Mental health care in Pune is often measured through hospital attendance, but the experience of families living with chronic psychiatric conditions begins after the consultation ends. The account of 85-year-old Amrit Bakhshy, who is seeking limited guardianship and complete care for his 53-year-old daughter Richa, exposes a difficult institutional question: what happens to a person with a long-term mental illness when the primary caregiver is no longer able to provide support?
Richa was diagnosed with schizophrenia in 1991. More than three decades later, her father remains her primary caregiver. His concern is not limited to medication or hospital visits. It is about who will help her manage daily life, medical crises, social vulnerability and decisions about her care after he is gone. That question places the family’s experience within a wider challenge for cities: chronic mental illness requires a continuing network of treatment, rehabilitation, legal support, housing and community-based care.
The case also shows how quickly a psychiatric diagnosis can become a family-wide responsibility. Dr Nishikant Thorat, head of the Department of Psychiatry at B J Government Medical College and Sassoon General Hospital, told The Indian Express that when one person develops a severe mental illness, the entire family is affected. Family members become caregivers, advocates and silent supporters while also facing emotional, social and financial pressures.
That burden is often invisible in public measures of healthcare. A hospital can record a consultation, issue a prescription or manage an acute episode. It cannot, by that encounter alone, resolve the practical questions that follow: whether a person is taking medication, whether someone is available during a crisis, whether the family can manage repeated hospitalisation, and whether care will continue when the principal caregiver dies or becomes incapacitated.
### The long timeline of schizophrenia care
Richa’s diagnosis followed incidents at school in Dehradun, where authorities contacted her parents after observing frequent altercations and what appeared to be nervous breakdowns. She was studying at Baroda University when her symptoms resurfaced. Her father recalled that friends told him she had left Rs 100 notes at a temple. She eventually returned home, and the family moved to Pune.
The family’s early experience also reflects the uncertainty that can surround serious mental illness. Bakhshy recalled that one doctor believed the episode might be temporary and discouraged the use of antipsychotic medication. The symptoms later returned. The report does not establish that this experience is representative of all psychiatric care, but it illustrates how diagnosis, treatment and family understanding can evolve over time.
Bakhshy began researching schizophrenia and looking for practical ways to support his daughter. In 2007, the family connected with the Schizophrenia Awareness Association, a community-based organisation supporting people with mental illness and their families. That connection became significant because the family needed more than clinical treatment. Bakhshy was also caring for his wife, who was battling ovarian cancer and died during the Covid-19 pandemic.
The family later stayed within the association’s campus. Bakhshy described episodes in which Richa suffered seizures and required hospital visits. He also described the routines of caregiving, including her checking on him every five minutes. His account is not simply about sacrifice. It shows how care is organised in practice: through family labour, community organisations, hospital services and informal knowledge accumulated over decades.
### What Pune’s hospital numbers reveal—and what they do not
Sassoon General Hospital’s psychiatry outpatient department sees around 150 to 200 patients a day, including at least 20 new cases, according to Dr Thorat. Hospital data cited in the report shows that 31,655 new and follow-up patients with mental health conditions received treatment between January and September this year.
These figures demonstrate substantial demand for psychiatric services. They also show why hospitals remain essential points of contact for people seeking diagnosis and treatment. But outpatient numbers cannot by themselves show whether patients receive continuous support outside the hospital, whether caregivers have access to respite, or how many people require long-term assistance with housing and daily living.
The distinction matters because chronic psychiatric conditions do not follow the time limits of an outpatient appointment. Schizophrenia and bipolar disorder may require long-term treatment, rehabilitation and continuing support, Dr Thorat said. He also identified stigma, discrimination, lack of recognition and understanding, inadequate family or social support and financial dependence as difficulties faced by people with mental illness.
In other words, the city’s mental healthcare capacity should not be understood only through the number of doctors, beds or consultations. The system also includes the support that enables a person to live safely and with dignity between clinical encounters. The supplied report does not provide data on the availability of such services in Pune, but the Bakhshy family’s experience makes their importance visible.
### The institutional problem behind a caregiver’s court petition
Bakhshy’s move to a district court seeking limited guardianship with complete care highlights the legal and administrative dimension of mental healthcare. A family may provide daily support for years, yet still face uncertainty over how future care will be arranged and recognised. The petition is therefore not only a personal request. It reflects the difficulty of translating informal caregiving into a durable framework for decision-making and protection.
The report does not state how the court will decide the petition or what broader legal changes may follow. It does, however, show why families often seek formal arrangements only after decades of care. As a caregiver ages, the question of succession becomes urgent. The next caregiver may be another relative, a community organisation, a supported living arrangement or a public institution, but the transition cannot be assumed to happen automatically.
The role of the Schizophrenia Awareness Association also points to the importance of community-based organisations in the urban care system. The association helped the family connect with practical support and provided a setting where Bakhshy and Richa could stay. Such organisations may bridge the distance between hospitals and households, although the report does not establish the scale of their capacity or the number of families they can support.
This is where governance becomes relevant. Mental healthcare is not delivered by one institution alone. Hospitals manage clinical needs; courts address guardianship and legal authority; families provide day-to-day care; and community organisations support rehabilitation and social connection. When these responsibilities are not coordinated, the burden falls back on the household—often on one ageing caregiver.
### Listening as a form of public infrastructure
Sassoon General Hospital has set up a Mental Health Wall where people have shared messages about recovery, asking for help and keeping hope alive. Dr Thorat said that understanding mental illness requires listening. The wall is a small intervention, but it reflects a larger need to make mental healthcare more visible and less isolating within the city.
For families such as the Bakhshys, stigma is not an abstract social problem. It can affect whether symptoms are recognised, whether treatment is pursued, whether a person is accepted in the community and whether relatives feel able to ask for help. The longer the condition continues, the more the family may need support that is medical, social, financial and legal at the same time.
Pune’s reported outpatient numbers show that people are reaching a major public hospital for mental health treatment. Bakhshy’s story shows the limits of treating access as the end point. A functioning urban mental healthcare system must also account for the years between diagnosis and recovery, for conditions that remain chronic, and for the moment when an elderly caregiver can no longer continue.
The evidence supplied in the report confirms the scale of hospital demand and the depth of one family’s caregiving challenge. It does not establish how many Pune residents face similar succession concerns, how much community-based capacity exists, or how guardianship cases are resolved. Those unanswered questions are central to understanding whether the city can provide continuity of care beyond the hospital. For now, the most immediate lesson is clear: mental healthcare is also a question of family support, legal preparedness and urban social infrastructure.
