The chapter examines issues in the conceptualization and management of mental illness as these bear out in the Indian context. Beginning with a historical overview of notions of mental illness and psychiatric care in traditional Western modes and postcolonial exchanges, we move to consider the impact of the British introduction of psychiatry in the subcontinent and the subsequent development of ethnopsychiatry, asylum culture and indigenous responses thereto. This discussion revisits the traditional Western paradigm of mental illness with respect to its impact in India and the critique that postcolonial ideas and narratives have brought to this paradigm, with a call for newer models, modes of thinking, ways of care and policymaking to emerge from the margins. This is followed by a focus on the ramifications of the World Mental Health Report (2020) and the Mental Health Act of 2017 (India) that are drawn upon extensively by psychiatrists and grassroots mental health workers, believing them to be something of a milestone. In conclusion, the implications of these recent developments in the long-term plans to address the growing issue (or rather increasing recognition) of the challenges of mental health in India are explored.