WE LACK THE HUMANE TOUCH IN OUR MENTAL HOSPITALS

The director and superintendent of Central Institute of Psychiat (CIP), Ranchi,. SS Raju, is directly involved with the treatment of mentaipátients in India. He spoke to Osarna Manzar on the status of mental health and hospitals ‘in India and how the situation can be improved.
What is your observation about the Indian mental hospitals, in general?
I must say That the mental hospitals In our country are not In a good shape. People say that humane reform for mentally ill had occurred one hundred years ago, but Indian mental hospitals are yet to see the humane reform. On the contrary, we find that humane care is evident in the general hospital psychiatry units.
What we lack In mental hospitals is the humane touch. The patients are kept In closed environs, between high walls and massive gates. Also, as the relatives of the patients cannot stay with the latter, the patients are left at the ward attendants’ mercy. If we could have a place where mental patients could be admitted with their relatives allowed to stay with thorn, even for a little while, It would certainly increase the recovery rate.
Can you give an example of such care, anywhere In the world?
I think In many Western countries, they are now demolishing the high walls and massive gates of the mental hospitals. But mental hospitals In India have not really done well, as far as the kind of care needed Is concerned.
What are the reasons of mental health problems?
Many of the major mental disorders, like schizophrenia and manic depressive Illness, are genetically determined. These are not due to the patients’. fault or worries or his strain and stress. Stress and strain. may contribute to mental problems but they are not the sole cause. Therefore, we must need to look after a mental patient like any other patient. The absence of proper treatment has been the only reason for mental patients languishing In mental hospitals, resulting in a no situation.
We are yet to reach the stage where optimum therapeutic situations are provided for the mental patients. In fact, mental asylums are known as mental hospitals today, at the instance of Lt Col AR Owen Berkeley Hill, the superintendent of Central institute of Psychiatry In the 1920s, who transformed the institute into a hospital.
Which is the most effective form of treatment for a mental patient?
Treatment depends upon the condition of the patient. To give the best treatment, accurate diagnosis Is the most Important thing for which we should attend each patient for at least. one hour every day. Unfortunately, in many centres, this much tithe is not spent. The treatment, meanwhile, are of different types: Psychotherapy, behaviour therapy, counselling, drug treatment and electro-convulsive therapy (ECT). Most of the minor mental disorders, like schizophrelila; mania and major depression, require mainly the drug therapy, and occasionally when drugs fail, ECT is also given.
Shock treatment is generally believed barbaric, but according to some doctors, BCT is preferred to drugs. What is your viewpoint?
Electro-convulsive therapy. nowadays, is not being given as frequently as it used to he a few years ago. Now we have more sophisticated and advanced drugs. However, ECT is occasionally recommended in severe forms of depression, where suicidal risk Is great. The medicine, as a matter of fact, takes three, weeks to help a mental patient and that period Is enough for the patient to commit suicide.
Compared to other illnesses, what Is the rate of occurence of mental health problems?
The most common type of illness Is depression. Surprisingly, It affects 10 to 15 percent of the population; Moreover, schizophrenia and epilepsy affect 1 percent and 2-3 percent respectively of the population. Though depression is 15 times more common than schizophrenia, with right dia gnosis and right treatment. for the right duration, it can cured successfully. As far as Schizophrenia is concerned, we are treating the patients, but about 30 per cent report unsuccessful.
What is the ratio of mental patients here and that In the other parts of the world?
In earlier days people used to think that mental health problem Occurs more In developed countries and less In developing countries, which Is a myth. Mental problems are as common In India as all over the world, except the fact that manifestations and symptoms may differ.
Our society Is not very open In accepting the mental patients, even after their cure. What role, according to you, does stigma play In the case of mentally ill patients?
Stigma has some role to play, I must say. But the Situation now Is much better than before. About 15 years ago, people were not coming readily for psychiatric help, but now the. people have started coming to us for help, Very often, patients come on their own volition.
Do you think that the mental health problem will ever be eliminated from the map?
Not as long as the world exists. But we can make the world safer and the life of people afflicted with mental illness much easier and healthier, by early diagnosis, proper treatment, adequate supervision and by doing more research.