Hegemony and the National Mental Health Programme: A Conceptual Preface
The objective of this paper is to elicit some contributions from the thought of Antonio Gramsci in order to develop a rudimentary conceptual preface to the problem of people's participation which afflicts the National Mental Health Programme today.
Mental health problems alone constitute about 8 per cent of the Global Burden of Disease, and more than 15 per cent of adults in developing societies are estimated to suffer from mental illness.1 The seriousness and urgency of the mental illness and mental health situation in contemporary India is best expressed by the fact that the estimated overall prevalence rates of mental illness vary from 9.5/1000 to 102.5/1000.2 It is further projected that nearly 3 crores of individuals suffer from mental illness every year and that 1.75 lakhs of new 'cases' of mental illness are added every year.3 There is also a significant degree of mortalitydFrom suicide: in 1993, 87,000 cases of suicide were recorded.4
The mental health services in India consist of specialised mental hospitals, psychiatric units in general and teaching hospitals, the National Mental Health Programme, private mental health clinics and nursing" homes, voluntary sector services, and the traditional services.
The dismal condition of the specialised mental hospitals and psychiatric units in general and teaching hospitals,5 the amorphous nature of the traditional services and their inability to satisfy the needs of the masses,6 and the limited scope of the voluntary sector services and the private mental health clinics/nursing homes have led to a recognition, especially amongst some mental health and civil liberties professionals, of the need to have a more public health oriented mental health services approach.
ģICSSR Doctoral Fellow at Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi.
Social Scientist, Vol. 23 Nos. 7-9, July-September 1995