What Are We Doing For Our Hospitals Providing Mental Healthcare?

by | Sep 2, 2018

The writer and journalist, Eduardo Galeano once said that, “One cannot remember with the memory of another. Men will record, but they won’t recall. They will repeat, but they will not live. They will learn of many things, but they won’t understand a thing”.

We are all programmed in a specific manner that we always find the other side to be greener but rarely do we pause for a second and water the grass on our own side.

Working in the mental health sector, there is underlying notion that whatever the lack is in the sector – it is due to the scarcity of facilities being provided by the system. However, even the mental health professionals fail to realise that their life itself can be an example when working with the vulnerable. It is a natural tendency that one gets so engrossed in their work that they lose sight of the sole purpose of doing the work.  During such times, it is important to retrospect and analyse where we stand.  The history of psychiatry is as intriguing as ever, especially in India. As surprising as it is, between California and Tezpur, going westwards, organised contemporary psychiatry had yet to appear by mid-nineteenth century. [1] Therefore, India has been concerned about mental illnesses and mental health since a time when majority of nations had not even acknowledged behavioural disturbances.

There are about 43 mental hospitals in India, and in Maharashtra alone, there are 4 mental hospitals found in different regions of the state – Thane Mental Hospital, Yerwada Mental Hospital in Pune, Ratnagiri Mental Hospital and the Nagpur Regional Mental Hospital. All of them date back to over a century.  Ranchi Mental Hospital was believed to be the all-white mental asylum while NIMHANS, Bangalore housed a mixture of races and ethnicities, including the disturbed soldiers of the war during the colonial period. It came to light that in the hospital (that was setup in the Bangalore Cantonment area), Charles Irwing Smith recorded some behaviour disturbances for the first time. It was also observed that many even fatally succumbed to the apparent insanity that they possessed. To examine the condition, multiple skulls were opened up and it came forward that there were some infections in the brain which had led the individuals to insanity.

The structure of the typical “lunatic asylum” was similar to that of a prison because the mentally ill were considered to be no less than criminals. The authoritarian positions are common, to name a few – Superintendent, Deputy Superintendent, Matron, Assistant Matron. Surprisingly, the structure is still the same and it makes me wonder if we are still living in the past. To add on, there are various processes in these mental hospitals that are still archaic and in spite of the new mental health acts being passed – the implementation seems like an arduous journey.

All this brings me back to the question of institutionalisation and its relevance today. A renowned psychiatrist who I had met once had stated that “Through institutionalisation, we are creating monsters.” I couldn’t help but agree completely because when one gets institutionalised – especially in the context of psychiatry – they become disoriented and time stands still. Correction – time stand stills only for the ones institutionalised and while they are inside, getting treated – the world moves on. It becomes difficult for them catch up once they are out. This leads to the reinforcement of the revolving door phenomenon. This phenomenon talks about the continuous readmission of the individual into an institution due to their inability to rehabilitate back into the community.

At the end of the day, I can only offer a solution to this problem which resonates with me personally… home. While we may place our undivided faith in science and progress and forms of rehabilitation, there is a distinct comfort one gets in the convenience of their own home, their own little nook of the world. Through community based therapies and sessions, we have the potential to reach people in the furthest corners of India, where people can together create sustainable systems of mental health care and are able to lean on a community that can lean back on them. Through new technology, communities are not only physical, but can span countries through the internet – we can create a world where support systems are basic, not a luxury.

So now that we know where we were, where are we going? Are we going to succumb to older ways where humanity was at its weakest? Or do we learn from history and come to terms with our past and ultimately understand how we can be better, that we can be better?

Maybe things are not going as well as anticipated but I am convinced that the grass is definitely greener than before. All we can do is keep challenging ourselves to continue watering the grass, even in the monsoons. You know why, because that is all we have!

[1] Jain, Sanjeev, and Sarin, Alok. The Psychological Impact of the Partition of India. SAGE Publications India, 2018.

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