Vikram Patel is professor of international mental health and founding director of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine. He’s been featured in Time magazine’s 100 most influential people worldwide. He spoke to Priyadarshini Sen on the dark side of mental institutions. Excerpts:
What are your thoughts on labelling a person ‘mad’ and committing him/her to a psychiatric care facility?
Well, being admitted under a magistrate’s order based on the current mental health act to a mental hospital is one of the most terrifying experiences that anyone in this country can experience: your basic rights to liberty and dignity are taken away from you, and you are likely to find yourself in a colonial- era asylum, in crowded and insanitary living quarters, locked away and forgotten by society.
What are the alternatives to institutionalisation in India?
The alternative best practice is a combination of general hospital in-patient care for acute and emergency situations, out-patient care for those who need medicines, and community-based care delivered by trained community health workers for the delivery of continuing psychological and social interventions.
Do you think the role of a family in admitting a member to a mental hospital should be more carefully defined?
Absolutely, for even though most people will have supportive families, there will always be instances where a family may wish to have a member ‘committed’ for reasons which are malafide and self-serving, rather than in the interest of the person. This is why in all progressive mental health legislations, an independent person or panel appointed by the state with semi-judicial authority is there to support the person to make a decision on their choice of care.
Is the Indian government doing enough to plug the loopholes in our mental health laws to prevent people from being admitted to a mental health institution for vested interests?
On paper, yes, like through the new national mental health policy, draft mental health care bill and the district mental health care programme. On the ground, though, we are yet to see any tangible impact. A key problem is that states have very variable interests and technical capacities to implement policy and programme instruments.
Recently, the government started a campaign to determine the condition of women across mental hospitals in India. Your thoughts on this?
It should appoint an independent public health research institution, not a government institution, to carry out this survey in an objective and impartial way to address the following questions: how many women live in these institutions; how long have they been incarcerated; what were the circumstances that led to their admission; what is the quality of care they have received; what is their current health condition; why are they not living in the community.