By Maya Palit
Just under 130 years ago, a young American journalist named Nellie Bly, went undercover as a mental illness patient and admitted herself to the Women’s Lunatic Asylum on Blackwell’s Island in New York. From starvation to brutality and sexual assault, the atmosphere she picked up over her 10-day stint there made its way into one of the most striking journalistic exposes of the time, Ten Days in a Mad-House, and eventually, her book led to various reforms being set up at the institution. A century later, it still takes interventions by social workers and journalists to put the goings-on at mental institutions around the world under the public radar.
The Delhi Commission for Women (DCW) chief Swati Maliwal and her team recently spent a night at the Asha Kiran Home for the mentally challenged in New Delhi and were horrified by what they found. After their visit, which was prompted by the fact that 11 women had died there in the past two months (and 600 patients since 2001), they issued a gruesome report. In it, they noted witnessing women who were made to strip prior to bathing, after which they wandered the corridors naked, and were filmed by CCTV cameras monitored by male staff. Bedridden women were urinating on beds, the floors were covered in faecal matter and blood since the women were not provided sanitary materials, and up to four women were sharing a bed. There was an apparent shortage of other facilities too: only one psychiatrist was visiting the home, and the doctors’ posts hadn’t been filled.
According to a report in The Hindu, the DCW has now issued a notice to the government’s Social Welfare Department, demanding an explanation within 72 hours for the gross human rights violations taking place at the institution. But this is hardly the first time that revelations of the outrageous conditions women patients experience in institutions have surfaced.
At the end of 2014, the Human Rights Watch exposed the overcrowding (way past capacity) taking place at Asha Kiran in Delhi, and 23 other institutions, in a report Treated Worse Than Animals: Abuses against women and girls with psychosocial disability in institutions in India. The report emphasised the rampant abuse of women patients in institutions across the country, including being subject to electroconvulsive therapy without their consent. And last year, NIMHANS, in association with the National Commission for Women, also found “inhumane” living conditions for mentally challenged women living in 10 institutions across the country. They were kept in environments that resembled prisons, forbidden from stepping out, had to use toilet facilities under the gaze of the authorities, and were not provided with adequate sheets or mattresses.
But a recent tendency of discussions deploring this treatment is that the conditions women have to face within the institutions become quickly overshadowed by the problem of these women being abandoned by their families. Particularly in cases when their families do not want them back, ensuring that the patients’ rehabilitation has become a major challenge, and ways around this have been discussed widely.
In September 2016, for instance, a government report recommended that legal safeguards and financial support schemes be instituted for women inmates to combat mistreatment after leaving the institution, and suggested that a detailed audit be created, describing the circumstances under which the patient is admitted and discharged. The National Commission for Women chairperson Lalitha Kumaramangalam told The Times of India in March 2016 that they were hoping to make the Aadhaar card mandatory for admission so that families can be tracked down later. (Of course, making it compulsory would undoubtedly create other complications, including creating a new hurdle for admission, not to mention impinging on patients’ privacy.)
While making sure the reintegration of patients into society after their treatment is a pressing issue, isn’t the first step to effective rehabilitation the proper treatment in facilities? And how can such horror-inducing conditions continue in our institutions despite report after report calling them out every year?
Archanaa Seker, an independent Chennai-based activist, who has previously worked with mental health rights organisations, argues that it is not quite possible to divide the issue into water-tight compartments. “You cannot separate the treatment phase from the rehabilitation period so easily — government institutions are used as dumping grounds as well because people with psychosocial disabilities are viewed as economic burdens.” She added that in her experience, women patients were the ones who were made homeless because of their illness, whereas men patients had gone looking for work in cities, ended up homeless, and became ill later. “It is imperative, therefore, that we examine their circumstances and experiences prior to admission so that we ensure there is an effective treatment and medication period, and a quick turn-around. At certain institutions, once you enter you become a nameless numbered person. There is a slim chance of you making it outside.”
The labyrinthine nature of institutions isn’t a new fact either, and we can return to the intrepid Victorian investigative journalist here for corroboration: The prospect of never making it out intimidated Nellie Bly enough for her to grill her editor about an escape plan.
Seker carried on to say, though, that these discussions shouldn’t replace urgent questions about the conditions of the institutions. “Why are there male staff monitoring these women patients in the first place? There can be men present but as social workers or psychologists. As for the terrible conditions, they stem more from a gross misunderstanding of mental illness — for instance, it was only recently concluded that solitary confinement tends to make patients more aggressive — overcrowding and a severe shortage of staff. Unless the institutions are provided with more funding, or primary health clinics are equipped with in-house psychiatrists, who can diagnose mental illness early (although this would require grassroots advocacy to change mentality so that people don’t hide their mental illness at the first stage), there is unlikely to be a tangible change for patients.”
There are many stories of patients’ harrowing experiences at hospitals around the country, and the facts are out there to observe. A detailed Hindustan Times report from December last year claimed that there were 0.301 psychiatrists for every 1,00,000 people in India, and over the years, countlessarticles have repeated facts about the hellish conditions at institutions.
Isn’t it about time that the conditions of institutions and the issues plaguing people with psychosocial disabilities who reside there made it to the forefront of our debates about mental health? Maybe there isn’t much point to engage in endless hand-wringing about it. But a poignant blog written by a Dehradun resident three years ago, recounts how he started a volunteering initiative after visiting Dehradun’s State Mental Health Institute, and perhaps points to one practical thing those interested in gender justice can do — organise locally, while campaigning for institutions that house and treat women with psychosocial disabilities to receive more funding. It’s certainly not enough for a small-scale outrage to flicker every time a shocking expose of an institution surfaces every year only to recede from public memory.