Plight of India's mentally ill

The patients are permanently chained together

The deaths of 28 mentally ill patients in the Indian town of Ervadi have raised concern over the conditions in which these patients are kept. The BBC's Jill McGivering visited Ervadi and found that there are still disturbing questions to be asked.

Jaikrishna's eyes were piercing. He had a very intense, intelligent gaze, which didn't falter for a moment when it met mine.

His head recently shaven, he was sitting on a straw mat in a hut which looked more like a cattle-shed than a home. Apart the rows of straw mats and about 50 men squatting on them, the hut was bare.

I didn't want to come here, they made me. I've been here for one year and one month

Jaikrishna

Jaikrishna, like everyone here, was fettered round the ankles by heavy iron chains. Another chain trailed across the floor, coupling him permanently with another man, convict style.

"I'm a graduate," Jaikrishna told me. "And divorced. I'm also a schizophrenic." His English was confident if imperfect. "When I'm on medication," he said, "it's under control but then I start forgetting to take the tablets and the problems come back."

Pleas for help

He broke off and his face hardened with tension, every muscle straining. In the sudden tense silence, his eyes never left mine. Then he erupted, half crying, half shouting: "I didn't want to come here, they made me. I've been here for one year and one month."

The tears were running freely now, his hands jerkily stretched out to me, pleading. "We haven't done anything wrong, we haven't hurt anyone. We have families, friends, we just want to see their faces again."

The patients are encouraged to pray in the shrine for a cure

A stout guard rushed in, shouting at us for causing commotion, telling us to leave. Jaikrishna seemed to crumple and rocked himself gently. When the guard turned to leave, Jaikrishna whispered: "They're the ones, it's them," then fell silent when the guard turned back threateningly.

Jaikrishna is confined in what's described here as a mental hostel. This one has 120 male patients, some of them chained here for the last 25 or 30 years. There are no doctors, no medicine, no activities and no facilities beyond the straw sleeping mats and basic toilets in the courtyard outside.

Twice a day the patients are taken out, as always chained in pairs, to the shrine at the centre of this small town. Muslims and Hindus believe the shrine has special powers to cure mental illness.

Business arrangement

That's why these so-called mental hostels have grown up - 16 of them, all privately run on a profit-making basis.

Or actually 15 now because one burned down a matter of days ago, killing 28 patients trapped inside. They couldn't escape the blaze because they were chained to pillars and no-one came to free them in time.

28 patients died when a hostel burnt down

The shrine itself, set in a sandy precinct, is a disturbing place. We watched men and women wailing and shrieking there, tearing at their clothes, beating their bodies against the sand or twirling, arms flying round and round, spinning out of control until they finally collapsed.

One woman was stamping up and down the same narrow stretch, shrieking and rambling incoherently. Another was prostrate on the sand, moaning and rolling full length, over and over, crashing backwards and forwards in the crowd.

The women's wailing was punctuated now and again by a young man letting out a piercing angry bellow.

Despair

At the side, we came across a teenage boy, chained hand and foot to a tree, his ankles ulcerated. His father sat nearby alongside a few bundles which were now, he told us, their only possessions.

To many here, their abnormal behaviour is seen not as illness but as a sign they're possessed by evil spirits or paying for sins from a wicked previous life

He had an air of quiet hopelessness. His son had started being disruptive, even violent, about three years ago, he said, when he was just 16. He'd gradually had to sell off his cattle and land as he paid for his son to see doctors and psychiatrists but nothing had helped.

This was his last hope. For the last two months the boy had been chained to the tree day and night. Now, his father said, he was at last sleeping and starting to eat.

As we left, a gaunt young man approached me and seized my arm. He pressed into my hand a small square of cardboard, covered with tiny scrawled words - the few I could read making no sense. He wrestled with broken English, sweating with the strain. "Please tell the Kuwait Government," he seemed to be saying, pawing desperately on my arm.

Every time I went back to the shrine from then on, he appeared at my side, eyes bright with hope, pleading and pressing more incoherent messages into my hands until my pockets bulged with them. Every time I nodded assurances and patted his arm until he seemed satisfied - then moved on feeling a fraud.

Penance not pills

Of more than 800 people with mental illness living at Ervadi, about 300 sleep at the shrine and the rest live chained in hostels. To many here, their abnormal behaviour is seen not as illness but as a sign they're possessed by evil spirits or paying for sins from a wicked previous life.

Chaining patients has now been banned

Penance and prayer are thought more effective than pills and psychiatry. The trustees at the shrine insist it does work miracles. About 80% are cured, one told me. The fact India's mental health sector is primitive and poorly resourced must make the promise of miracles all the more attractive.

But this week's tragic fire at the hostel has put an embarrassing media spotlight on Ervadi. The local authorities are in turmoil. While we were there, they announced a ban on chaining the mentally ill - and sent inspection teams with clipboards round the hostels to warn them to comply.

We watched Jaikrishna and his friends shuffle out of their hut, shackled two by two and line up to have a guard smash off their chains. They seemed dazed.

Angry owners of the hostels say it's impossible to control the patients without chains - they'll run away, said one, or hurt themselves.

Despite the ban, I found it hard not to feel I was abandoning the patients when we left. I'm still haunted by a vision of the gaunt young man, waiting day after day at the shrine gates for news that his scribbled messages to the outside world have finally been delivered.

And by Jaikrishna's anquished question: what harm have we done to anyone that we're kept prisoner like this?