Most of us have seen Salman Khan’s “Tere Naam”. The place where “Radhe” was kept to get treatment for his mental illness is something that you can never forget. And those who haven’t seen the movie, YouTube “kyun kisi ko” song, you will get the idea. Although, the movie is fictional but the place is not.
In 2016, National Institute of Mental Health and Neurosciences (NIMHANS) conducted National mental health survey and surprisingly it was India’s first of a kind. Though in India, it is still a taboo to talk about mental illness and the data released by NIMHANS portrayed a clear picture of our standards in countering this problem. To treat more than 7 crore mentally ill people, there are less than 4000 doctors and most of these trained psychiatrists are located in metro or two tier cities. More than 35 lakh people need hospitalization but only 40 such hospitals are there in the country and most of them are asylum-styled institutions with high boundary walls where patients are being kept in solitary confinement.
The inside picture of these institutions is even more frightening. The way these patients are treated is so excruciating to watch. They are forcefully medicated using electric shocks. They are made to work like slaves by the staff and are kept food deprived. They are shackled to bed and walls and in some institutions rather than taking care of their hygiene, to avoid lice problem, their heads are shaved off. They are stripped and sprayed with insecticides which are meant to kill cockroaches. Funds that these hospitals receive for food, clothing and mattresses are mostly siphoned off by the officials.
Very few families of these patients are able to afford full day care services, and rest left with the option of going to state-run hospitals to get treatment.
The other option which is mostly opted by the families is going to faith healers and quacks. According to a study, 69% of patients are first taken to faith healers before a psychiatrist. General medicine doctors fail to diagnose psychiatric illness and this is where superstition kicks in as families think that the doctor is unable to cure it and activities of the patient seem paranormal to them. Such patients are chained, tortured, whipped, made to inhale burnt chilli, have chilli paste smeared into their eyes, some are even branded with red hot coins and finally are used for extracting money from their families.
In 2012 an incident occurred in Thrissur district of Kerala where an illegal asylum was raided by the local health authorities. They found 41 naked patients sitting on their own excreta and some even consuming it. Other than torture marks, some of the patients had surgical marks which indicated possible links of asylum with organ thieves. In 2001, 28 mental illness patients were charred to death after a fire broke out in the asylum. They couldn’t escape because they were chained to their beds.
Here also in the world of psychiatric ill patients women are the ones who suffer the most. In 2016, an inspection at Asha Kiran Home by Delhi commission for women revealed that women patients were made to take their clothes off in the corridor before going to bath and the CCTVs were monitored by the male staff. It is assumed by our patriarchal society that women with disabilities have less worth than other women and are often termed as “unproductive”. In April 2018, a report by Human Rights Watch, based on investigations of 17 rape cases of women with disabilities in Indian states, cites a case from 2014 where a woman with cerebral palsy and multiple disabilities was raped by three men in a remote West Bengal village. The villagers took sides with the rapists as they felt that 3 productive men are more important than an unproductive woman who can’t even talk or walk properly. When the victims gather themselves and decide to report the issue, they face victim-blaming, gross mistreatment by the cops.
National Mental Health Policy 2014 and Mental Healthcare Act 2017 were recently enacted with the support of all parties in both houses of the parliament but still India is under the clouds of Lunacy Act 1912 (act which guided the destiny of psychiatry in India). Most of India’s mentally ill patients are kept in under-staffed, under-developed state-run institutions for treatment but these institutions are the ones which are required to be treated first. Only 1-2 percent of health budget is contributed to mental health.
Recently Supreme Court of India heard a PIL on chaining of patients in Badaun mental asylum Uttar Pradesh. After seeing the pictures of patients, the bench (Justice AK Sikri and Justice S Abdul Nazeer) asserted that the practice of chaining mentally ill patients is inhumane and in violation of the provisions of Mental Healthcare Act as well as Article 21. “Even if a person is suffering from mental disease, he is still a human being and his dignity cannot be compromised”, the court stated and ordered UP state government and Centre to look into the matter.
Indian never had the reputation of taking mental illness as a serious issue but now is the time to fortify mental healthcare. For starters, we need more trained ethical psychiatrists and if possible, one in every district. It is true that violent patients are hard to control and some are even required to be chained for their own safety. Also it is hard for the under-staffed institutions to keep check on every patient all the time. But to left them in chains forever is only going to deter their condition. For this, staff should be well trained on how to tackle such situations. More funds are required to improve the condition of pre-established institutions and to establish new ones. In developed nations 10-13% of health budget is assigned to mental health care. Also many financial consulting groups have id’d mental healthcare services as the next revenue generators and medical tourism being a growing sector in India, psychiatric healthcare can be included to the list of services. Also a regulatory body is needed to ensure transparency in the field. Awareness campaigns are needed to be organized by the government and NGOs to aware people that there is nothing wrong in talking about mental illness and dumping affected people into those asylums is not the solution.
Hopefully there will be a time when India will stop dancing to tunes of superstition, patriarchy, corruption and black magic.