Introduction

Mental health systems globally and in India continue to prioritise biomedical treatment and functional integration. They often overlook lived experiences of distress, social exclusion, and structural vulnerability. There is a need for a fundamental shift: from care as a technical service to care as disability justice, grounded in dignity, equity, and relational accountability.

Reframing Mental Health Care Beyond Treatment

1. Dignity-Centred Care: Positions dignity, rather than cure or productivity, as the primary objective of mental health systems.
2. Disability Justice Lens: Recognises mental illness as shaped by intersecting social, economic, and political structures.
3. Relational Accountability: Frames care as embedded in relationships, not limited to institutional or clinical settings.

Limits of Dominant Psychosocial Disability Models

1. Productivity Bias: Prioritises economic functionality and independence as markers of recovery.
2. Reductionist Integration: Treats community inclusion as an end-state without addressing exclusionary social norms.
3. Invisible Chronic Distress: Marginalises individuals whose suffering does not conform to biomedical recovery trajectories.

Structural Determinants of Mental Distress

1. Material Deprivation: Highlights housing insecurity, income precarity, and food scarcity as persistent stressors.
2. Social Abandonment: Identifies shame, rejection, and relational breakdown as under-recognised drivers of distress.
3. Political and Cultural Loss: Notes erosion of cultural meaning, safety nets, and social identity as contributory factors.

Multiplicity of Explanations for Mental Illness

1. Biological Factors: Includes neurotransmitter alterations and inflammatory markers.
2. Psychological Factors: Covers trauma, grief, and interpersonal loss.
3. Socio-Structural Factors: Integrates caste, gender, class, and institutional neglect into causation analysis.
4. Intersectionality: Emphasises overlapping vulnerabilities rather than single-cause explanations.

Care as Relational and Material Practice

1. Everyday Care Practices: Includes shelter, nutrition, social connection, and safety as therapeutic.
2. Non-Linear Recovery: Rejects uniform timelines and outcome metrics.
3. Shared Responsibility: Frames care as a collective moral obligation rather than individual compliance.

Justice-Oriented Mental Health Engagement

1. Recognition of Harm: Acknowledges that distress often arises from unjust social arrangements.
2. Ethical Accountability: Asks what society owes to those it has marginalised.
3. Transformative Focus: Shifts emphasis from symptom management to social repair.

Implications for Education, Research, and Practice

1. Curricular Reorientation: Calls for training that values lived experience and contextual care.
2. Practice Diversity: Recognises non-specialist and community-based care providers.
3. Interdisciplinary Learning: Supports integration of social theory, ethics, and practice.
4. Systemic Support: Emphasises that professional competence requires institutional backing, not credentials alone.

Conclusion

Mental health care must be reimagined as an ethical, relational, and justice-oriented practice rather than a narrowly clinical intervention. By centering dignity and disability justice, the article calls for a paradigm shift that recognises suffering as socially produced and care as a shared societal responsibility.

PYQ Relevance

[UPSC 2024] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest measures through which the State can enhance the reach of public healthcare at the grassroots level.

Linkage: The article directly links to GS-II (Social Justice, Health) by highlighting the limitations of market-centric and outcome-driven public healthcare in addressing mental health and disability. It also enriches GS-IV by framing mental health care as an ethical obligation grounded in dignity, compassion, and justice rather than mere service delivery.

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