On a scorching summer afternoon Jaya sits outside a row of decrepit houses near the Varkala beach, a top tourist hotspot in the State. Her right arm is covered in a tangle of cuts and she has a bad gash running down her temple that just missed the eye – the aftermath of a razor blade attack by her 23-year-old son.
He had started off with cannabis at the age of 17, later switching to synthetic drugs that kept him irrational and violent mostly. But the last time he went berserk like a man possessed and tore down a part of their ramshackle house, she dialled the helpline number given by her ward member.
“I told them I will kill myself and soon some officials arrived. But they wanted me to file a police complaint and I did not want him sent to jail,” she says with a sigh.
Also read: On the substance abuse trail in Kerala
When Rajesh found his 14-year-old daughter overdosing on prescription drugs, it came as a huge shock for the family. After some secret trips to a private medical college hospital in Kozhikode and some counselling sessions, he thought the matter was settled. But by the time she started Plus One, the young girl had waded into more dangerous territory.
She was using LSD stamps and her tantrums were beyond control. Even after months of therapy, there are bouts of aggression and self-harming. On some extremely difficult days, her father goes in search of the local peddler to get her a quick fix as “it shatters us to see our child in such condition”.
According to the police, a large percentage of suicides, homicides, and domestic abuse cases stem from substance abuse. “Crimes triggered by drugs or alcohol have been on the rise, especially intimate partner violence. Addiction often impairs judgement and users in their desperate drug-seeking mood can be highly dangerous. Studies show that drug and alcohol dependence also escalates suicidal tendencies and we should remember that the suicide rate in Kerala is high when we compare it with national average. At the same time, our current system is quite inadequate to address the menace of addiction, which has far-reaching consequences,” says a senior officer.
Training for law enforcers
Though it is possible to reduce and eliminate the risk factors while dealing with drug abuse, at present there is no system for targeted interventions. Despite implementing seemingly strong strategies, the result is hardly promising as the process is riddled with roadblocks.
According to healthcare professionals, everything from political will to community-level awareness matters and they seem quite apprehensive even after Kerala government’s ordinance amending the Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Act of 2012 by introducing more stringent penal provisions against those perpetrating violence against hospitals and by widening the definition of healthcare workers.
“Violence by persons with mental illness is not common in general casualty settings. People who unleash violence in hospitals are not those who face mental health issues but anti-socials under the influence of substances. Very often law-enforcers require proper training to assess a situation when they are dealing with such cases. The police should be able to anticipate contingencies and be proactive as the Kottarakara incident proves that they can go to any extent. They cannot bring in people with aberrant behaviour to casualty without proper precautions,” says M.T. Harish, psychiatrist.
He adds that the entire system needs an overhaul as most casualties in government hospitals function as extended outpatient departments. “This leads to increased workload as the duty doctor, who is posted to take care of real emergencies, spends a lot of available time seeing walk-in outpatients who do not need emergency care. If you look at the workforce, a vast majority are women and their safety is at risk. The government amended the Act with a good intention, but we must also realise that there is a nexus between the police and local politicians that sabotage the entire process,” he says.
Psychologists and counsellors working with government institutions and the Vimukthi Mission say they often feel unsafe. “The scale of violence will depend on the kind and amount of the substance they take and often patients on the early stages of rehab exhibit compulsive aggression. While private de-addiction and therapy centres are fully equipped to deal with such situations, we survive on luck. There have been incidents, but nobody cares,” says a counsellor working with the department.
Meanwhile, the police feel that the force should not be judged on the basis of a stray incident. “What happened in Kottarakara was totally unfortunate. But we have been grappling with staff shortage for a while. A large number of police stations in Kerala are understaffed. That does not mean that we can avoid any duties or delay investigation. But it will definitely affect their efficiency and performance. Notorious criminal Aadu Antony could kill a policeman as the patrolling team had only two members,” says an office-bearer of the Kerala Police Association.
He adds that though the Home department had plans to recruit more persons the decision was put on the back burner due to the post-COVID-19 crunch.
“At present all local police stations in the State are manned by less than 25,000 personnel which is far from ideal staff strength,” he says. He adds that they are also concerned about the media trial that follows incidents where a police officer is forced to physically subdue a person.
“You will find at least a hundred online links about an incident in which a policeman kicked a poor ticketless passenger. In reality, he was a habitual offender and an accused in multiple sexual abuse cases who was just released from prison. The policeman had to use force when this fellow tried to assault female passengers, but the assistant sub-inspector was suspended to satisfy the media. Such incidents affect our morale,” he says.
Law enforcers usually deal with addicts on a regular basis as they are the first responders during emergencies. “Every evening we get phone calls from distressed family members and neighbours. We have been handling such cases for a long time and officers are experienced enough to manage such situations. But what we need is a permanent solution as keeping the person at station for a night will not magically reform the addict. They call us when the person turns violent or threatens with suicide, but as soon as we defuse the situation, the family requests us not to file any complaint. Without their cooperation, we are also helpless,” says a senior civil police officer.
Gaps in the system
Though the Excise department has established de-addiction centres across the districts under the Vimukthi Mission, getting an admission is not possible without a caregiver.
“There are limitations for law enforcers to get involved. Most families are not willing to file a complaint and, in some cases, to get the person treated. All we can do is to warn them and I do not think admonishing will make any difference in the case of hardcore druggies and alcoholics. We get a huge number of distress calls from all excise ranges, but a good percentage of the families do not want to go through the official route and we have no other option. Even if we know a person is a potential threat, we cannot do any follow-up unless the family contacts us. We can intervene only when the person gets involved in another crime or peddling,” says a high-ranking official of the Excise department.
He adds that the department is at present readying a proposal to streamline the process. “If we do not launch a strong and sensible strategy there will be a spike in overdose deaths and associated crimes. We need systematic intervention, de-addiction treatment, and counselling so that there are no chances for a relapse. At present, we are helpless even if we know the person is prone to violence due to drug use disorders. From the surface our system may seem perfect with so many campaigns and events to prevent substance abuse. But most efforts are futile as we need a lot of changes to ensure they are properly treated and rehabilitated. But only the government can take a final decision in such matters,” he says.
*Some names changed to protect identities