No improvement in state of mental health patients, despite legislation

More than two years after the Mental Health Act, 2017, was passed, life of the mentally ill in India, especially of women, has not improved. While the provisions of the Act discourage long-term institutionalization of the mentally ill, the government’s task force has found that around 36% of them were still lodged in mental hospitals, as they could not be rehabilitated, or because they were deserted by family members.

The joint task force was formed in 2018 by the ministry of health and family welfare, the ministry of social justice and empowerment, and Hans Foundation, a charitable trust. It reviewed and assessed the condition of those who had recovered from their illness, but were still languishing in mental homes for more than a year.

Around 4,935 people, or 36.25% of those who were cured, were residing for one or more years across 43 state mental hospitals in 24 states. A recent directive of the Supreme Court and guidelines issued by the health ministry mandates that the period of stay in these institutions should not exceed six months.

“On an average, the people were living in mental hospitals for six years, with the minimum duration as one year and the maximum 62 years. At least 48.4% of the participants had been living for between one and five years in these hospitals, accounting for the majority of users,” the report said. Mint has reviewed a copy of the report.

Shockingly, among long-stay users, 11.4% had been there for over quarter of a century, in effect, a better part of their lives had been spent within the confines of the mental homes, while 40 had spent 50 years or more.

“They can all be discharged immediately, but where will they go? Nobody wants them. Institutions kept them on humanitarian grounds to prevent them from becoming homeless. To change this, we will have to first make the society more benevolent,” said B.N. Gangadhar, director, National Institute of Mental Health and Neuro Sciences (NIMHANS), and a member of the task force.

Gender differences were also observed in Uttar Pradesh and Jharkhand, where men on an average remained longer than women. In Maharashtra, significant gender differences were observed with women hospitalized for more years than men, the report added. Pan-India, more women (54.26%) were confined in state mental hospitals than men (45.74%).

The task force report said that surveyed people were diagnosed predominantly with schizophrenia (50.4%) followed by psychosis.

Nimesh Desai, director, Institute of Human Behaviour and Allied Sciences, Delhi, said: “Institutions should not admit patients unless it is absolutely necessary. Re-integration with the family has higher success and those who do not have an family, can be placed in long-stay or halfway homes. Nobody should be hospitalised.”

The task force has recommended constituting a national steering committee for inclusive living. The officials have found that complex multi-factorial social disadvantage, coupled with challenges in institutional care, accompanies their (patients) long-term stay at these facilities—a significant proportion has experienced homelessness. The recommendations of the task force include entailing placements with the family and in community-based housing with supportive services and simultaneous enhancement of local-level mental health services. “The aim of the report was to enable exit pathways and reintegrate such people into community living options,” SM Mehta, CEO, The Hans Foundation said.