Dec 14, 1998
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KERALA Condemned for Life About 400 patients in the state's mental asylums have been certified fit to leave. But with nowhere to go, they stay on in sub-human conditions. By M G Rashkrishnan Paramapurusham hridayabhavamekam... the famous Swati Tirunal keerthan wafts through the air as the listless campus of the Government Mental Hospital in Thiruvananthapuram reverberates with its sad notes.
Elsewhere on the campus, former school teacher Gangadharan Nair, 72, is busy pottering around the garden. Known as a workhorse, he has seldom been idle in the 32 years that he has spent in the hospital. If it isn't asylum work he's doing, he is reliving the past conducting imaginary classes. In the female ward is Bhagavathi Ammal, 65. Also a permanent fixture -- she has been in the hospital for 28 years -- she laid the foundation stone when a new block was being built years ago. The block was even named after her: Bhagavathi Mandiram. Like Iyer, Nair and Ammal, there are 170 others who consider the sanatorium home, having stayed there for years, in some cases decades. Ironically, most of them have at one time been certified fit for discharge. But they stay on as they have nowhere to go. "People think of the stigma attached to having a mental patient at home," says Dr Prabhakaran Nair, superintendent of the hospital. "We regularly get letters from VIPs requesting us to retain such patients." Some months ago, Bangalore-based National Institute of Mental Health and Neurosciences (NIMHANS) conducted a study of Kerala's three mental hospitals in Thiruvananthapuram, Kozhikode and Thrissur which together are home to about 2,000 mental patients. Its report says at least 20 per cent of them are dischargeable but have stayed on because no one turns up to take them or are turned away when they go home. Iyer, for instance, was discharged in 1985 and returned home to his brother. "But he sent me back the same day. I have not seen him since." The hospital has rarely turned away such cases. "What can we do when they say they have no place to go?" asks Nair. Things could have been different had there been serious efforts at rehabilitation. But as Dr T. Murali, member of the NIMHANS study team, observes, "Rehabilitation programmes are virtually non-existent." Even the one rehabilitation centre that the state Government completed three months ago is yet to become functional as Chief Minister E.K. Nayanar has not found the time to inaugurate it. As a result, the state's asylums are overcrowded with abandoned patients. The one at Thiruvananthapuram, for instance, has a bed strength of 507 but there are 830 patients while the one at Kozhikode has 700 patients when there is room only for 400. The conditions are sub-human but the patients do not complain as they are desperate for a place and someone to look after them. At the Thrissur hospital, they are forced to wear just undergarments and are denied even bedsheets as the authorities fear they may use the linen to commit suicide. Worse, the study notes, several recommendations made by various commissions to improve facilities at the hospitals remain unimplemented. "Even the cell system where patients are kept like prisoners in solitary confinement continues," says Dr Murali. Add to that the shortage of staff. Often, doctors and nurses posted to these institutions manage to get themselves transferred by pulling strings. Though 18 nursing assistants were transferred to the Thiruvananthapuram hospital this year, none has joined so far as they have all managed to get the transfer orders stalled. Nursing assistants apart, there is a dearth of nurses trained in psychiatry. Though Kerala provides a bulk of the trained nurses in the country, there are just three who are specially trained in psychiatry in the state service. Male nurses too are few and far between. Thus most of the staff working in the hospitals are those on punishment postings. "Fifty per cent of them are here because of lapses elsewhere. So how can you expect efficiency?" asks Dr Mathew Verghese of NIMHANS. Traditionally, Kerala has concentrated upon primary health care and, compared to other states, has made considerable gains. "The next step," says Kerala Health Minister A.C. Shanmughadas, "will be to give speciality areas specific attention." According to him, the state Mental Health Authority (MHA) is preparing a policy, the first of its kind in the country, to overhaul the mental health care system in the state. "The emphasis would be on community-based rehabilitation and improving facilities," says Health Secretary V. Vijayachandran. A special cadre of psychiatry-trained nursing assistants is on the cards. So is including mental care in primary health care. Health care officials say that though the extent of chronic schizophrenic illnesses in the state is less than the national average (0.4 per cent of the population), increasing rates of suicides and divorces, lower death rates and the breakdown of support systems like joint families are likely to increase the demand for mental care. Also, there is a growing tendency among children to contract problems as a result of examination-related tension. The MHA plans to launch an early-detection project in schools to identify such children. As for the abandoned patients in Kerala's asylums, the authorities realise that immediate steps are necessary. With the issue increasingly drawing public attention, they are thinking up novel ways of addressing it. Like dropping all women patients in vehicles at their homes. "If relatives refuse to accept them, we will seek police help," says one official. The patients, naturally, are dreading that day. For them the sanatorium, for better or for worse, is their only home. To be driven out and to live on the streets is unthinkable. |
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The music is familiar. So is the
singer, Krishna Iyer. A former Carnatic music teacher, he is 70 and has been in the
hospital for 37 years. "I was so young when I was admitted and have seen generations
of doctors, nurses and patients come and go," he says matter-of-factly. 
