The doctor is out. In fact, he’s only an occasional visitor. There are no full-time psychiatrists across jails and borstals (juvenile detention centres) in Maharashtra. Section 103 of the Mental Health Care Act, 2017, requires state governments to set up a mental health establishment in the medical wing of at least one prison in each state, where prisoners can be referred to and cared for. Certainly, such psychiatric wings can be found in Maharashtra’s jails—it’s just that they have no resident doctors, only visiting psychiatrists.
Sandeep Mahamuni, visiting psychiatrist at Yerawada jail, tells Outlook, “There are no full-time psychiatrists. I work as a visiting psychiatrist at the jail. There is also another clinical psychologist who visits as and when required. The patients are evaluated for anxiety, depression, schizophrenia and other mental illnesses. There is a psychiatric ward inside the jail. The prisoners who are suicidal and need immediate attention are admitted to hospitals in Pune—since there are no full-time doctors at the jail, where they are kept on oral medication. The clinical psychologist conducts counselling sessions for the prisoners.”
Maharashtra’s inspector general, prisons, confirms this, saying. “There’s no full time psychiatrist for any jails in the state. As and when any undertrial or convicted criminal has a need, they are referred to the relevant doctors.” He adds that jail staff may also be called upon to take up the slack: “Further, when there’s a need for the staff to acquire knowledge, police conduct in-house training for jail staffers by calling in psychiatrists.”
Can such provision be adequate? “Prisons embody a vicious cycle of mental disorders and human rights violations. Due to the lack of any psychological support inside, this situation often precipitates into mental disorders, which can lead to serious impairments and disabilities. So while some prisoners commit crimes when mentally ill, many develop mental disorders while in detention. In both instances, courts can, after ensuring that the accused is of unsound mind and is incapacitated to stand trial and further allow delay of the trial,” says a prison inspector at Arthur Road jail in Mumbai.
Counselling and support are vital for young offenders. “Juveniles at the borstals like to explore their sexuality. Sex education at juvenile observation homes, jails and borstals is very important. Sodomy in jails is a common issue. Mental conditions in the jails can be transformed by humanising the experience through communication,” asserts psychiatrist Harish Shetty.
The law may also call for regular treatment for inmates. According to Dipak Chattopadhyay, an advocate at the Bombay High Court and former member of the Juvenile Justice Board, “Section 330 of the Code of Criminal Procedure, which provides for the release on bail of a mentally ill undertrial, is confusing, but suggests that where bail cannot be granted, the court must order the accused to be kept in a place where regular psychiatric treatment can be provided. If implemented, this would mean that mentally ill prisoners can no longer be kept inside a prison. The National Legal Services Authority’s scheme for mentally ill persons also supports the intent of Section 330, inasmuch as it directs state legal services authorities to carry out inspections in all jails with the assistance of state mental health authorities. These checks seek to ascertain whether there are mentally ill people in prisons, and if such persons are located, legal services authorities must seek appropriate directions to shift them out for treatment.”
Implementation is the crux here; Chattopadhyay adds, “More than 5,000 people with mental illnesses are currently imprisoned across India, and despite the law’s corrective measures, little has been implemented.” Why not? Nilesh Jerurkar, visiting psychiatrist at the Nashik central jail, observes, “In my experience of serving at the jail for the last 3.5 years, I have been treating around 3000 patients. Many of them have been suffering from mental irritation, schizophrenia and other mental illnesses. We keep tabs on the behavioural changes of the prisoners, a diary entry of the medicines prescribed to them is made, and counselling is given to them. The priorities of the jail authorities are different. Hence, no full-time psychiatrists are appointed.”
By Neel Shah in Mumbai