When the government announces the upgrade of premier mental health institutions at Ranchi and Tezpur and the establishment of a new National Institute of Mental Health and Neuro Sciences (NIMHANS) in north India, as it has done in Budget 2026, it is tempting to read this as a long-awaited acknowledgement of a neglected sector. After more than three decades of working at the intersection of mental health, disability and gender, I do not dismiss the importance of these announcements. India needs better training institutions, stronger research capacity, and well-resourced centres of excellence. These investments matter.
But experience teaches one to look beyond what is announced to what is enabled. The real question is not whether we are building institutions, but whether we are building a mental healthcare system that is consistent with the rights Indian Parliament has already guaranteed — and with the everyday lives of those for whom care is most out of reach.
Help miles away
In a district hospital in Bengal I visited recently, a young man was told the nearest psychiatrist was 180 kilometres away.
His mother nodded quietly and asked about bus timings.
This is where mental healthcare actually begins in India.
India is not short of progressive law in this domain. The Mental Healthcare Act, 2017, fundamentally altered the relationship between the citizen and the state by recognising mental healthcare as a justiciable right. It placed obligations on governments to ensure access to affordable, acceptable and quality mental healthcare services, preferably in the community. It spoke explicitly of dignity, autonomy, informed consent and protection from coercion. Similarly, the Rights of Persons with Disabilities Act, 2016, recognised psychosocial incapacity as a disability and affirmed the right to equality, non-discrimination, reasonable accommodation and independent living.
These laws were not drafted in abstraction. They emerged from years of engagement with people whose lives were shaped by neglect, confinement and silence. They were meant to signal a decisive move away from custodial and charity-based models of care. Any budgetary commitment to mental health must therefore be judged against these legal and ethical commitments — not merely against the number of new brick and mortar structures sanctioned.
A familiar tension
This is where Budget 2026 reveals a familiar tension. The emphasis is overwhelmingly on capital investments — new campuses, upgraded institutions, expanded tertiary facilities. What remains conspicuously absent is a clear and strengthened commitment to the National Mental Health Programme and its district-level backbone.
For most Indians, mental healthcare does not begin at NIMHANS, Ranchi, or Tezpur. It begins, if it begins at all, in primary health centres, district hospitals and overstretched community services.
In a small town in Maharashtra, a schoolteacher stopped working after panic attacks made travel impossible.
There was medication available — for a month.
No follow-up, no counselling, no return-to-work support.
Without sustained programme funding — trained personnel, medicines, outreach, follow-up, crisis response — institutions risk becoming islands of excellence in a sea of unmet need. Mental health does not function like other forms of infrastructure. It depends on continuity, trust, and proximity. Buildings alone cannot provide these.
Care is not about compliance
Mental health also cannot be meaningfully separated from disability. Many people living with long-term or episodic mental health conditions experience disability in deeply practical ways: inability to retain employment, difficulty accessing housing, loss of social standing and erosion of legal capacity. The disability law recognises this, but policy and budgets often continue to treat mental health as a narrow medical issue rather than a cross-cutting question of rights and social participation.
The consequences of this gap are especially stark for women. Women with psychosocial disabilities are more likely to be confined within homes, denied control over finances or property and excluded from decisions about their own treatment.
In a village in South Bengal, a woman diagnosed with depression was brought to a clinic by her brother.
He answered every question addressed to her. When she tried to speak, she was told, gently, that it would “only upset her further.”
This is not an aberration; it is a pattern. Mental distress in women is frequently used to justify surveillance—of movement, sexuality, work and social life. Medication is adjusted not to support recovery, but to ensure compliance at home. Decisions are made in the language of care, but without consent.
Budget 2026’s emphasis on institutions, without parallel investment in community-based services and rights oversight, risks entrenching this logic rather than challenging it.
Programme cost not in focus
Budget 2026 speaks eloquently of employment-led growth, skilling, and productivity. Yet untreated or poorly supported mental health conditions quietly undermine these ambitions.
Young people drop out of education and training pathways. Workers slip into informality or long-term unemployment. Women exit the labour force altogether, absorbed into unpaid care roles that go unrecognised and unsupported. This is not individual choice; it is systemic exclusion.
From a governance perspective, this raises uncomfortable questions. Capital expenditure is politically visible and finite. Programme expenditure is ongoing, less glamorous, and more accountable. The Mental Healthcare Act requires states to establish review boards, grievance mechanisms, and community services. These are not optional add-ons; they are legal obligations. When budgets privilege institutions over programmes, the law remains intact on paper but hollowed out in practice.
Systems that reach people
The increasing use of the term “care ecosystem” in budgetary discourse deserves scrutiny here. Care, when framed without rights, risks becoming discretionary. For women in particular, care without rights often becomes control without consent. For persons with psychosocial disabilities, this distinction is not semantic—it determines whether support can be demanded or merely requested.
In one family, a woman was taken out of care when funds ran out.
The hospital discharge note said “stable.” Her life outside was anything but.
None of this is to argue against institutions. Over the years, I have seen how strong institutions can transform practice and train generations of professionals. But institutions must be embedded within systems that reach people where they live. They must strengthen district services, support primary care, and reinforce community-based models, not substitute for them.
Budget 2026 presents an opportunity. If the state truly intends people-centric development, mental health must be integrated across employment, housing, education and social protection. Funding priorities must reflect the full continuum of care envisioned by law — from prevention and early intervention to recovery and social inclusion.
As someone who has witnessed cycles of reform and retreat, I remain cautiously hopeful. Institutions can be built quickly. Systems take patience. Rights, once promised, require daily investment. The measure of Budget 2026 will not be the number of campuses inaugurated, but whether it makes mental healthcare real, accessible, and dignified in the ordinary lives of ordinary people.
Ratnaboli Ray is founder and managing trustee, Anjali, a mental health rights organisation