Saturday, May 10, 2008

The Plight of Mental Patients in India

We call a mentally ill person "mad" and throw him/her into an "asylum", and then forget about the person. I don't mean that everyone does that, but a lot of families do that. We think that mental illness is something very different from physical illnesses, something that is probably caused by some "spirits", something incurable. And many people find this a way of eliminating a claimant for property. And some even find this an easy way to get rid of an unwanted spouse. Remember the case of Anjana Mishra, who was put in a mental hospital without even her knowledge, apparently to get rid of her. Fortunately, she found her way out, but how many other women might not have been so fortunate? Remember Ervadi where several mental patients charred to death because they were chained to their beds? We and our hospitals often tend to treat mental patients as though they were not human. This has to stop.

Some time back, when the daughter of a mental patient went to meet her mother in the hospital (Pavlov Mental Hospital, Kolkata) along with a doctor of the hospital, they found all the women in the ward totally nude, as I have explained in an earlier post. Recently, in another hospital, when a patient asked for some more curry, she got a rap on her wrist instead. (Remember Oliver Twist?) These are really nothing compared to what Anjana has written about her stay in the hospital (see the magazine Manushi, issue no. 120). Just a short quote: "The dining hall, situated a little away from the wards, constitutes the most unhygienic part of the entire establishment. Dirty wooden tables line the wall, with the remnants or leftovers of earlier meals, especially, rice and dal particles. Almost a dozen dogs loiter around. The afternoon meal consists of coarse, half-cooked rice, watery dal and a tasteless, odourless curry. All of this put together can kill the appetite of even the hungriest human being. 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." Hospitals give Electro Convulsive Therapy (ECT), what we call "shock treatment" without following the norms laid down for it. ECT is supposed to be given only under anesthesia, but then, many hospitals have no anesthetist. ECT is sometimes used as a punishment for not obeying instructios. In most developed countries, ECT is banned. Even the so-called modified ECT is not used in most of Europe and America. Because adverse effects of ECT are reported. There are doctors who admit people without even seeing them, for a consideration. Some time back Tehelka exposed one such doctor. In short, while the condition of mental patients is very bad inside or outside a mental hospital, clever people use these hospitals to get rid of people they don't want.

On the other hand, the social stigma of mental health is so strong, families refuse to accept even relatives who have been cured. Once out of the hospital, former mental patients have often nowhere to go. In most of the cases, they cannot get back to their former jobs, and they cannot find a new job either. Their only recourse most of the time is to go back to the hospital and live the rest of their lives there.

All mental hospitals are overcrowded. The budgetary allocation for mental health is much lower than the need. It is a small fraction of the health budget, but mental patients form a significant fraction of all patients. Many hospitals in the country have no nurses. Sometimes, the hospital Superintendent is not even a psychiatrist.

All this is a big tragedy, and all this has to change. But who will take the initiative? Political parties cannot be interested because mental patients cannot vote, anyway. The hospital staff, doctors, nurses and others, are not interested because the present set up is good for them. The public does not get to know about the issues because hospitals are out of bounds for the ordinary public. But there has to be a change, and the earlier the better. This is a blot on our country, our civilization.

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