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Monday, 6 August, 2001, 15:32 GMT 16:32 UK
Silent suffering of India's mentally ill
Map showing location
By Jill McGivering in Delhi

Reports from the scene of the Tamil Nadu tragedy paint a depressing picture of mentally ill patients living in cramped conditions and routinely chained as a means of restraint.

The private institution where the fire broke out is one of about 15 such concerns in the small town of Ervadi, described as a poor community which has seen little development, in the Ramanathapuram district of Tamil Nadu.

The private institutions have grown up round the town's Muslim shrine.


In a country of more than a billion people, there are only 500 qualified psychiatrists

Many of the patients are said to be extreme cases of mental illness, typically involving violent behaviour, and from poor families, who were brought to the town in the hope that the religious powers of the shrine would have some curative impact on their condition.

Police said many of those who died were Muslims who originally came from the neighbouring state of Kerala.

They also say the institution was not licensed - and it seems as if the care and treatment of the mentally ill in this and similar private ventures were almost entirely unregulated.

Stigma

It is an extreme example - but many people working in the field of mental health say inappropriate treatment, stigmatisation and inhumane conditions are prevalent in many parts of the country and in many parts of the public health sector too.

In a recent report, India's National Human Rights Commission expressed its own deep concern at the conditions in India's public hospitals for the mentally ill.

Many of them, it said, functioned as custodial rather than therapeutic institutions - and it listed such problems as overcrowding, lack of basic amenities and poor medical facilities.

Tamil Nadu mental asylum
The mentally ill are not one of India's top priorities
One of the doctors involved in preparing the report said he had seen examples of four or five highly disturbed patients locked together into a single room for long periods without basic toilet facilities.

Food, he said, was passed in to them through a hatch and in many cases relatives were not allowed reasonable access to the patients nor the patients allowed reasonable access to the outside world.

Many patients, he said, were left all day with nothing to occupy their time - and there was little attempt at real rehabilitation.

Those campaigning for change are quick to agree.

They say there have been marked improvements in recent years, particularly in the leading psychiatric hospitals in large cities which have been brought much more into line with international standards.

Inadequate resources

But they say such moves towards change are not yet affecting the vast majority of the population.

Resources are woefully inadequate.

In a country of more than a billion people, there are only 500 qualified psychiatrists and many general hospitals lack specialist facilities for mental health.

Some workers in the field say there is increasingly more willingness to discuss and understand mental health problems amongst the educated upper middle class - but elsewhere misconceptions about mental illness and stigmatising of the mentally ill are still widespread.

It is common for families, especially in rural areas, to disown relatives with mental illness, especially women.

Village in Tamil Nadu
Poor villagers are at most risk from mental illness
This social rejection also reduces the likelihood of rehabilitation. Other families react by hiding away a relative with mental illness because of shame or embarrassment and fear the stigma associated with mental illness could affect the family's general reputation.

This too can lead to abuse of the mentally ill within the home as well as the denial of possible medical treatment.

Superstitions associated with mental illness are prevalent.

Families seeking treatment and perhaps unable to find help from basic general health facilities available to them may commonly react by seeking mystic healing - some of which can also lead to physical and mental abuse of the patient.

Clearly in recent years awareness, especially amongst the better educated, has increased and efforts are now being made to identify correctly and treat those with mentally illness.

For a developing country like India, with a population of more than a billion people and a broad range of basic livelihood needs, mental health is simply not seen as a top priority.

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 ON THIS STORY
BBC's South Asia Correspondent Jill McGivering
"The conditions are inhumane"
See also:

07 Apr 01 | Health
Stark warning on mental illness
19 Feb 01 | South Asia
India's violent homes
16 Dec 99 | South Asia
Jailed for 37 years without trial
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