MUMBAI: Psychiatrist Fabian Almeida was stunned when the co-operative society next to his clinic outside Mumbai wrote to him complaining about his patients, who suffer from mental health issues.
He was told that those receiving treatment for conditions ranging from depression and obsessive compulsive disorder to hyperactivity and dyslexia were a nuisance to other residents and should be kept inside.
"They were talking about them spreading germs," he told AFP by telephone from the commuter town of Kalyan, in the Indian state of Maharashtra.
Almeida's experience is not an isolated case in India, with long-standing concern about attitudes towards the country's estimated 40-90 million people with mental and physical disabilities.
"The whole system is not ready to help people," said Aqeel Qureshi, a disability rights activist who manages the Disability News India website and campaigns for better access for disabled people.
Qureshi, a wheelchair user, said he was stranded at New Delhi's new $2.7-billion international airport terminal for two hours earlier this year after the lifts broke down.
On other occasions he said he missed flights because of a lack of lifts to the aircraft. Disabled people have been stopped from flying altogether by some airlines.
In Indian towns and cities, high kerbs, poorly maintained or non-existent pavements, stairs and a lack of wheelchair ramps are common hazards, making daily life difficult or impossible for the physically disabled.
Packed buses with high access steps, overcrowded suburban trains that halt only for 30 seconds in stations or a lack of public disabled toilets add to the problems.
In Mumbai, new pedestrian crossings have recently been installed at busy junctions but the audible signals -- designed to tell the visually impaired when to cross -- have been silenced.
Residents complained they were too noisy, the Hindustan Times newspaper reported last week.
Lack of awareness and not consulting disabled people or the groups representing them is often to blame, Qureshi said.
"The problem with authorities is that they think they're very smart and very intelligent and that they know our needs. It's an attitude problem," he said from his base in Tokyo.
"The whole thing is not helping people with disabilities. That's why most people with disabilities are not empowered.
"The basic needs for people with disabilities is to provide better infrastructure so that you can go outside and live like any other citizen."
The World Bank has said that people with disabilities are among the most marginalised in Indian society and that some 50 percent of people it surveyed saw disability as a "curse of God".
"A lot more needs to be done in implementation and 'getting basics right'," the organisation said, calling for greater integration of disabled people into Indian society.
Researchers have found that disability in India is often seen as a punishment for a person's misdeeds in a past life, particularly in rural areas.
It has also been seen as lowering the status of a family in India, where social standing -- particularly through marriage -- remains important.
For some, India's rapid economic growth, which has fuelled a construction boom in big cities, is a perfect opportunity to make new buildings and infrastructure more disabled-friendly.
A landmark disabilities act introduced in 1995 was praised as one of the most progressive among developing countries, even if its implementation is patchy.
The country's popular Hindi-language film industry, Bollywood, has also helped raise awareness of conditions from dyslexia to Asperger's Syndrome in recent years.
Psychiatrist Almeida says progress has been made, highlighting the messages of support he has received for his clinic after he received the letter from next door.
"Incidents like this become speed breakers in our path to progress. Some people have chosen to remain ignorant," said Almeida, whose clinic uses yoga, art therapy and sport to help patients.
But India needs to do more as it develops and so-called Western lifestyle diseases such as depression become more prevalent and physical infirmity increases as the population ages, he added.
"I think we need to be providing mental health services more and tackling the stigma and taboo associated with it... There's so much more to do," he said.
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