Hospitals or Hell?
By V. Sasi Kumar & Sundar Ramanathaiyer
01 December,
2008
Countercurrents.org
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)
Shame
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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