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Last Updated: Thursday, 10 July, 2003, 10:14 GMT 11:14 UK
Goa's radical mental health institute
Goa has long lured tourists from across to the world to its idyllic beaches and palm trees.

Corridor in Goa's Institute of Psychiatry and Human Behaviour
The hospital's corridors give the impression of free space
But unknown to its many visitors it is also one of the few states in India to be formally committed to mental healthcare.

And a key part of Goa's radical approach is the Institute of Psychiatry and Human Behaviour, on the outskirts of the capital Panjin, where the most seriously ill patients are to be found.

The building is modern - there are no high fences or extended grounds to act as a buffer between the institute and the outside world - while the interior has been designed to make it easy for patients to access medical care whenever they need it.

"This is the best way of keeping up with the times and the concept of what psychiatry is today," senior psychiatrist Professor John Fernandez told BBC World Service's Health Matters programme.

"Many of our psychiatric patients had been kept up in closed rooms or in chains, and we wanted to get rid of this concept."

Openness

This philosophy had even altered the design of the building.

"Any wall makes a man feel like he should climb it," Professor Fernandez explained.

Six or eight treatments and the person is back on the road
Professor John Fernandez

"We got rid of these walls so that you get the feeling of openness."

The building is also designed so that psychiatrists can observe the patients unobtrusively, from above.

"It reflects the thinking of Goa and the thinking of people who have been in this place for a long time," Professor Fernandez added.

Most of the wards are open, and the patients are free to move about - although occasionally patients who are unhappy about being brought to the institute do appear tied up in ropes.

Traditionally in Goa, people with mental disorders were believed to be possessed by spirits, and treated by being taken to a priest.

Now, many priests refer them on to the Institute.

Scattergun approach

There are around 200 patients in the hospital, of which around half are psychotic, and the Institute takes the approach of using a number of different methods to help the patients recover from their illnesses.

They range from drugs to one of the most controversial methods of psychiatric treatment - electro-convulsive treatment (ECT).

Reception at the Institute of Psychiatry and Human Behaviour
The Institute makes efforts to give easy access to whatever care is needed
ECT works by applying electric shocks to the brain while the patient is unconscious.

Many claim that not only is ECT highly dangerous, its benefits are at best dubious.

But the Institute insists its use has meant a quicker recovery time for many patients.

"In a country like India we have no insurance coverage, and the longer the patient stays the poorer he and his family become," Professor Fernandez said.

"He is an earning member and he has to go back to work. I thought that ECT is one of those therapies which can get a person back to his normal life faster.

"This is what we have seen. Six or eight treatments and the person is back on the road."

He added that the side effects were no worse, comparatively, than with drug therapy which Professor Fernandez also argues takes longer.

"What I feel is ECT, when used moderately, is one of the very good treatments in psychiatry."

Stigma

However despite the Institute's success, there remain problems in getting the right treatment to patients, partially due to India's caste system.

Hospital staff
ECT is used only on patients who are homicidal or suicidal, the hospital insists
Ironically, it is often the worst off who receive the best treatment.

"You will see only the middle and lower class people in the hospital," explained Dr Brubandan Concolienka, the medical superintendent at the Institute.

"Higher class people will not come to the hospital."

Dr Concolienka added that another, related problem was the importance of securing a good marriage in India.

Mental health problems in a family would often be covered up to avoid any risk of losing a good match.

"Another stigma is marriage," Dr Concolienka said.

"If somebody's sister or brother would like to get engaged, the moment that it is known they are a psychiatric patient, they will think twice."




SEE ALSO:
Plight of India's mentally ill
11 Aug 01  |  From Our Own Correspondent
Use of shock therapy restricted
02 May 03  |  Health


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