The Crusader of Mental Health

The Origins of NIMHANS

Dr. Charles Irwing Smith, a British medical practitioner in Bangalore convinced the Commissioner of Mysore province, Sir Mark Cubbon, to set up in-patient wards for the mentally ill, who had been abandoned by their families or could not stay in Bangalore. Separate male and female wards were built from 1938 – 39 in Pete or Pettah, Dharmambudi tank area (today it is at the intersection of Kempegowda Road and Avenue Road in Bangalore). Later was named as Bangalore Lunatic Asylum . It was an airy building with 50 beds. The patients could move about freely and were kept engaged in work like gardening, weaving, making rope, and domestic work.
Power was transferred from the British to the Kingdom of Mysore in 1881. Due to the expanding population of Mysore Province, a larger mental hospital was thought necessary. In 1920, the Maharaja of Mysore agreed to the building of a new mental hospital; he donated over 200 acres of land in Lakkasandra, which was a hillock outside Bangalore. The idea was that mental patients were to be isolated from the general population and patients should be accommodated in an airy, spacious campus with greenery. Work on the buildings started with support from Mysore State’s Dewan (Prime Minister), Sir Mirza Ismail. He along with Dr. Frank Xavier Noronha, the first superintendent of the Mental Hospital, helped design the new campus with wide open spaces and landscaped gardens to create an environment which was safe and conducive for recovery. The Mental Hospital was shifted from Pete to its present location in 1937. All other mental hospitals in India were designed like a prison, but this hospital was designed as an open hospital in a sprawling campus with extensive greenery. It was considered a model hospital with its open wards, where patients were free to walk in the campus. The hospital provided outpatient and in-patient services, with departments of psychiatry, neurology, neuro-surgery. It had four closed pavilions with 3 wards each. In these closed wards, patients were not free to go out on their own, but unlike in other mental hospitals, patients’ families could visit them freely.

The remaining wards were open wards. Any number of members of a patient’s family could visit the patient at any time and stay as long as they wanted. They were encouraged to learn about and participate in the treatment.
During the early years, many patients were admitted and later the families would abandon them and not turn up to take them back. This resulted in overcrowding of the wards. It was difficult for the doctors to give time to each patient, and quality of treatment suffered. Such patients would plead with the doctors to discharge them. Later, reforms were introduced. A deposit was taken at the time of admission. In case no one turned up at the time of discharge, the patient was sent back home with some money. Families were counseled on how to take care of the patient at home, and early discharge was practiced. Most patients were treated as out-patients, and number of admissions was minimized.

All India Institute of Mental Health (AIIMH), the first postgraduate training institute in psychiatry in the country, was established in the same campus in 1954 by the central government. It offered diploma courses in psychiatry, mental and social psychology, social services in mental health, and nursing. The Mental Hospital and AIIMH were merged in 1974 to form National Institute of Mental Health and Neuro Science (NIMHANS). NIMHANS became a deemed university in 1994 with 22 departments, 1000 beds and allied facilities. It offers Post-Graduate, M.Phil and Ph.D level programs, post graduate degree and diploma courses (DPM and MD), fellowship courses and short term trainings.

Patients holding BPL Card (Below Poverty Line) are not charged for consultation, their stay and all investigations, except for costly investigations like MRI scan, which are charged at concessional rates for these people. When a poor patient cannot afford expensive investigation like CT scan, the cost is waived. Almost half the patients are treated free of cost in the hospital. Other patients are given discounts on base rates depending on their income level. Here too the rates are very nominal compared to private hospitals. A single room in special ward in psychiatry costs only Rs. 400 per day, and this includes diet, doctors’ consultation and nursing. In OPD, any person can get consultation from the senior -most doctor by paying only Rs. 20 for a token. This of course means that there is a rush; around 1000 patients visit OPD every day and one has to get a token at 8 AM and wait for a few hours to be screened first by medical officer and then see the doctor. In 2015, the Government of India declared NIMHANS as an Institute of National Importance and gave it total autonomy.