Can we close down the mental health centers?

Recently I received a request to sign an online mass memorandum requesting the authorities concerned to close the mental health centers in Kerala. Being a down-to-earth practitioner in psychiatry I couldn’t sign the memorandum.

The hue and cry of psychiatrists for closure of mental health centers started up as a consequential effect of the murder of a young law student who was in the maniac phase of bipolar mood disorder. As I pointed out in the last post, in Malayalam, of this blog the murder of Satnam Singh Mann was the culmination of malicious and murderous process triggered by the attitudes prevailing in Kerala. He was accused of being Islamic terrorist attempting to murder Amruthanadamayi, the internationally known human-god managed by the Rashtreeya Swayam Sevak Sangh. The last scene of the murderous process occurred in the Government Mental Health Centre, Trivandrum. He was locked up in a cell of the ‘asylum’ with other patients and he was found to be unconscious next day. He was transferred to the Medical College Hospital where he succumbed to the injuries he sustained.

I understand from the press reports that the professor of psychiatry, Trivandrum, certified the ‘patients’ locked up in the cell with Satnam are ‘normal’. It means that these ‘patients’ can be held criminally responsible for the murder of Satnam! 

Asylum culture prevails

Thirty years ago I was working as psychiatrist at Kuthiravattom. A young, good-looking, unmarried lady in good physical health, suffering from epilepsy and psychosis, under my treatment, was admitted in the female ward. That was the fourth “incarceration” of the young lady. When the psychosis remits she is discharged and when it relapses she is brought back.

After a few days of the fourth admission, one morning one of the nurses informed me 'secretly' that "something brutal" was done to the young lady at night by a male nursing assistant. I interviewed the patient. She narrated that one nursing assistant raped her last night. She could not cry or fight because she was heavily sedated. I reported the matter to both the superintendent and resident medical officer in writing. They didn’t take any action. Next day I went to the Medical College Police station and lodged a written complaint. The Inspector called the superintendent and enquired. The inspector expressed his helplessness, because the superintendent said that nothing of the sort occurred in the hospital. I was in an embarrassing situation.

Rosewood Campus in UK

I had no other option than bringing the matter to the public notice. I contacted the young lady’s brother, who was a teacher in a government college. I got the consent from him to ‘leak’ matter to the press without disclosing the identity of the young lady. I contacted the city bureau chief of the Malayala Manorama (I still remember his name) and narrated the story. The bureau chief and his wife, working in the telephone exchange, came to the hospital under the pretext of the close relatives of the young lady. I gave them permission in the form of a ‘pass’ to visit the patient and interview her. (An illegal act, perhaps!) Next day, as I expected, a bomb exploded. Waves of protests by various political parties thronged the premises of the Mental Hospital. Both the superintendent and the resident medical officer were kept under suspension pending departmental enquiry. Criminal case was charged against the culprit and punished by the court of law.

I am not repeating the narration of incident of murder of the mental patient Martin Mendes which I narrated in the last post. It took place in the mental health centre, Trivandrum, ten year after the Kuthiravattom incident.

Immediately after the murder of Satnam Singh, another murder took place in the Mental Health Centre, Kozhikode.

All these incidents are, in my opinion, the symptoms of serious malady, that is, the asylum culture still prevailing in our mental health centers. The psychiatrists working in these institutions are vicariously responsible for it. Closure of the mental health centers is not the remedy.

What happened in western world?

Melanie Mcfadyean wrote on the closure of Tooting Bec Hospital with 2500 inmates, in 1995 in South London, after its existence almost 100 years, in The Independent: “Once, they were conveniently locked away in mental hospitals. Today, the mentally ill are back on the streets, more visible than at any time in living memory. Have they simply been cast out to save money? Or have their difficult lives actually been made more tolerable by the modern patchwork of 'community care' schemes?” 

She wrote: “June McKerrow of the Mental Health Foundation explains: 'In some areas community care is working, but in others services are clearly feeling beleaguered, defensive and dumped on, expected to provide simple solutions to impossible problems by government and public alike.' The NHS and Community Care Act of 1990 devolved power away from the NHS and on to the social services. The result has been to stretch social service professionals and health professionals beyond their limits.”

If such is the situation in UK, a developed country with much less population than ours, what will be condition of the chronic psychotic patients who will be thrown out of the mental health centers? Decades ago, one of the superintendent of the MHC Kozhikode discharged a large number of ‘inmates’ on an experimental basis. After a few weeks I happened to go to Palakkad in connection with organizational work. After the work I arrived at the Palakkad bus station. One person came to me and joyously lunged “Doctor! Doctor!” The public gathered around us and questioned me. I confessed. Yes, I am a doctor. I know this man. He is Mr. Mariyappan, an inmate of MHC Kozhikode. The people around us told me that Mariyappan has no place in this world to go other than the Mental Health Centre, Kozhikod! The public collected some money and tried to give it me to meet the expenditure of taking Mariyappan back to Kozhikode MHC. I refused to accept the money, but promised them to take the patient back to the hospital, which I carried out honestly. I had narrated this incident under the caption, “Mariyappante Thiricuvaravu” in my Malayalam book on anecdotes, titled Thalam Thettiya Jeevithakathakal. While these articles were being serialized in the Deshabhimani Weekly, one of my colleagues in Kozhikode MHC bluntly ridiculed me as populist writer because of my writings in Malayalam, in the lay press!

The psychiatrist, basically being scientists, should not be carried away by the sentimentalism propagated by the popular media and the publicity mongers.  They have to consider the ground reality before taking up the popular slogans like closure of mental hospitals.

The remedy for the malady is eradication of "asylum culture" still prevailing in our mental health institutions.