Calculation gone wrong

In 2010-11, the Central budget allocation for the mental health programme was just 1103 crore—less than 1 per cent of the total health expenditure. According to the World Health Organisation, about 10 per cent of any country’s population suffers from some form of psychiatric disorder at any given time. And one in every four persons suffers from some mental disorder at some point of time in life.

Even if we consider that a conservative 7 per cent of India’s population suffers from some mental disorder at a given time, it amounts to about 8 crore people. “That means we have a budget of 113 per mentally-ill patient per year, when at least 1500 per patient per month is required to provide at least basic medicines, food and shelter,” says Tapas Ray, founder of Sevac, a Kolkata-based NGO.

A senior officer, who has worked in the Mental Health Cell of the Union ministry of health and family welfare, says mental health has never been a priority of the government. The District Mental Health Programme, introduced in 1982, remained on paper till 1996, when the government finally launched it in 27 districts across the country with a budget of 127 crore. Today, the programme has managed to cover just 123 districts, with 40 per cent posts lying vacant.

The problem is not shortage of funds, says a senior ministry official; there are times when the states return the money, as they couldn’t utilise it, he adds. “There should be a close monitoring of mental hospitals. But unfortunately, there is no manpower to do even that. We do have the Central Mental Health Authority, but its members have not met for the past three years. There is similar official apathy at the state level, too.”

The Comptroller and Auditor-General slammed the previous V.S. Achuthanandan government in Kerala for not utilising 14.07 crore of the alloted 19.98 crore. That, in a state where prevalence of mental disorders is almost three times the national average.

Caught between fate and faith

With the medical system in a mess and awareness about mental disorders lacking, faith healers and quacks are making hay. According to a study by Dr Shiv Gautam, former superintendent of Mental Hospital, Jaipur, 68 per cent of mentally ill people are taken to faith healers before a psychiatrist.

“The reason, besides superstition, is that most general medicine doctors fail to diagnose psychiatric illness,” says Gautam. Apparently, psychiatry is not a separate subject in the MBBS curriculum, and there are just 11-12 lectures on the stream.

“Moreover, there are hardly 250 postgraduation seats in psychiatry, and most of the pass-outs opt for jobs abroad,” says Dr Sunil Mittal, director, Cosmos Institute of Mental Health and Behavioural Sciences, Delhi. “In fact, there are more Indian psychiatrists in the US than in India.”

Many patients initially consult a general physician during the onset of a mental disorder, and if that doctor fails to diagnose the problem correctly, generally the next option is faith healing, which, professionals say, is hogwash. “A mentally ill patient displays symptoms which superstitious people believe are paranormal,” says Gautam. “Such patients are tortured, chained and used for extracting money from their families.”

Valliappan is currently unemployed. She found out that medication could control the disorder, but not the stigma. She first worked as a baTake the case of Hema. Until a few months ago, the postgraduate in English used to call herself Mrs Sonu Nigam, assuming to be the Bollywood singer’s wife. A clear case of schizophrenia. But, her family took her to Datar Sharif dargah near Ahmedabad. They believed an evil spirit was at play. She spent a year there, chained, pained. And it was only when her condition deteriorated to an extent that incontinence set in, her family brought her to Gautam. “In 15 days, Hema started improving and, now a month later, she is normal,” he says.

Businessman Sanjay of New Delhi, however, is still awaiting emancipation. Four years ago, he was diagnosed with mild mania. He was put on medication and his condition improved. But as soon as Sanjay stopped medication, the symptoms returned. Then, his father took him to Narhar Sharif dargah in Jhunjhunu district, Rajasthan.

“For three months, I have been chained here. I want to go back home and meet my doctor, but my father is not allowing me,” he says. “My father has been convinced by people here that I can go only when I get orders from the dargah.” Taking me to be a patient’s relative, Sanjay offers heart-felt advice: “Never bring anyone, under whatever circumstance, to the dargah.”

In the case of disorders like hysteria, a patient has a tendency to do whatever is suggested. Faith healers take advantage of it. Their sidekicks keep performing certain actions in front of the patient, who is likely to imitate the actions. The faith healers call this paishi or arzi, a process in which God talks to patients and heals them.

Some others, especially schizophrenics, are treated cruelly. Some are whipped or caned, some are made to inhale smoke from burnt chilli, some have chilli paste smeared into their eyes and some get branded with red hot coins. “I recently got a patient whose burn was just 2mm away from his windpipe,” says Gautam.

Despite laws banning the practice, many dargahs and temples keep patients chained. Some, for a lifetime. In 2001, a fire at a dargah in a coastal village, Erawadi, in Ramanathapuram district of Tamil Nadu charred to death 26 mental patients, who could not escape the blaze as they were chained.

Soon after the incident, the Supreme Court directed the Centre to conduct an all-India survey to identify registered and unregistered asylums. The court also ordered that each state government should establish at least one mental health hospital. But even today, states like Haryana still do not have a government mental hospital.

The unwanted

Thanks to official sloth and societal apathy, families of mentally ill people are increasingly opting for the easy way out: ‘dumping’.

A recent shocker came from Thrissur district in Kerala, where an illegal ‘asylum’ was busted. Thirty-five men and six boys from across India were rescued from inhuman conditions. Apparently, it was the stench from their unwashed bodies and excreta that made neighbours alert the health department.

As officials raided the asylum, they found naked and chained inmates, who had been dumped there by their families after paying the asylum owner. Some were found crawling in their excreta, some even consuming it. Their bodies bore marks of torture, and some had surgical scars on their backs, prompting allegations that the asylum had links with kidney thieves. Of 78 patients entered in the register, only 41 were found during the raid.

An even more shocking trend is of patients getting dumped in jungles, especially in the forest reserves of south India. Families, mostly from the north, pay lorry drivers to ‘drop’ these hapless victims, including children and women, in the forest ranges. Social activists in reserves such as Wayanad and Bandipur say drivers rape the female victims before dumping them at the mercy of nature.

“Before we term the families as ‘cruel’, we must look at what forces them to take such extreme steps,” says social activist Murugan S., who has lost count of the number of mentally ill people he has rescued from streets, railway stations and bus-stands across Kerala. And, finally, he concludes with what has become clichéd in Indian society: “The system needs a holistic change.”

with S. Neeraj Krishna