The horrid state of mental health care in India can drive one insane. Does anyone care?
It is a hot, humid afternoon at Lumbini Park Mental Hospital in Kolkata. About 30 male patients in tattered clothes huddle in a dormitory. The stench from the lavatory next to it is nauseating. On the next floor, two female patients lie sprawled on the narrow corridor outside a female dormitory.
Things are no different at another state-run hospital in the city, Pavlov Mental Hospital, where about 400 patients share 250 beds. Patients at a severe stage of mental illness are locked up in 4x5ft cells, with an Indian-style closet—they eat sitting next to it. And to kill body lice, says a hospital employee, patients are stripped and sprayed with insecticides meant to kill cockroaches.
The pathetic and horrible condition is compounded by inhumanity: “The funds that come to the hospital for food, clothing and mattresses are siphoned off by the officials. They even take home the bedspreads and curtains,” alleges an employee.
The hospital looks nice from the outside, but it has no rehabilitation facilities to engage patients in vocational training. As a result, even patients who become stable lose their cognitive abilities and succumb to negative symptoms such as withdrawal, lack of concentration, reduced productivity and, eventually, lack of will to live.
“A lot of cosmetic measures have been taken in the past two years to improve the overall look of the compound,” says an official, “but the patients still live in inhuman conditions.”
Mental Hospital, Varanasi, was conceived as a jail in 1809 for criminals with mental illness. Today, only 54 of 290 patients are prisoners, yet the same old colonial rules are followed.
Patients live in stinking barracks. The cells have no fans, even as the temperature soars over 40 degrees Celsius. Patients are forced to sleep on the dirty floor, as there are no beds in most wards. And thanks to the strict adherence to the old ‘jail manual’, patients spend over 17 hours a day in the lockup, without any recreational facilities.
The ‘jail’ authorities thrash the patients if they demand basic facilities, says a patient in the male ward. “We don’t even get sufficient food,” he says.
The hospital has about 300 in-patients and handles as many out-patients a day, but has just two psychiatrists. No nurse, no clinical psychologist, no occupational therapist, no social worker.
“For the 24 years that I have been here, nothing has been done to improve the living conditions of the patients,” says a senior doctor at the hospital.
Be it West Bengal, Madhya Pradesh, Uttar Pradesh or Maharashtra, most state-run mental hospitals are in a deplorable state. According to the National Human Rights Commission, there are only 43 government mental hospitals in India, of which hardly half a dozen are in a “livable” condition.
“The NHRC was asked to report on the condition of mental hospitals in the 90s. We brought out our first report in 1999; the condition of most mental hospitals was shocking. Even after a decade, it remains the same,” says P.C. Sharma, member, NHRC. “It shows the government’s attitude towards the mental health care in the country.”
In fact, the NHRC’s reports in 1999 and 2011 look almost identical. Most hospitals lacked, and still lack, even clean water and ventilation. Many hospital buildings are in a dilapidated state, as they were colonial structures, mostly jails.
Take the case of Bangur Institute of Psychiatry, Kolkata. Patients here still live in the same dark, damp, dirty jail cells. Forget rehab activities for the patients. “If a bulb blows, it takes five days to get it replaced,” says a voluntary psychologist at the hospital.
Posing as the daughter of a patient, I ask this social worker whether I should admit him in the hospital. “It is nothing more than a jail,” he says. “It will only deteriorate your father’s condition; it is not for people like you.”
In its 2011 report on the Institute of Psychiatry, Kolkata, NHRC’s then special rapporteur Dr Lakshimidhar Mishra writes: “Around 12 noon I inspected the dining hall of the Institute of Psychiatry. About 10 in-patients were taking lunch which comprised about 100g of rice, 50g of dal (mostly watery), a potato and mixed vegetable curry and a small piece of fish. There was no salad and no other fried vegetable, spinach or fruit.” The nutritive value of the aforesaid meal is 1,500 cal; a normal human being needs at least 2,500 cal.
Mental Hospital, Indore, hardly looks like a hospital from the outside. The male ward, with a dozen patients, is dusty. The window panes are broken. Lavatories, as expected, are stinking, and many of them in the female wards do not have doors.
In the book Mental Health Care and Human Rights released in 2008, the NHRC notes, “Mental Hospital, Indore, is in a highly deplorable state in almost all aspects of human care. Evidence of chaining patients, clinical abuse and active neglect are seen.” Things are almost the same even today. Quite understandably, hospital superintendent Dr Ramgulam Razdan bars me from talking to patients and staff.
“The new building is under construction and we will shift all the patients in three to four months,” he says. “This building had a thatched roof when I took take charge in 1998. Lack of political will delays reforms.”
Can we afford the delay?
At least 10 crore people suffer from mental illness in India. About one crore need hospitalisation. There are just 43 government mental hospitals, most of them in a pitiable condition. There are only 4,000 psychiatrists in the country; 70 per cent of them practise in private hospitals in urban areas.
There is a severe shortage of paramedics, too. In 2008, according to an NHRC report, a single psychiatrist was found manning the 331-bed hospital in Varanasi. There were no sanctioned posts of general medicine officer, clinical psychologist, psychiatry social worker, occupational therapist, dietician and nurses. Four years down the line, all that the hospital has got is an additional psychiatrist.
Furthermore, over 30 per cent posts of psychiatric nurses are lying vacant in most mental hospitals across the country. Besides, there is a severe shortage of grade D staff, who are responsible for the day-to-day care of the hospitals and patients. And at most of these hospitals, electroconvulsive therapy is still given without anaesthesia, as there are no anaesthetists available.
“The problem,” Mishra says, “is in the attitude of authorities managing these hospitals. Most of the hospitals in India are not managed by psychiatrists. So they don’t understand the complexities of mental health care.”
For instance, Mental Hospital, Varanasi, is managed by Dr K.K. Singh, an ENT surgeon. There are physicians and even gynaecologists who are in charge of mental hospitals. “These doctors don’t understand the intricacies of a psychiatric illnesses and the comprehensive care the patients require,” says a psychiatrist working in a state-run mental hospital in UP.