‘I chained him to protect him from the spirits.’ What are the challenges for psychiatrists in India?

Approximately 20% of the adult Indian population are affected by a psychiatric disorder that requires intervention from a mental health professional (Math & Srinivasaraju, 2010). In spite of this, the provision of mental healthcare is poor. Therefore, to learn more, between July and August 2014 I undertook a 4-week elective at the Psychiatry Depart ment of Sawai Man Singh (SMS) Hospital in Jaipur, Rajasthan, India. The Psychiatry Department was founded in 1952. It has a total of 332 beds, with nearly 20 000 patients admitted per year and an attendance of nearly 100 000 annually at the out-patient department. I wanted to go to India after reading a report about someone named Keshava, in Davangere district, Karnataka (Nagaraj, 2012). He was diagnosed with schizophrenia in his early 20s. Once his second course of medication had finished, his family had no money to pay for more and were not aware of the availability of free anti psychotics. They felt they had no choice but to handcuff him and when that was not enough to contain his behaviour they took to bricking him up in a room. There, deprived of sunlight and a toilet, the man remained for the next decade. People in the village began to forget about his existence and when local journalists attempted to investigate what had happened to this missing person, his mother informed them that he had died. Once his case had been reported in the local news media, regional officials took action and arranged for his admission.