Shristi is a cluster of homes at Musundagiripatti, 20 km from Madurai, where the mentally challenged are treated after initial medical care. It is more like a resort. The inmates are not chained or manacled. Each one is assigned a task - gardening, cleaning the cowshed, packing soap powder, making greeting cards, cooking, and so on. The premises, with a beautiful two-acre garden, are spic and span.
The basic objective of Shristi, run by the M.S. Chellamuthu Trust and Research Foundation under the guidance of its founder-trustee Dr. C. Ramasubramanian, a well-known psychiatrist based in Madurai, is to enhance the quality of life of the mentally challenged and reintegrate them into society. Started in 1992, Shristi now offers de-addiction therapy, helps the mentally retarded, organises community support groups, and provides vocational and skill-development training. To meet the recurring expenditure and to help impart skills to the inmates, Shristi runs a printing press, small industrial units making chalk, soap and agarbathi, a dairy farm and a computer centre.
Shristi was chosen as the best non-governmental organisation (NGO) by the Tamil Nadu government in 1996-97. It is recognised as a research institution in the field of mental health by the Department of Science and Technology, Government of India. The Rehabilitation Council of India recently recognised Shristi as a training institute. Dr. Ramasubramanian was a member of the Regulatory Committee set up by the Tamil Nadu government last year to look into the condition of the homes in Erwadi.
Dr. Ramasubramanian spoke to Asha Krishnakumar at his Madurai clinic. Excerpts from the interview:
What is the incidence of mental illness in India and how do people deal with the problem?
There are today an estimated 70 million mentally ill in the country. The degree of their illness ranges from marginal to severe, yet they all need treatment. There are hardly 10,000 hospital beds for the mentally ill and a few doctors to treat them.
The stigma associated with mental illness, the fear of social ostracism, unaffordable treatment and the myths that mental illness is contagious or incurable force many to try several crude methods before seeking psychiatric help.
First they try magico-religious methods. This is common in villages and is closely associated with culture, cutting across religious divides. This method, usually adopted by priests, makes use of hypnotism. Minor problems arising from pressure and fatigue, such as fainting spells, chest pain and breathlessness can probably be cured using this method. But major problems cannot be addressed.
Another method is shock treatment. This is usually a painful procedure in which some special herbs and leaves are made into a paste and administered through the nose, mouth and eyes. Or, the patient is suddenly pushed into a deep well.
If all this fails, they are taken for 'religious', 'divine' or 'faith' healing in Erwadi, Gunaseelam (near Tiruchi), or Courtallam (Tirunelveli district). Here, most often the patients are chained. They are beaten when they become violent. Faith-healing has no role to play in treating the mentally ill. It is a waste of valuable time.
Most patients stop with faith-healing; only some take the next step - of going to a psychiatrist. Unfortunately, by the time they come to us their situation would have become chronic.
What should be the nature of the treatment for the mentally challenged?
Total cure is possible. Mental illness, like any other illness, is curable, treatable and preventable. Most important is early detection, followed by effective treatment and appropriate rehabilitation. Treatment is incomplete if the patient is not integrated into society. He needs to be accepted by the family and then society. Vocational training and skill development are crucial for the patient to develop self-esteem, to be independent and to live with dignity. Follow-up and continuing medicines are a must.
Has pharmacology kept pace with the increase in the incidence of mental illness?
A silent revolution has been on in psychiatry. Some wonder drugs have been developed in the last five years. Drugs such as lithium have revolutionised treatment. Several medicines that do not make patients drowsy have also been developed.
But, even the rich and educated do not accept mental illness as a disease that can be cured. There is an urgent need to change society's attitude towards mental illness. For this, educating the people and creating an awareness is very important.
How expensive are the treatment and the medicines?
Right now the medicines are expensive. But the prices will come down. State intervention is important. Drugs should be subsidised. There should be community-based rehabilitation and self-help groups to deal with such problems.
Is the Mental Health Act, 1987, implemented in Tamil Nadu?
Only a few States have implemented the Act. Tamil Nadu has not. Had the Act been implemented, the Erwadi problem would have never happened. As, according to the Act, no home could have been set up.
But under the Act, it is an elaborate and cumbersome process before a patient can be given treatment. A 'Magistrate' and an 'Inspection Committee' need to approve a case for treatment. There is a need to simplify these procedures before implementing the Act, for which there is an urgent need.
What needs to be done immediately to help the hapless people who fall into the trap of "faith-healers" and quacks?
Inmates of all faith-healing homes in Tamil Nadu should be given immediate medical attention. There should be an outpatient psychiatric department in every taluk. There should be a well-equipped van (with a psychiatrist) to visit every taluk at least once a week. Generating awareness that the disease is totally curable and even preventable, and educating people on the various treatment opportunities and the availability of drugs can go a long way in addressing the problem. The success of the programme would, however, depend on how well the NGOs and the community are involved.