Emerging trends in the history of mental health globally emphasise the need to critically examine the history of mental health, and this applies to colonial India as well. However, despite the inseparable relationship between social hierarchies (such as race and caste) and mental health outcomes, we find that archival sources on mental health in colonial South India remain inaccessible, limiting researchers’ ability to understand the complexities and nuances of this relationship. Despite an extensive search through state archives, records of mental health institutions, and other government departments, anticipated sources remain elusive. We argue that mainstream mental health systems exhibit a lack of sensitivity to the socio-historical roots of mental health crises and are plagued by systemic issues, such as staff shortages and limited access to sources, which contribute to a poor understanding of marginalised peoples’ experiences. Mental health systems need to deepen their awareness of the socio-historical determinants of human suffering. This is vital to realising an ethical, people-centred mental healthcare ecosystem.