New Delhi: A new survey of 43 mental health hospitals across India has found that 36.25% of their patients have been residing in the facilities for a year or longer.
The figure is way above the averages of the South East Asian region (11 per cent) and world (18 per cent).
While the survey, titled the National Strategy for Inclusive and Community Based Living for Persons with Mental Health Issues, takes the one-year mark is an operational definition, its findings say a large number of the patients surveyed had spent over a quarter of a century in the mental health institutions.
Stigma, homelessness, no source of income or support system, gender disadvantages — there are several factors that are said to make the patients’ stay at mental health facilities in India much longer than required.
According to Dr B.N. Gangadhar, Director of NIMHANS who was on the task force of the study, most patients admitted to mental health facilities are usually fit for discharge within four to six weeks. “Hospitals and doctors don’t want to keep patients for a long time. Patients end up staying because they’ve been abandoned or have no other place to go.”
Dr Gangadhar added, “Treatment should continue after discharge. It’s not necessary for the patient to be in the hospital to receive treatment.”
The survey aims to evolve a national strategy that can help move this group of people out of these facilities and back into the mainstream.
“Currently, available options for long term care outside psychiatric hospitals are mostly limited to institutional set ups run by state and non state actors,” says the report, adding, “In the last decade, India has seen some movement towards de-institutionalisation. But these are in small measures, mostly individual endeavours, and far from the holistic, community based support services in true spirit and form.”
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Long-term ‘patients’ are mostly women
Of the 13,610 patients surveyed, nearly 5,000 had been staying in mental health facilities for over a year, and 54.3 per cent of them were women.
“Women face a lot of gender-based disadvantages. If there’s a relational disruption, with their families or partners, women are left with no social capital or network after that. People are not very supportive of women when they develop a mental health issue,” said Lakshmi Narasimhan, head of the Centre for Mental Health and Inclusive Development, and contributor to the paper.
The survey was conducted by the Hans Foundation in partnership with NIMHANS, the Tata Institute of Social Sciences, and several civil society organisations on directives issued by the ministries of health & family welfare and social justice & empowerment.
It terms long stays as “one of the most profound manifestations of social exclusion of people with mental illness” where they are “segregated and removed from the outside world”.
The rate of isolation among in-house psychiatric patients in India is high — 93.5 per cent of the participants hadn’t stepped out of the institution during their stay, 86.5 per cent had never had a visitor, and 94.8 per cent had never visited anyone out of the hospital.
“A majority of these wards (77.1 per cent) are closed, which means patients cannot leave their locked wards or spend any time outside the ward. There’s truly no need to have closed ward systems, because you could inherit secondary deficits which could affect mental health further,” Narasimhan said.
While nearly 50 per cent of long-term residents lived in institutions for between one and five years, the report found that 11.4 per cent had been there for over a quarter of a century. “…in effect a better part of their lives had been spent within the confines of these facilities,” said the report.
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Step towards national strategy for reintegration
Long-term stays in mental health facilities in India are driven by multiple factors, including stigma, homelessness, resource and policy deficits for possible discharge, and histories of caste, class, and gender disadvantages.
Even with high numbers occupying mental health hospital beds for the long term, most — 78.6 per cent — are said to have “none to moderate” problems while transitioning to community placement among their families or other supportive environments like group homes.
“Governments need to increase financial investment defined by a policy and accompanying the National Scheme for Personal Assistance and Housing Options to promote community living for people with long-term care needs,” says the report.
The study recommends imagining and implementing a community care system to facilitate de-institutionalisation, aided by state and national committees under the Ministry of Family Health and Welfare. These committees are to function as “a stakeholder collective to pursue shared visions of moving from long term institutionalisation to community based alternatives”.
The community care system should “keep pace with supports needed when people move out of hospitals, and decisively alter progressions and re-entry into homelessness and long term institutionalisation”, says the report.