Facilities, staff inadequate, say psychiatrists

: Just seven months after 41 persons with mental illness (PMI) were found shackled at a private mental health facility at Avanoor in Thrissur district, which shamed the mental health care sector in the State, the death due to alleged torture of a Bihari youth at a government-run mental health centre has shocked Kerala.

Psychiatrists, social activists and rehabilitation workers expressed shock that an acutely mentally disturbed person was allegedly knocked out of life at the State Mental Health Centre at Peroorkada, Thiruvananthapuram, on Monday. They were outraged that Satnam Singh, 23, of Gaya in Bihar, who had misbehaved at Amritanandamayi Madom at Vallikkavu, had been charged with attempt to murder by the overenthusiastic police.

They also wondered why was Mr. Singh, a PMI, sent to prison instead of being taken to a mental health centre.

Dr. Verghese Punnoose, honorary secretary of the Indian Psychiatric Society, Kerala, who termed the incident “shameful and shocking” said it should never have happened in this time and age. “It was quite clear even to a layperson that Mr. Singh was mentally ill and the police and the magistrate should have straightaway committed him to the mental health centre. The delay aggravated his condition.”

Dr. Punnoose, however, pointed out that the incident was proof that the mental health care facilities in the State were grossly inadequate, overburdened and understaffed.

State agencies blamed

Litto Palathinkal, lawyer and president of Kaniv, an association of mental health rehabilitation NGOs, told The Hindu that all State agencies involved in the incident were at fault. “From the investigating officer to the judicial officer to the prison authorities to the SMHC staff had blundered,” he said. The investigating officer should have immediately taken Mr. Singh to the magistrate and reported about his abnormal behaviour, the magistrate should have sent him at once for medical examination and the mental health centre should not have lodged him with others and given him adequate care and security.”

“The incident shows that a person with mental illness, particularly if he is poor and without family or relatives, is not safe in our mental health care institutions,” C.J John, chief psychiatrist at Medical Trust Hospital here, said. “It also shows that our institutions are yet to evolve out of the concept of custodial asylums.”

A former senior psychiatrist, who had worked at Peroorkada, said the staff there were not trained in or oriented at handling violent patients. Lower-level staff often tended to respond to patients who did not obey them with violence.

This was totally wrong as the disobedience was the manifestation of the patient’s state of illness.

He noted that giving a haircut and shave as part of the patient’s personal hygiene were routine at the SMHC; but this should have been carried out with discretion.

“Satnam Singh must have taken the attempt to cut his hair as a huge personal assault on him and must have tried to defend himself,” the psychiatrist who did not want to be identified said.

He also called for posting at least one policeman at the forensic ward and that the ward should be constantly monitored.

Dr. Punnoose said professional training in handling PMIs should be made mandatory for all the staff at the centre. Patience, humaneness, knack and the awareness that they were dealing with mentally unsound people were necessary for the staff. The centre, he pointed out, was thoroughly understaffed.

“In the afternoon, only one psychiatrist was available for the more than 500 inmates and dozens of outpatients. This psychiatrist has to attend to medico-legal and other cases too,” he said.

General nurses were attending on PMIs as psychiatric nurses were not available. Many of the staff had arrived there on punishment transfer and their commitment to the welfare of the patients naturally was suspect.

“Like in the case of Avanoor, which prompted a rethink on the running of mental health rehabilitation centres, the Peroorkada incident should trigger action on drastically improving the mental health care delivery system in Kerala,” Dr. John said. PMIs are the most defenceless and marginalised section of society, he noted.

  • Stress on need to improve health care delivery

  • ‘Professional training mandatory for staff’