Treat with care, dignity

Mental health is finally getting some sarkari attention. Now, health minister Ghulam Nabi Azad has admitted that it is a neglected area and needs much improvement. He spoke anxiously of developing multinational partnerships, and of significantly increasing manpower to improve mental health services.
Under the National Mental Health Programme, the government is setting up 11 institutions across the country as centres of excellence in mental health on the lines of Nimhans (National Institute of Mental Health and Neuro Sciences) in Bengaluru. Thanks to these institutions, India would have 44 psychiatrists, 176 clinical psychologists, 176 psychiatric social workers and 220 psychiatric nurses more every year. Besides, the states had been asked to start postgraduate courses in mental health. This would add another 60 psychiatrists, 240 clinical psychologists, 240 psychiatric social workers and 600 psychiatric nurses annually. “Together, these two schemes would help us produce 1,756 qualified mental health professionals annually and enable us to bridge the gap between our requirement and the availability of mental health professionals”, the minister said. He admitted that a major constraint in implementing the national mental health programme was lack of manpower.
Sure, dearth of mental health professionals and hospitals has been a longstanding concern. Especially since mental illness affects about 70 million Indians. There are three psychiatrists per million people and one bed per 40,000 population. So the government’s initiatives are extremely welcome.
But we need more. We need to look at mental patients as full citizens with equal human and legal rights. And psychiatric care givers need to be held accountable for the violation of these rights. We cannot continue with the fill it, shut it, forget it attitude that we have towards “loonies in loony bins”. The condition of patients in mental hospitals remains deplorable. We only sit up when something dramatic happens. Like 12 patients dying last month at the Berhampore Mental Hospital. They had chronic illnesses, said the hospital, ailments that had worsened in the severe cold. So why were preventive steps not taken? And why were they not treated earlier? Is a mental illness so dehumanising that hospital authorities think it unnecessary to treat patients for physical diseases?
Mental patients are in hospital because they cannot look after themselves — they need to be fed and clothed and protected. Much like children. Particularly so, because patients are brought in by families when they are absolutely fed up — and the patient herself may be malnourished and sick. Unlike free people, inmates of a mental hospital are totally under the control of their caregivers, they don’t have access to food or clothing unless it is provided to them. They cannot protect themselves from the freezing temperatures, they cannot take preventive steps, they cannot go see a doctor. The hospital they are admitted to has the entire responsibility of their physical and mental well-being.
Like most public hospitals, our government-run mental hospitals are also in a pathetic state. In general, mental hospitals have a long-standing record of neglect, abuse and poor medical care. This winter, India’s largest psychiatric hospital, Yerawada Mental Hospital in Pune, struggled to get warm clothes for its 1,800 patients, even appealing to the public to donate woolens for inmates, as the hospital lacked funds. Many patients had died, and without public support, many more would have.
The lack of public accountability for the deaths of psychiatric patients in hospitals is worrying. We often hear of patients dying of food poisoning or even being beaten to death in our mental hospitals — sometimes by other inmates, occasionally by the wardens themselves. We ignore routine neglect that kills, and only notice catastrophes.
Like when 28 inmates were burnt to death and several badly injured in a mental home in Erawadi, Tamil Nadu, in 2001. The inmates had raised an alarm, but they couldn’t escape the flames as they were all chained to beds and posts. And help was far delayed. National dailies frontpaged photographs of charred bodies spread out among cinders in a grey, ashen landscape, still fettered to charred poles. All patients here were chained — irrespective of whether they were violent or docile, raving mad or just depressed. Because we deal with mental illness in black and white — you are either sane or insane. There is no middle ground. If you are schizophrenic, bi-polar, depressed or even mentally disabled with cerebral palsy, Downe’s syndrome or autism, you fall in the “other” category — those who are not quite like us, not as human as us. And you send them off to some hospital, dutifully paying fees and medical expenses, occasionally visiting them. Sometimes you send off family members to mental homes to settle property disputes, or to keep them apart from a lover you may not approve of. They are the new outcasts, once they are out of the way, normal life can resume for their family.
Of course, like any illness, mental illnesses do need professional care, and hospitalisation remains the best option for most beleaguered family members. But that faith in medical care is more often than not destroyed by the abysmal treatment that their child or spouse or parent gets at the mental institute. After the Erawadi deaths, the Supreme Court had ruled that the human rights of the mentally disabled had been violated. But not as much has happened to protect these rights as was expected. Last year, 26 patients died of cold in Havana Psychiatric Hospital. Cuba is seeking prison terms of up to 14 years for the hospital authorities. There is also a demand for the heads of higher government officials and ministers. Sadly, in India, we cannot imagine holding any high official — let alone ministers — accountable for the deaths of lunatics.
We are used to the general apathy and the rot that has set into every government institution. We are not horrified when children are abused in orphanages and women raped in Nari Niketans. So why should we be shocked by the abuse and criminal neglect of patients in mental asylums?
Rectifying the huge shortage of psychiatric doctors and nurses will certainly help. But that is not enough. A proper mental health policy is essential to deal with the whole spectrum of psychiatric problems and to make treatment possible for the most neglected high-risk groups — women and the underprivileged. And perhaps more than multinational partnerships, the government needs better partnerships with voluntary organisations working in this area. Besides, we need urgent public education to counter the stigma and change our attitude towards mental illness. For mental patients deserve not just proper care, but dignity as well.

Antara Dev Sen is editor of The Little Magazine. She can be contacted at: sen@littlemag.com