In recent years, marginalisation of women and third gender in mental health discourse has raised several issues vis-à-vis promised goals of holistic health for all as targeted by several national and international agencies (https://www.who.int/publications/i/item/WHO-MSD-MDP-00.1). Some attention is being paid to the perceived ‘gender gap’ that substantially enhances vulnerability of women and little explored third gender. Several research Studies (Albert, 2015; Pattyn, et al., 2015; https://www.news-medical.net/health/The-Gender-Gap-in-Mental-Health.aspx , accessed on 25th August 2024) have confirmed that this is no longer a perception as the data confirms two to third fold more women experience depression and other related psychological and mental health issues vis-à-vis men. Social and cultural marginalisation plays a far more significant role in gendered discourse on mental health other than biological aetiology. Other problematic area where gender marginalisation is distinctively visible is in the institutional provisions for mental health care. This is a subject that has remained elusive and ambiguous in the texts of prescribed care for people suffering with intellectual disability, pejoratively spoken as ‘mental disorders’ in common parlance. Institutional confinement of the intellectually challenged in Asylums was started by the Arabs in Baghdad in the eighth century and later in Damascus and Aleppo in 1247 (Alexander and Selesnick, 1964). Inhuman imprisonment of people in these ‘total institutions’ (as described by Goffman, 1961) in the twenty-first century is a manifestation of abject indifference to our approach to psychological well-being. Goffman conceived these as anti-democratic institutions that inflict ‘negative experience of self’ (cf. Gordon and Williams 1977, p. 18). They add to a sense of alienation and isolation. Many would call these shelter homes as ‘social death knells’ (Finkelstein, 1991; Miller and Gwynne 1972). I do not have access to exact numbers but whatever data I am able to generate suggest that subjugation and exploitation of women and third gender in these institutions is far more than that of men. There are several questions that need immediate attention and thus forms the focus of this chapter that calls for a paradigm shift in the manner; mental health policy and institutional care are scripted in India.