24 August,2025 08:00 AM IST | Mumbai | Arpika Bhosale
Imaging/Aparna Chaudhari
The Indian government has pushed mental health in a big way in 2025. Earlier this year, the Economic Survey 2024-25 highlighted that mental well-being encompasses all our mental-emotional, social, cognitive, and physical capabilities. In 2024, the government also finally brought mental health services under a national health insurance policy, namely the Ayushman Health Services.
One of the biggest mental health crises is schizophrenia, and recently the disease has come into the limelight after a former Bollywood actor made a public statement claiming he was wrongly diagnosed as schizophrenic. His declaration has once again brought the focus on how the stigma, lack of awareness, and the burden of care all come together to form a web that is almost impossible to untangle - both, for the patient and their family members.
Amrit Bakhshy, 82, has become the face of many such families, as he has been taking care of his daughter Richa, 53, who suffers from paranoid schizophrenia, for the last 34 years.
Bakhshy, the former president of the Schizophrenia Awareness Association (SAA) and now a trustee, was called upon by the government in 2010 to help in drafting a newer draft for the Mental Health Act of 1987. When the committee, which included Bakhshy, suggested a lot of changes, it was decided that a new Act was needed. One major push was to prohibit the use of Electroconvulsive Therapy (ECT) on minors, and on adults only under general anaesthesia and administered only by a psychiatrist in a licensed institute or hospital.
Richa's story began at the age of 18 in 1991 when Bakhshy received a call at his Cuffe Parade office from the boarding school in Dehradun where his 18-year-old daughter Richa was studying, asking him to rush there as she had had some sort of nervous breakdown. "I hopped on a flight to Delhi, went to Dehradun by road through the night, and finally reached the school where they had kept her in the infirmary," Bakhshy tells us over the phone from Dhayari, Pune.
That was Richa's first episode of paranoid schizophrenia, triggered when her uncle - her local guardian - died at home. "We think seeing his body unresponsive, with his jaw slack, triggered the episode," says Bakhshy, who will turn 83 next month. "The doctor at the infirmary, though, was extremely accurate in his diagnosis of what had taken place and told us then itself that she most probably had paranoid schizophrenia. Medication was started for it almost immediately," adds Bakhshy.
After consulting a psychiatrist in Mumbai, who Bakhshy felt gave the "very, very wrong" advice that it was just a one-off episode, Richa - who loved painting and drawing - was taken off her medication. She went back and gave her Standard 12 examination and, believing everything was fine and that she shouldn't miss an academic year, Bakhshy and his wife secured admission for her in Baroda University to pursue her love for the creative arts. However, she soon got into bad company and began to blow through her monthly allowance, while being off her medication.
Bakhshy, however, was a parent who was invested in his daughter's treatment. "I found an article in Time magazine that talked about the medication for schizophrenia, it cost me Rs 7000 at the time for one strip, and we paid duty on it too," he says.
Bakhshy's wife (whom he subsequently lost to cancer in 2020) had quit her hospitality job in London to take care of their daughter full-time back in 1991 itself, and began to visit temples and healers in search of hope. "She wasn't religious, but it was a very tough time for us. At the same time, the medication was causing severe side effects. Richa slept a lot, and drooled, and it was very difficult for us to see her like that. Then a homoeopathic doctor told my wife that she needs to be taken off her meds and âdetoxed' in order to begin his medication - and that was a big mistake because you cannot just take someone off such medications; they have to be tapered off. Also, much like being on medication for diabetes, you can never go off it," he adds.
What followed, which Bakhshy describes as "very bad days", finally prompted the family to go to a doctor in Pune who had warned them never to stop the medication. Bakhshy feared backlash, but the doctor did treat Richa, and then came the conversation about dosage.
Bakhshy contacted the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru, where doctors suggested that Richa's dosage could be gradually upped from 250 mg to 800 mg. "We went to 500 mg, but when we took it to 700 mg she had seizures; we then brought it back to 500 mg, which we realised through trial and error was right for her," he says. This went on until 2007. Bakhshy felt that he was financially secure to retire and dedicate himself to taking care of his daughter full-time, but Mumbai was too chaotic for her and the family moved to Pune, where they still live.
We ask Bakhshy if he felt that the 34 years he has dedicated to his daughter's care came at the cost of his personal identity. "I have no regrets," he replies quickly. In another life, he confesses, he would have become a writer. Today, he says he is happy to be an empathetic ear to many primary caregivers to those with schizophrenia. "I don't go for long holidays, I don't remember the last time I went for a movie or a play; but it gives me a lot of satisfaction that I can reduce someone's suffering to some extent by talking to them, by giving them some advice. Because there are no listeners for their suffering, I listen to the story that I have heard many times, and I don't keep the conversation short, even if I am in the middle of something. This is my life and I am very satisfied."
72%
The treatment gap that is between diagnosis and actual treatment in the country
83.3%
Treatment gap in non-metro areas, which is higher than the national average
3.5
Average no. of months that pass between onset and consultation
29
Average no. of months that pass between diagnosis and treatment
Insight in schizophrenia refers to a person's awareness and understanding of their illness, including recognising symptoms as abnormal and needing treatment. Poor insight, a common feature of schizophrenia, can lead to non-adherence to treatment, negative outcomes, and challenges in daily functioning.
'National Mental Health Survey (NMHS)
Although in the very initial stage, dogs are being trained especially to help those who have hallucinations.
The dogs help the pet parent identify visual hallucinations; if they say some command words like "greet" and the dog doesn't respond, it is an indication that what the patient is seeing isn't there.
They also prevent patients from self-harm during auditory hallucinations with some tools like jumping on their lap and laying their head against the pet parent's, preventing the person from hitting their face, and bringing them back to the present moment.
Dr Prabhak D Jain, Associate Professor & Head of Department, Psychiatry - Terna Medical College
Dr Jain says there is awareness now about schizophrenia being treatable. "Also, you can treat almost 70 per cent of the illness; it is a chronic illness, though - you might be in remission, but you will always have it for life," he says. There is also the increased acceptability to medical management of the disease, coupled with the fact that most patients are forthcoming about what they are experiencing and not being secretive. "They volunteer information like âI am hearing voices'," he adds.
Dr Jain also talks about how ECT under the government and the Mental Health Care Act has vastly improved, as it is given under general anaesthesia. "We never took a positive view of the treatment, but it has far fewer side effects than most others and has proved a fast recovery among patients. The old way, where patients were tied and given shock sans anaesthesia, is banned in India," he says. This, however, is very difficult to explain to family members who fear ECT, "Mainly, the movies portray it very differently from how it is done even today, solidifying the âdimaag mein current lagaayenge' narrative," he adds.
While Dr Jain admits that families understand the long-term need for treatment, he, too feels that most do not understand that schizophrenia is lifelong.
Aarti Pandit, MPhil in Medical and Psychiatric Social Work, Schizophrenia Awareness Association, Pune
Stigma continues to be one of the big challenges for caregivers. The Schizophrenia Awareness Association (SAA) is a place where family members can enrol those suffering from the illness, to help equip them to be a part of society.
SAA in-charge Aarti Pandit says, "We accept physical illness very quickly, but not mental health issues. We rush to the doctor for a fever, but if we feel depressed, anxious, or have delusions and hallucinations, we won't go to a psychiatrist. When we tell caregivers to take their ward or child to a psychiatrist or therapist, we often face pushback like, âMy child is not mad.'"
In schizophrenia, she adds, a patient might not always have "insight" or be aware that they have a mental health issue. "This often comes and goes. In our counselling sessions, people might be in denial when asked what has happened - they may say, âI'm perfectly fine. It's my family that has problems. I don't need psychiatric help."
Unmonitored or untreated, schizophrenia can result in fatal mishaps caused by delusions, self-harm, or even harm to closest family members.
The SAA team, which includes Pandit and also a psychiatrist, builds rapport with the patient and asks them - if all is well, why aren't they able to keep a job? "It's at this point we often notice a pause, and then they say things like, âThere's just a small problem, but I can manage and get a job now. I don't need medication.' So insight is key when they come to our centre. With proper psycho-education, it becomes easier once patients understand, âYes, I have some mental health issues,'" says Pandit. Enquiring about trauma is one of the big things when they begin to work with a patient. "During admission, we also look at any history of sexual assault or post-traumatic disorders that might trigger schizophrenia. We often observe persons with mental illness (PMIs) having comorbidities like obsessive-compulsive disorder (OCD), mood disorders, or anxiety spectrum disorders," she adds.
Pandit shares the case of a patient, who exhibited grandiose ideation. "He believed that if he threw money, all the traffic would clear for him. He is currently in remission, has found a job, and has dropped out of the rehab centre without a proper relapse prevention plan - which raises serious concerns about his long-term recovery," she says.
Dr Milan H Balakrishnan, Head of the Department of Psychiatry and Psychology at Masina Hospitals
Has the treatment or the disease itself changed from when he began practising 14 years ago? "Only context has changed with times; otherwise, the disease has remained the same, but treatments have improved significantly," says Dr Balakrishnan. "The brain in schizophrenia has neurochemical changes at a molecular level, and is trying to protect itself from threat all around it, and threat has gone from âpeople are following me and that radio is playing news about me' to saying that âAI is talking about me or people have cameras that are tracking me and they are trying to harm me through that'. Otherwise, the core of illness remains the same," he adds.
The ethical conundrum is another coin for psychiatrists. "Families in India are more involved in treatment, and they have more ability to make decisions on behalf of the patient when he or she is very unwell; but when the family is not available or not there at all, the legalities of treating the person are more
complicated," he says.
"Sometimes, we can't do much because legal barriers will prevent us from treating someone where no family member is involved. There isn't a good way to manage a situation because the law says that if the person has the capacity to understand that he has an illness but doesn't want to take treatment, then the choice is with the patient. Until the person is a risk to himself and others, that can manifest in terms of no self-care, as in the patient is not eating or harming someone, only then can we do something. If I know a person is unwell and is going to be a risk, the law says I can't do anything until he actually harms someone - for example, if it looks like someone may harm their wife in a few months because of paranoia and suspicion. For a doctor, the most vulnerable person here is still the patient. But, do we not think about the wife?" he asks.
Treatment challenges also include the fact that many patients do not take oral medications, in which case repository injections, with dopamine and serotonin inhibitors, come in. "These injections can be given every month, and the these are releasing adequate doses every day - so that medication is continuous. Most of these patients need regular medications in this illness," he says. "You might be in remission, but you may need to be on some form of medication."
