Punjab’s mental health crisis: policies exist, but care remains out of reach for most families

The survey, conducted by Government Medical College and Hospital, Chandigarh, in coordination with the National Institute of Mental Health and Neurosciences (NIMHANS), flagged a widespread prevalence of mental health conditions and gaps in access, awareness and care.

As per estimates presented in the Punjab and Haryana High Court last year, there were 12.83 lakh adults living with mental illnesses in the state in 2016.

The 2016 survey was conducted across 60 clusters in four districts — Faridkot, Ludhiana, Moga and Patiala — and 2,895 respondents aged 18 or older from 719 households were interviewed. The prevalence of lifetime and current mental morbidity was 17.94 per cent and 13.42 per cent, respectively.

‘Punjab has been found wanting’

In the Rajpura case, the man began drinking in his early twenties and now consumes nearly a bottle daily, spending about Rs 5,000 a month. He never sought medical help and was identified during a field visit under the survey. In Moga, the accountant, who developed obsessive behaviours at 18, eventually sought treatment after it began affecting his work. He has been on medication for six months and is managing better.

Such cases are not isolated. The survey found that a significant proportion of people with mental health conditions remain untreated, often due to a lack of awareness and access. With Punjab’s population at 2.77 crore (Census 2011), the number of those requiring care runs into several lakhs.

The lifetime prevalence of mood disorders was pegged at 7.58 per cent, with depression accounting for nearly 95 per cent of these cases. Neurotic and stress-related disorders had a current prevalence of 3.25 per cent, while psychotic disorders affected a smaller but significant segment. The burden was higher among lower-income groups.

Despite this, key provisions of the Mental Healthcare Act, 2017, remain unimplemented in the state. The law mandates access to care, community living, and non-discrimination, and requires states to notify the public of the rules within 9 months of their enforcement in May 2018.

“Punjab has been found wanting. In the case studies, the patients were fortunate to get help. However, in Punjab, most patients do not receive help. They, along with their families, continue to struggle in the absence of proper mental health care,” said Aditya Vikram Rametra, an activist with Pushpanjali Trust.

A Public Interest Litigation (PIL) filed by the Trust in May 2024 before the Punjab and Haryana High Court sought enforcement of the Act and the establishment of community-based facilities, such as group homes. In May 2025, the High Court expressed shock that Punjab had still not notified the rules and directed both Punjab and Haryana to do so within 60 days. More than 10 months later, the rules remain pending.

A key gap is the absence of group homes for persons with severe mental illness, mandated under the Act. Correspondence to identify land began in 2021, but Punjab has no government-run facility. Many patients are instead housed in destitute homes.

“The abandoned ones end up at places like Pingalwara in Amritsar and Prabh Asra in Mohali. These places are not equipped to handle such patients. Yet, they are doing yeoman service,” Pushpanjali Trust’s Rametra said.

He questioned the functioning of the institutions established under the law.

“Punjab has constituted a State Mental Health Authority under the Act and notified rules in 2019. But effective enforcement is limited. It is only a pretence. The Authority and Mental Health Review Boards exist on paper. Families say their letters are returned undelivered. No annual report has been prepared. The mental health policy reads like a wish list,” Rametra said.

Gap between policy and practice

Punjab notified its State Mental Health Policy in October 2025, focusing on integrating mental healthcare with primary services, early detection, awareness and community-based care, especially for vulnerable groups.

However, psychiatrists say the gap between policy and practice remains wide.

Dr Anirudh Kala, a Ludhiana-based psychiatrist, said the shift away from institutional care has left families to manage patients. “Earlier, large homes and communities could absorb and support such individuals. Now, homes have shrunk, and community support has weakened,” he said.

He underlined the need for group homes. “Patients often return home without structured support after discharge. Some go missing, some die. Many end up homeless or in detention for vagrancy. Those with severe conditions like chronic schizophrenia are often unable to care for themselves,” he said.

He added that while Punjab is working on a facility at the Amritsar mental hospital, running group homes requires specialised skills. “It remains to be seen how effective this will be,” he said.

Responding to concerns, Health Minister Dr Balbir Singh said the government was expanding services. “We are on top of the situation. We already have psychiatrists and counsellors in tertiary care hospitals and are appointing them in district hospitals. A clinical psychiatrist has been appointed at Mata Kaushalya Hospital in Patiala. We are appointing well-trained counsellors,” he said.

“We have also set up helplines — 104 and 14416. People can report symptoms like sadness and insomnia and get counselling over the phone,” the minister added.

On the absence of group homes, he said, “We already have an Institute of Mental Health in Amritsar, where this home is being set up.”

For now, however, the gap between need and access persists, with families continuing to shoulder the responsibility of care in the absence of a fully functional system.

Other states

Unlike Punjab, several other states have established networks of supported living for those with mental disabilities.

Maharashtra has 19 Mentally Deficient Children (MDC) homes for those with intellectual disabilities. Of these, 14 are government-aided and five are non-aided. Separately, two government-run homes function under the Social Justice Department.

Tamil Nadu has a wide network of government-aided homes for adults with intellectual disabilities. Official Social Welfare Department listings show dozens of such institutions across districts, including Chennai, Kancheepuram and Salem. Kerala has two government-run homes and six Asha Bhavans.