A lapse of sanity

ERWADI'S TRAGIC VICTIMS tell the tale of all that is wrong with India's system to take care of the mentally ill. The 26 manacled patients who were burnt to death are but a small representation of the much larger number of mentally-ill, who are either shunned by society or for whom the benefits of modern health care remain elusive. Nothing but a total abdication of responsibility by several sections of society - successive Governments and their administrations, the civil society and not to forget, the parents of the victims - could have resulted in this most tragic end. The immediate task is to bring in strict controls on the mushrooming of private ventures near traditional healing centres. At Erwadi, the Tamil Nadu Government should waste no more time and order the closure of all unsafe dwellings where the mentally ill are incarcerated. Simultaneously, steps should be taken to ensure that such patients are taken proper care of, through scientific and safe intervention mechanisms. In addition, strict punitive action should be taken against the perpetrators of this heinous crime.

A root cause for such events is the complete mismatch between the number of those afflicted with mental disorders and the availability of modern medical care. That there are only 23,000 beds in 37 hospitals across the country to take care of the estimated five crore Indians suffering from various forms of mental illnesses reveals the low priority that has been given to mental health. In a way, the predominant approach to curing mental illnesses - with a significant dependence on faith-healing techniques - is indicative of the low level of understanding of such disorders as well as the inability of the modern systems of medicine to enthuse public confidence in the effectiveness of the scientific cures available. Needless to say, the recourse to non- medical means to find a cure for such disorders only makes the case for further intensifying the efforts to enhance the quality of trained medical personnel and make them available across the country. In providing ready access to such patients even at the district level lies much of the solution. Existing predominant notions that mental illnesses are a result of either the supernatural, the occult or of some inexplicable phenomena should be countered effectively through a systematic and well-conceived project of public education on the causes and the cures of disorders relating to the mind. As a corollary, the role played by places such as Erwadi, of which there are several examples across the country as well as in other parts of the world, should be understood. These centres have become a part of the public mindset largely because they have found relevance in a society that has failed to deliver on its basic commitments to cater to the interests of the needy, the vulnerable and the ill.

Chaining of the mentally ill, as is being done at several places, is a violation of the principles relating to human rights of the mentally ill. A resolution passed by the U.N. General Assembly in December 1991 states in clear terms that every patient should be given ``the right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to the patient's health needs and the need to protect the physical safety of others''. That the victims were all manacled goes against the principle that the ``treatment and care of every patient shall be based on an individually prescribed plan, discussed with the patient, reviewed regularly, revised as necessary and provided by qualified professional staff''. Continued acts of omission by the Government will only result in more ghastly recurrences of Erwadi. The measure of success of a state lies in its ability to care for its most vulnerable and helpless sections. For India to emerge with some amount of credible success on this front, it is imperative that correctives steps are taken to ensure the availability of the benefits from medicine to all.

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