The State of India's Mind

On a quiet September morning in the criminal ward of the Psychiatric Centre Jaipur, Ramesh caught hold of 70-year-old Muhammad Janaad by his hair, yanked him out of his bed and threw him on the floor. Then he dragged him under one leg of the bed, climbed on to it and kept jumping till Janaad was killed. No patient is supposed to be treated like a prisoner at the Psychiatric Centre Jaipur but those housed in the criminal ward might as well be in jail. Covering the incident, Tehelka informs that in a country of more than a billion people, there are 36 state-run mental hospitals in India and only 500 qualified psychiatrists manning them. This too in an age when mental illnesses and particularly stress related and induced disorders are increasingly blipping on the radar screens. Unlike other areas of health care, our procedures and systems in the area of mental health continue to be governed by antiquated procedures and rules. Though in theory, the mental health scenario in India is governed by the provisions of the Mental Health Act of 1987 which repealed the Indian Lunacy Acts of 1912, many of the procedures have not changed much.

As the term “lunacy” in legal usage itself indicates, the evolution of the mental health law in India has interesting origins. In the early 19th century, experts and administrators believed that the tropical climate was one of the causes of mental disorders among the Europeans living in India. Accordingly European patients, who did not improve within six months after their admission in a mental hospital in India, were sent to England for treatment. The passage money and other expenses were paid by the East India Company as loan to be repaid by the recovered patient. The practice began in 1818. In course of time the cost-effectiveness of this exercise was called into question. In order to regulate the selection of such patients the need for enactment of a law became apparent. In 1851 the “Lunatics Removal Act” was passed. This Act has the dubious distinction of being the first mental health legislation in British India. In pursuance of this Act and the rules framed there under, the flow of patients gradually dwindled, till it came to an end in 1891.

The enactment of India Lunacy Act, 1912 had a far-reaching consequence and impact on the whole system of mental health services and administration in India. Under this new legislation the central supervision of all mental hospitals became a reality. This is a fundamental change in the management of mental hospitals. These hospitals were thus removed from the grip of the Inspector General of Prisons. The next most important change was the recognition of the role of specialists in the treatment of mental patients. Psychiatrists were appointed as full time officers in mental hospitals

However, the mood and climate that faces the mentally ill is that of the eternally doomed. The winds that blow through the mental health ward are not those of concern, love and compassion but of regimentation, confinement and callous indifference. The over all management of many psychiatric institutions is still quasi judicial. The judiciary can order hospitalization of prisoners when it might not be required and in these cases professional psychiatrist expertise is essential. There is little hope for patients in a custodial environment which breeds isolation and exclusion. They are deprived of any skills for daily living and social interaction. There is no counseling to prepare patients for adjustment problems, relapses, re-admission or abandonment.

Less than one per cent of India’s total health budget is spent on mental health, with a large chunk being devoted to communicable diseases. A national mental health programme has been in place since 1982, but its implementation has been hindered by a greater focus on illness rather than on comprehensive mental well being. Even the Mental Health Act of 1987 is narrow in focus relating to severe illnesses and disability and the The Indian experience on institutionalized mental help as well institutionalization of patients itself has not been civilizing.

A report prepared for the National Human Rights Commission (NHRC) in 1999 after an empirical study of mental hospitals in the country made a condemnation of the state of mental health institutions. Clearly in the years gone by since then, not much has changed and a lot of attention and resources is needed to shake the state out of its state of apathetic lethargy