Review of Psychiatric Homes/Mental Hospitals of Government Sector in India With Special Reference to the Female Patients in IPD

The report identified several deficiencies in the infrastructure, facilities, and care within psychiatric institutions particularly in relation to female patients availing in-patient care. The issues observed included overcrowding, lack of recreational facilities as well as inadequate availability of necessities such as running water, electricity, and clean bedding.

According to the National Institute of Mental Health and Neuro Sciences (NIMHANS) report, female patients faced a lack of privacy while bathing, dressing and using the toilet. This encroached on their right to basic dignity. The patients also reported they had their hair cut without consent, they had not been provided adequate information regarding their illness and treatment and that they had limited say in decisions regarding their health.

The report cites the National Mental Health Survey of India, 2015-16 published by NIMHANS to state that there is a severe shortage of mental health facilities and trained mental health professionals in India. The ratio stands at 0.3 psychiatrists per one lakh population although the requirement states for at least one psychiatrist.

As per the survey samples, there were 177 sanctioned positions for clinical psychologists and psychiatric social workers in 24 of the 27 institutions surveyed. There were no sanctioned positions for such personnel in the remaining three facilities. The report also found that there were no norms in place to determine the number of health workers necessary per certain number of patients/beds.

Data collected from the various institutions showed that 40 per cent of female patients were aged 35 to 50 years. Around 33 per cent were from the age group 18 to 34 years and 22 per cent were aged 50 years and above. Only four per cent female patients were younger than 18 years.

From the data set, 35 per cent of patients were married whereas 28 per cent were single. Around six per cent had divorced or were separated and four per cent were widows. The report categorises the remaining 27 per cent as ‘destitute/others’.

Highlighting the importance of familial contribution in helping patients deal with mental illness, the report notes that 22 institutions allowed family visits. It recommends that all facilities should allow for family visits, the frequency of which can be decided by consulting the psychiatrists in charge.

Of the 170 sanctioned posts for general duty medical officers in 24 psychiatric homes, 105 were filled. Of these 41 were women. The report notes the number of psychiatric patients under their care to be 5,101.

Only 11 of the 27 facilities surveyed had a dietician managing the food requirements of the patients. The menu in many of the places was also repetitive with no special food being provided to the patients on a weekly basis.

The report advocates for the Central Mental Health Authority to develop norms for determining psychiatric health worker posts in all such institutions. These should consider the average number of patients and provide for the hiring of female health workers.

The report recommends constitution of an Internal Complaint Committee (ICC) under provisions of the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013. It also says that the ICC must hear complaints from the female patients – both inpatients or outpatients.

Focus and Factoids by Cherish Mundhra.

PARI Library’s health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India