By V. SASI KUMAR and SUNDAR RAMANATHAIYER
In the mid nineteen eighties, one of us (Sundar) wrote about what he saw in the Trivandrum Mental Hospital thus: “Total of 200 women. .... They have to piss and shit into a small pit ... There are no toilets in the cell. ..... The stench is unbearable. ....... ’You should have come before 10 a.m. You wouldn’t have been able to stand anywhere. Shit puddles everywhere. They pour a bucket of water over it. Then it has an unbearable stench’, says a patient.” (Ee Bhraanthaalayathinu Naavundaayirunnenkil, in Malayalam, Mathrubhumi Publications, Kozhikode, 2007)
This was more than two decades ago. Things did change in the Trivandrum Mental Hospital. Strangely, the exposure about one hospital did not lead to an examination of the conditions in other hospitals in the country. In the late 1990s Anjana Mishra wrote:, “As one approaches the wards, a strange stench hits the nostrils. The sight is even more horrifying and nauseating. To the wooden railings of the long verandah are tied —- actually tied with ropes —- the patients diagnosed as violent, sitting on their own human waste. On either side of the verandah are located the two toilets —- unusable and ?lthy. The toilets have absolutely no water, either running or stored.” (Manushi, no. 120). This was about the Central Institute of Psychiatry, Ranchi.
Study by NHRC
The conditions of mental hospitals in India, in general, are very poor. They are generally understaffed, lack sufficient facilities and trained manpower, and often have insufficient space to handle the large number of patients. There are something like 37 mental hospitals in the public sector in the country, with a total of around 30,000 beds. And they have to serve an estimated one crore odd people with severe mental illness. And several times that number who do not need hospitalisation. As per an estimate, around 12% of all patients in India are mental patients, yet only about 1% of the health budget is allocated for mental health. There are only 3,000 psychiatrists in India as against a demand for over 32,000.
Quality Assurance in Mental Health (1999), a report by the National Human Rights Commission, evaluates mental hospitals in India as follows: “The findings reveal that there are predominantly two types of hospitals. The first type does not deserve to be called hospitals or mental health centres. They are dumping grounds for families to abandon their mentally ill member, .... The living conditions in many of these settings are deplorable and violate an individual’s right to be treated humanely and live a life of dignity. Despite all advances in treatment, the mentally ill in these hospitals are forced to live a life of incarceration.”
“The second type of hospitals, are those that provide basic living amenities. Their role is predominantly custodial and they provide adequate food and shelter. Medical treatment is used to keep patients manageable and very little effort is made to preserve or enhance their daily living skills. These hospitals are violating the rights of the mentally ill persons to appropriate treatment and rehabilitation and a right to community and family life” As the NHRC itself admits, both types of hospitals violate basic human rights.
Few dispute that mental hospitals have long since been dehumanized through neglect, and had failed to meet patients needs” wrote Philip Bean and Patricia Mounser (Discharged from Mental Hospitals, Macmillan, 1993) Though written in a somewhat different context, this is valid even today in our country. Patients are abused, bullied, molested, harassed and physically assaulted and their rights, ignored.
Patients or Criminals
Mental patients are often locked up, chained and sometimes even beaten. They are treated like criminals. This is about hospitals in the public sector. We often cannot even enter private hospitals. But the most heart-wrenching scenes came from a private hospital in Tamil Nadu, when the building caught fire.
“The chain is blackened and the ring is horribly twisted but still fastened to the charred stump—of a leg. Mentally challenged and physically shackled he was, yet Murugaraj had desperately tried to free himself. Twenty seven more mentally ill people died with him in the early hours of August 2001, when a fire engulfed the thatched roof of the Moideen Badhusha Mental Home at Erwadi, ... in southern Tamil Nadu .... They were stripped of dignity when they lived—chained, confined and ill treated. The manner of their death was even worse.” (Asha Krishnakumar, Frontline, Aug. 18-31,2001).
“Shocking!” is the least one can say. Of course, this prompted the
government to act. But such a tragedy was waiting to happen the moment people were chained. Years later, the situation in many mental hospitals remains similar. A report in 2007 says, “violation of human rights is committed in hospitals where basic amenities and services are not provided, inhuman and degrading treatment is very common and patients are subjected to ill treatment and abuse.” (http://www.bpaindia.org/Enewsletterfinal %20Report%20April%20-% 20June%2007.pdf). Even the report of NHRC says, “The attenders use long lathis to control the patients who often get beaten up.” According to the report, many hospitals do not even have nurses, and some do not even have vacancies for nurses.
There is obviously a severe shortage of funds. When female patients in a hospital in Kolkata were found naked (see http://www.telegraphindia.com/1080314/jsp/opinion/ story 9016006.jsp), the reason given was that the washerman comes only once in a fortnight, and the patients have only three sets of dresses per head. The questions to be asked are i) How come the washerman does not come more frequently? and ii) Why don’t patients have more dresses? The possible answer, in each case, is lack of funds.
The food given to the patients leaves much to be desired, both in terms of quality and in the manner in which it is served. For instance, Anjana Mishra wrote, “The dining hall, ..., constitutes the most unhygienic part of the entire establishment. .... Almost a dozen dogs loiter around. The afternoon meal consists of coarse, half-cooked rice, watery dal and a tasteless, odourless curry. ... Again, privileged patients, like myself, were entitled to a piece of fried fish, a little curd and a pappad. All the patients eat in a child-like fashion, hogging a mouthful and then taking a walk, then coming back for a second mouthful. The dogs happily lick the plates in this interval. ... Some of the very ill patients even put their food on the floor and have it along with the dogs, while the ayahs in charge exchange gossip.” (Manushi, no. 120)
Electro Cunvulsive Therapy (ECT) is regularly used, often as a punishment too. ECT has been discontinued in most parts of the world because of various reasons. Even in India, the Mental Health Act says that only modified ECT, where drugs to suppress fit-like effects of the electric shock, should be used. And even this is supposed to be done under anesthesia. But many, if not most, hospitals do not have anesthetists. Often, neither the hospital personnel nor the patients have any idea about the rights of the patients.
In short, mental hospitals in India are very much like hell. No one seems to be bothered about what happens there. People, even journalists, are not allowed to visit the wards. Very little news comes out of their prison-like campuses. Once in a while we even hear reports of rape and sodomy. Becoming a mental patient is often worse than death. Remember the case of Machal Lalung who was put in a mental hospital in 1951 and forgotten. He was released in 2005 only through the intervention of the Human Rights Commission. Society does not often want its mental patients back. Once a mental patient, it is as though (s)he is deleted from the hard disk of life, and even from the memory of their near and dear ones. Shame on us!
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