National Human Rights Commission Project
Until the 1950s there was no effective drug therapy for mental illness. The only therapy available was electroconvulsive therapy or ECT, which was used for treating multiple psychiatric illnesses, especially schizophrenia and depression. Largactil (Chlorpromazine) began to be used after clinical investigations proved its efficacy in psychiatry in 1952. Till then, mental patients were put in mental asylums for life under custodial care. The asylums were built like a prison. The patients would die of infections like TB, which was rampant, malnutrition, or injuries due to fights between inmates or self inflicted injuries. Around the time when India became independent, there were 19 asylums. After independence, around 18 more were created. later, these asylums were converted to mental hospitals, though most of them continued to function like an asylum.
During the 1980s several public interest litigations about violation of human rights of mentally ill persons and the deplorable conditions of mental hospitals were filed in courts. The Supreme Court passed a series of judgments. The practice of keeping non-criminal mentally ill persons in prisons and of keeping unruly mentally ill persons chained or tied up were declared to be illegal or inhuman; the court directed that they should be examined by a psychiatrist and sent to hospital for treatment. Mental Health Act was passed in 1987, and the Indian Lunacy Act of 1912 was repealed.
The Supreme Court ordered a detailed enquiry into the conditions prevailing in the mental hospitals in Delhi, Ranchi, Tezpur, Gwalior and Agra. It directed that some of the mental hospitals, particularly those in Delhi, Ranchi, Tezpur and Agra should be revamped, guided by NIMHANS as a model. National Human Rights Commission (NHRC) was asked to monitor the status of mental hospitals. The NHRC conducted a preliminary survey and discovered that the conditions in these hospitals were very poor. NHRC commissioned the Project on Quality Assurance in Mental Health in 1997; it entrusted the task to NIMHANS. CRC was a member of the team which visited 33 state mental hospitals in the second phase of the project to evaluate the quality of services provided and issues related to the implementation of the Mental Health Act and the protection of human rights.
The NIMHANS team visited the mental hospital in Varanasi and found that the conditions were appalling. All the doctors, including the psychiatrists and medical superintendent believed that all under trial prisoners and medico-legal cases brought to the hospital had to be kept isolated in a cell, kept naked to prevent harming themselves or others, and that no medication should be given for 10 days or until court orders. These cells had grill doors so that the inmates could be observed. They had to relieve themselves in the cell; food was pushed into the cell in a plate. The doctors said that they were following rules in the book; when asked to produce the book, they admitted they had not seen any book and that these practices were passed down the years in the hospital.
These facts had not gone public; no one was allowed in the hospital, not even the police. Family visits took place in a visitors’ room next to the medical superintendent’s office. Only doctors, nurses and ward boys were allowed into the wards. They viewed the inmates as dangerous people who should not be exposed to other patients. All presumed mentally ill under-trial prisoners, medico-legal cases from all over UP, parts of Bihar and other places were sent to this hospital, which was treated as a forensic psychiatric hospital by the British and later by the Indian courts.
The team told the hospital administration that that these practices had been laid down in Indian Lunacy Act, 1912, which had been replaced by Mental Health Act of 1987. The staff was informed that keeping a patient in a cell without treatment violated human rights and that they could be charged under law. The team took photos, videos and submitted these with their report to the court and the central government.
CRC visited King George’s Medical College and Hospital in Lucknow. He found that psychotic patients were kept chained. The psychiatrists justified it by saying that these patients could escape or attack other people. Even the general patients would insist that these patients should be chained else sent to Varanasi or Ranchi mental hospital. The situation in Shimla General Hospital was similar.
The doctors, when told that they could go against the earlier procedure, expressed concern that the local courts could question them as to why they had kept mental patients unchained in a general hospital. When told that NIMHANS did so, they said that courts would not question NIMHANS.
Even judges those days were not aware of various types of mental illnesses; they knew about only mental retardation and ‘madness’ (insanity) as mental disorders. They were of the opinion that such people should be kept in a mental hospital to protect the society.
The mental hospital in Amritsar had about 40 patients, who were from Pakistan and were left in Amritsar after the Partition of India. These people did not know where to go when they were fit to be discharged; no one came forward from Pakistan to claim them. When CRC visited the hospital, 25 people remained of the original lot, all of them now very old and feeble.
At that time, a mental hospital in a state used to serve several neighboring states, which contributed Rs 8 per patient per day towards maintenance; the sum remained the same from 1948 to 2000. The superintendent in Ranchi asked the visiting team how was he to provide food and clothing and other necessities for Rs 8 per day. The secretaries of many state governments were not even aware that their state was paying Ranchi mental hospital for patients from their states.
The onsite study revealed that the infrastructure and living conditions were poor in most hospitals. Human rights and dignity of patients were violated in many instances. Not all hospitals complied with Mental Health Act; two hospitals still followed the earlier Indian Lunacy Act, while seven were following both the acts.
In the second phase, several workshops of one-week duration were conducted for the staff from the hospitals. The focus was to sensitize them to protection of rights of the mentally ill, provide a feedback on the existing conditions in the hospitals and to generate solutions for problems.
The NHRC report made many recommendations for the improvement of the structure, functioning and treatment facilities in the hospitals; for the setting up of monitoring process to prevent human rights abuses, and for the strengthening of community based healthcare. Many states started implementing the recommendations made by the report.