Maharashtra Health Minister Prakash Abitkar recently visited the Regional Mental Hospital, Yerawada, on January 3, where he discovered several flaws. Following his visit, he issued orders to inspect all four mental hospitals in the state.
During his visit at the mental hospital in Yerawada, the health minister reportedly expressed significant concern over the facility's unhygienic conditions, poor patient care and infrastructural neglect. He also warned officials of strict action to be taken against those found responsible for "misconduct and negligence."
Accordingly, all the directors of health services in the districts of Pune, Thane, Nagpur and Kolhapur received directives by Additional Director (Health Services) Dr Vijay Baviskar. The state health minister demanded reports from all four mental hospitals on several aspects including outpatient services, inpatient services, cleanliness, food services, medication availability, Information, Education and Communication (IEC) activities, telemedicine services, etc.
The minister has instructed the deputy directors of all the four hospitals to submit a detailed report by January 7. However, that looks unlikely, say those in charge of the hospitals, citing "too short notice" as the reason. Pune region's Deputy Director (Health Services) Dr Radhakrishnan Pawar reportedly said that "it won't be possible to complete everything in a day."
During the press conference in Pune, Abitkar also proposed a budget of Rs 132 crore for enhancing the state's four hospitals and the plans to upgrade RMH Pune to the standards of the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru.
Experts question the very existence of the term 'mental hospital' and suggest that it be replaced with alternative terms such as 'Institutes of Mental Health.' Adding to the health minister's observation of the 'deplorable conditions', academic experts believe that for the proper functioning of these hospitals, it is mandatory that all the physical and clinical requirements for work be met.
"The current trends to show us that almost half of the patients continue to vegetate in a dehumanised manner within the hospital as relatives often do not want to take patients home. There are many long-stay patients who are being abandoned by their families. Hospitals serve as dumping ground which is convenient for relatives of unwanted mentally ill patients. There is also an uneven distribution of the available psychiatric services. Vast sections of the population and large geographical areas in many states lack even rudimentary mental health care," says Muktesh Daund, who published a paper titled, 'Mental hospitals in India: Reforms for the future,' in the Indian Journal of Psychiatry. "There is a need for rebuilding and revamping the existing infrastructure in these hospitals. The mental hospital of the past needs to be converted to a state-of-the-art tertiary psychiatry centre with various subspecialty psychiatry clinics being available for the use of the common man," he added.
The present form of treatment in most mental hospitals is basically custodial rather than therapeutic, say psychiatrists. They further add that there is a need to develop and cultivate outpatient services with the availability of counselling, psychotherapy, child guidance, and psycho-educational services. These hospitals with huge inpatient bed facilities can be converted into state-of-the-art tertiary centres for psychiatric care, and postgraduate training must be strived for in these centres.
Mental hospitals stemmed in India from the era of lunatic asylums – a concept that was British and European in its conception. The whole purpose of the concept of a mental hospital was to segregate the mentally ill from the community and not treat them as normal but rather detention away from the community, says Daund. "Most mental hospitals in India were built in the British and pre-British eras when the emphasis was never on community-based treatments and in that era psychiatric patients were viewed as a danger and menace to the society. However, now it is high time that things change."
At present, say experts, while hospital psychiatry units and community-based mental health initiatives are effective in identification and treatment of most minor and less severe forms of illnesses, there still exist a large number of patients who require long-term in-patient care in hospitals. These patients are mostly those with more severe forms of illness, poor social supports, and significant family and societal burden.
