants of psychological distress. Such an approach risks pathologising normal responses to chronic adversity and inadequately serving populations facing poverty, gender-based violence, caste discrimination and other forms of structural oppression. This commentary argues for a shift towards inclusive, community-based mental health systems integrated within primary health care. Drawing on evidence from Indian programmes such as the National Mental Health Programme, District Mental Health Programme, VISHRAM and Sangath, the paper highlights the need for culturally responsive, decentralised and socially grounded approaches that move beyond pharmacological reductionism to improve population mental wellbeing.
References
1. GBD 2019 Mental Disorders Collaborators. Global,
regional and national burden of mental disorders
in 204 countries and territories, 1990–2019. Lancet
Psychiatry. 2022.
2. Sagar R, Dandona R, Gururaj G, et al. The burden of
mental disorders across the states of India: the Global
Burden of Disease Study 1990–2017. Lancet Psychiatry.
2020.
3. Ramos M. Against biological reductionism in
psychiatry. Boston Review.
4. Gururaj G, Varghese M, Benegal V, et al. National
Mental Health Survey of India, 2015–16: Summary.
Bengaluru: NIMHANS; 2016.
5. Patel V, Saxena S, Lund C, et al. The Lancet Commission
on global mental health and sustainable development.
Lancet. 2018.
6. Patel V, Chisholm D, Parikh R, et al. Addressing the
burden of mental, neurological and substance use
disorders in India. Lancet Psychiatry. 2016;3(2):125–
132.
7. Meyer IH. Prejudice, social stress and mental health in
minority populations. Psychol Bull. 2003;129(5):674–
697.
8. Bhugra D, Becker MA. Migration, cultural bereavement
and cultural identity. World Psychiatry. 2005;4(1):18–
24.
9. American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders. 5th ed.
Washington DC: APA; 2013.
10. Kroenke K, Spitzer RL, Williams JB. The PHQ-9:
Validity of a brief depression severity measure. J Gen
Intern Med. 2001;16(9):606–613.
11. Ministry of Health and Family Welfare. National
Mental Health Programme and District Mental Health
Programme: Operational Guidelines. New Delhi:
Government of India.
12. Patel V, Weobong B, Weiss HA, et al. The Healthy
Activity Program and VISHRAM: Community-based
psychological interventions for depression in rural
India. Lancet. 2017;389(10065):176–185.
13. Patel V, Chowdhary N, Rahman A, Verdeli H.
Improving access to psychological treatments:
Lessons from developing countries. Behav Res Ther.
2011;49(9):523–528.
14. Trivedi JK, Dhyani M. The Dawa-Dua model:
integrating faith and psychiatric care in India. Indian
Journal of Psychiatry. 2014.
15. Murthy RS. Community mental health care in India:
reflections from NIMHANS initiatives. Indian Journal
of Psychiatry. 2011.
16. Ridley M, Rao G, Schilbach F, Patel V. Poverty,
depression and anxiety: causal evidence and
mechanisms. Science. 2020.
17. Machado DB, Rasella D, Dos Santos DN. Impact
of income inequality and conditional cash transfer
programmes on suicide rates in Brazil. Lancet
Psychiatry. 2018.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Kimberley D'Souza

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.