Rural Mental Health Center in Sakalavara Village
During 1970s in India, mentally ill people were treated with inhuman methods like starvation; branding with hot metal; inducing vomiting in the belief that they had been poisoned by their enemies; taking them to temples, durgahs , churches, swamis reputed to have supernatural powers, gurus, godmen or tantriks; or chaining them up in temple compounds, where they were exposed to the elements. Patients with violent or severe symptoms were locked up in a room or chained up at home. Some patients escaped from their homes and wandered long distances, foraging or begging for food. In course of time, such people died due to starvation, road accidents or illness; very few reached a mental hospital or a charity home.
WHO released a report in 1974 on the treatment of mental ill people in developing countries. The report suggested that general physicians could treat mentally ill with selected 4 to 5 medicines and that doctors should visit villages, study the problems and treat patients. Against this background, the Community Mental Health Unit was started at NIMHANS in 1975 to evaluate and carry out training programs in basic mental health care for different categories of health care personnel. Dr. Ravi L. Kapur, a psychiatrist working in Manipal, Karnataka, was invited by the director to start community health services. Kapur was an interesting personality – he was a good singer and orator; he had a deep interest in mental health issues in society and in finding solutions for the problems. He had done a survey in Kota along with another psychiatrist, Dr. M. Carstairs; based on their research, they published a book, ‘The Great Universe of Kota: Stress, Change, and Mental Disorder in an Indian Village’, on how lifestyle changes affect mental health in the community. They had found that in a sample population of 1000, 367 people had more than one psychological problem, out of which 67 needed immediate treatment. The authors said that existing mental health services did not reach even 5% of the needy. In 1975, apart from those in NIMHANS, Karnataka had only around 25 psychiatrists; in the entire country, there were only 900 psychiatrists. The total number of psychiatrists, psychologists and mental health social workers was only around 1000, and these were concentrated in major cities. The book was a landmark study; it made people involved in mental health care in India sit up and take notice.
Dr. Kapur was appointed as the Professor of Community Psychiatry with a team of 3 psychiatrists, 1 clinical psychologist, 3 psychiatric social workers and 2 psychiatric nurses.
To develop and conduct training programs in basic mental health care for the Medical Officers and health workers of Primary Health Centers (PHC), it was decided to set up a separate rural mental health training centre in Sakalawara village, located about 15 km from NIMHANS. There was already a small primary health care facility in this village, run by a voluntary organization, ‘Arogya Foundation of the Mahabodhi Society’, in a 13 acre plot. NIMHANS had experience of previously working with the Mahabodhi Society from the mid sixties at Sakalawara. It was decided that NIMHANS would collaborate with Arogya Foundation in setting up the rural mental health training centre.
Work was started with grant from the Karnataka government on construction of an out-patient block to provide the primary health care needs of the nearby villages, out-patient care for neuropsychiatric patients, limited inpatient facilities, residential facilities for the staff and trainees, and on renovation of existing old building to create offices, lecture halls, rooms for group discussions and records.
A field program for the identification and management of epileptics and psychotics from the villages around Sakalawara was taken up. Identification of the severely mentally ill and the persons with epilepsy was done by a simple method of asking a few questions to around 5 per cent of the people of village and key people like the village head, the temple priest, the school teacher and formal and informal leaders. During this initial phase of organizing the service program and the feasibility study (1977-80), 122 villages with population of 76,000 within a radius of about 15 km from Sakalawara were covered.
The team consisting of one psychiatrist, one psychiatric social worker and one psychiatric nurse, visited villages around Sakalawara, collecting basic socio-demographic data as well as information about persons with epilepsy and psychosis. The patients were examined at their homes and the treatment was started. The family was told how to take care of the patient and bring the patient for follow-up to the Sakalawara centre.
CRC joined this group in January 1977. They increased the range of their periodic visits to 150 villages around Jigani, Bannerghatta road, Bannerghatta to Jigani and Anekal road, Bangalore to Chandapur and Anekal road. They urged patients’ families to visit the clinic instead of traditional healers, and educated villagers that such illnesses can be treated. The group was moved by the plight of the people they visited, their helplessness, suffering, poverty, ignorance and in contrast, their innocence, friendliness, hospitality. They felt enriched by their experiences.
During house visits, most villagers welcomed the doctors warmly. “You are Krishna who has come to Kuchela’s house”, they said humbly and gratefully. Not all people welcomed them : “You are paid by the government, but what do we get out of it?” they asked. Some spread a rumor that doctors had come to take away mad people. The self-appointed wise people counseled the doctors to treat only patients who visited the hospital, and leave the rest to their fate, since it was impossible to teach ignorant people and make them give up their faith in traditional healing methods.