Since the Delhi High Court judgement (2009), reading down IPC 377 that criminalised homosexuality, the Indian judiciary has been at the forefront of invoking constitutional morality to uphold LGBTQIA+ rights. In contrast, the mainstream mental health systems have failed to uphold human rights and protect LGBTQIA+ people ethically, except for a few position statements. Though the Supreme Court directed the mental health fraternity to exercise utmost sensitivity to LGBTQIA+ issues, they have not risen to the occasion. The absence of gender affirmative guidelines and failure to put in place punitive action against those practising conversion therapies set apart Indian mental health systems, in stark contrast to international mental health associations. Here, we review landmark judgments and the actions of professional mental health bodies regarding LGBTQIA+ rights in India, from 2009 to 2022 — especially those regarding conversion therapies and the discriminatory medical curriculum — to examine the deepening crisis of public health ethics.