National Strategy for Inclusive and Community Based Living for Persons with Mental Health Issues
This report was published in 2019 by the Hans Foundation, a charitable trust based in New Delhi. It contains the results of a survey of patients at government-run mental healthcare facilities in India, to study their needs and suggest ways to enable sustainable and inclusive community living.
Foundation set up a Task Force comprising of government institutes, hospitals,
and other organisations, which surveyed 13,613 ‘inpatient clients’ at 42 psychiatric
establishments from August 2018 to February 2019. The team examined establishments
across 24 states with varied numbers of hospitals surveyed in each – for
instance, as many as four were studied in West Bengal. The average age of the
participants in the survey was 45.88 years; the youngest participant was 12
years while the oldest participants were 99 years old.
36.25 per cent (4,935 patients) of those residing in the surveyed
government-run facilities had been living there for over a year. The report
states that such high rates reflect “the institutionalisation of people with
mental illness.” The lack of adequate rehabilitation measures segregates and
alienates patients from the world outside the health facility. This keeps them
from accessing socio-cultural opportunities and exercising the right to dignified
177-page report is divided into eight chapters: Executive Summary (chapter 1);
Background (chapter 2); Methods (chapter 3); Key Findings (chapter 4); Strategy
to address Long-stay in State Mental Health Hospitals in India (chapter 5); Action
Plan (chapter 6); Conclusions (chapter 7); Glossary and References (chapter 8).
Among the surveyed states, West Bengal (971), Tamil Nadu (612), Punjab (233), Madhya Pradesh (206) and Uttarakhand (19) recorded the highest proportions of those who resided in State-run mental healthcare facilities on a long-term basis – that is, for more than a year.
Kerala (168), Karnataka (69), Telangana (50), Andhra Pradesh (25), Assam (10) and Bihar (9) recorded the lowest proportions of those who resided in such facilities on a long-term basis.
The percentage of long-term users of residential services in mental healthcare facilities was greater for females than males – the former accounted for 54.3 per cent and the latter formed the rest out of 4,935 patients. Qualitative notes gathered during the study suggest that this difference emerges from gender discrimination and the abandonment of women especially as a result of family disruption, marital discords and violence in intimate relationships.
The average duration of stay in the mental healthcare facilities was reported to be six years. Among the surveyed individuals, a majority (48.4 per cent) had stayed in the facility for between one and five years.
Among the patients who lived in mental healthcare facilities, 33.1 per cent were brought to the hospitals by their families while 55.4 per cent were referred there by local authorities such as the police or magistrates.
Over half the participants reported suffering from schizophrenia. Bipolar disorder was detected in 4.7 per cent of the surveyed individuals, while acute psychosis was diagnosed in 4.6 per cent of the participants.
Most patients did not have opportunities to engage in social or professional interactions outside the hospital. Around 93.5 per cent of participants had remained confined to the hospital premises since admission – most of them had not been employed in work outside the hospital since two years prior to when the survey was conducted.
The report notes that patients are not sufficiently rehabilitated into mainstream society after institutional care. It discusses their inability to reconnect with family; their disinclination to return to trauma-inducing environments; and the stigma associated with mental illness. In several instances, they return to households with insufficient resources, lack of caregivers, little or no access to medicines or money – adding to the household’s expenditures. The report states that such circumstances often lead to readmission into government-run facilities. It notes a spike in readmissions during festivals and wedding seasons.
The report recommends that the government set up a National Steering Committee under the Ministry of Health and Family Welfare, with the aim of helping patients suffering from mental illnesses to move from long-term institutionalisation to more inclusive community-based alternatives.
Launched in 1996, the government of India’s District Mental Health Program (DMHP) is a key initiative to provide mental healthcare resources after patients’ discharge from hospitals. The report states that the policy has been especially effective in the states of Uttar Pradesh and Gujarat.
However, the DMHP too suffers from inadequate infrastructure, lack of human and medical resources at the level of primary health centres, and bureaucratic hurdles leading to delays in disbursing funds.
Focus and Factoids by Debadrita Saha.
The Hans Foundation, New Delhi
The Hans Foundation, New Delhi