Escape from Erwadi

Print edition : September 01, 2001

The State government comes to the rescue of the mentally ill lodged in Erwadi's faith-healing homes, but a lot more needs to be done for their complete cure and integration into society.

SHANTI shuffles along, dragging her feet, as if she were chained. She is not, but she is yet to realise fully that she is free of the fetters that bound her for eight years. Shanti is one among the many mentally ill persons who were transferred to the Institute of Mental Health (IMH) in Chennai following the closure of the "mental homes" at Erwadi in Tamil Nadu's Ramanathapuram district. Such has been the treatment meted out to her at the mental home that even if she were to be cured of her illness, the trauma of having been chained, confined and ill-treated is sure to haunt her.

Mentally ill patients who were brought from Erwadi to the Institute of Mental Health in Chennai on August 16.-V. GANESAN

Yet Shanti is lucky at least to be alive, and she owes her "freedom" to the 28 chained inmates of the Moideen Badusha Mental Home who died on August 6 unable to escape the fire that engulfed the thatched shed that housed them (Frontline, August 31, 2001).

The mental health care system in Tamil Nadu has remained in a deplorable state, with successive governments failing to act on the various reports and studies on the plight of the mentally ill at the various faith-healing centres. The Erwadi tragedy, which caught the attention of even the international media, has forced the State government to act. It has decided to implement, after 14 years, certain sections of the Mental Health Act, 1987, and has announced some immediate measures to deal with the situation. However, this will be done without addressing the larger issues of treatment, care and rehabilitation of the mentally ill.

The measures announced on August 10 to regulate mental homes include the immediate closure of all such homes functioning in thatched sheds and the "unchaining" of all inmates. Inmates of all "faith-healing" homes in the State are to be examined by doctors, and those with violent tendencies will be admitted to government hospitals. Those found to be normal are to be reunited with their families; those abandoned will be given an old-age pension and sent to homes for destitutes run by the government or reputed non-governmental organisations (NGOs).

All 15 mental homes at Erwadi were closed on August 13 and their 571 inmates taken under the government's care. As stipulated by the Mental Health Act, all inmates were produced before the District Magistrate, and a team led by Dr. M. Soundararajan, Professor of Psychiatry at the IMH, the Secretary to the State Mental Health Authority and the coordinator of the District Mental Health Programme (DMHP), examined them. Many are now being treated for schizophrenia, cerebral palsy, epilepsy and mental retardation. While 11 inmates, who had a tendency to become violent, were admitted to the Ramanathapuram Government Hospital, 152 were sent to the IMH and the rest back to their families. According to Tamil Nadu Health Minister S. Semmalai, all government hospitals and primary health centres (PHCs) in the State will provide medical attention to the inmates who have been sent home.

Twenty families have so far received the ex gratia payment of Rs.50,000 announced by the State government to the families of those who died in the Erwadi fire. The Tamil Nadu Medical Supplies Corporation has sanctioned Rs.5 lakhs to procure drugs for the 152 inmates admitted to the IMH, while the government has sanctioned another Rs.15 lakhs to improve the basic amenities at the IMH to accommodate the new patients.

Ramanathapuram Collector S. Vijayakumar has set up a monitoring committee comprising the Village Administrative Officer, the Revenue Inspector, the Health Inspector and the Erwadi village panchayat president to prevent the setting up of any more mental homes and to ensure the monitoring of the mentally ill who are staying with their families within the premises of the Erwadi dargah.

THE belief that "holy water" from the dargah and oil from the lamp burning there have the power to cure all illnesses, particularly mental disorders, had people flocking to Erwadi in search of a cure. The situation worsened with some people (mostly those who themselves had come to Erwadi in search of a cure) setting up "homes" for the mentally ill.

The government has now made it mandatory for anyone setting up such a home to obtain a licence as stipulated by the Mental Health Act, 1987. It has also ordered the setting up of a monitoring cell in every district, under the Collector, to make sure that the homes conform to norms.

A chained mentally ill person in the premises of the Erwadi dargah.-K. GANESAN

On August 7, a five-Judge Bench of the Supreme Court, comprising Chief Justice A.S. Anand, Justices K.T. Thomas, R.C. Lahoti, N. Santosh Hegde and S.N. Variava, suo motu issued, on the basis of media reports on the Erwadi tragedy, notice to the State and Central governments asking them to submit a "factual report" of the incident. The Bench observed that the issue "raises important questions concerning human rights of inmates of the mental asylum, who could not escape the blaze as they had been chained to poles or beds". The Centre has ordered the mapping of all faith-healing homes for the mentally ill in the country. Union Health Minister C.P. Thakur has ordered the implementation of the guidelines for maintaining minimum standards in mental homes. The Centre also plans to modernise all government mental hospitals.

On August 20, the Tamil Nadu government launched the DMHP in Ramanathapuram and Madurai districts with an initial fund of Rs.27 lakh each (the total project cost is Rs.1 crore). The programme consists of three components - health care, training, and education and communication. According to Collector Vijayakumar, the main objectives of the programme are to provide basic mental health services on a sustained basis and to put in place a system for early detection and treatment.

The IMH in Chennai will be the nodal agency, and its Director the officer in charge of the programme. The five-year programme, sanctioned in 2000 by the Centre under the National Mental Health Programme (NMHP), is to reach every taluk in the two districts. According to Semmalai, a team of doctors and paramedical staff will visit every taluk regularly, screen people for mental illness, and provide treatment for those who are ill. Those needing hospitalisation would be referred to government hospitals.

Tamil Nadu, which implemented the DMHP four years ago in Tiruchi (the other three States that have the programme are Assam, Andhra Pradesh and Rajasthan) as part of the NMHP, has made some success; 42,000 patients have come for review and 2,700 have been identified as needing medical attention. The thrust of the programme has been on training village and community leaders, providing medical help at the taluk level, and generating awareness, particularly in the rural areas. This success, according to Dr. Soundararajan, is largely because of the massive strides made in public education, and this will be replicated in Ramanathapuram and Madurai districts.

The State government is planning to build a 10-bed hospital exclusively for the mentally ill in every district. An awareness programme that will cover the symptoms, treatment and management of mental illnesses, is also to be initiated in every district. A training programme for doctors and paramedics is also planned. Psychiatrists are to be posted at all district headquarters hospitals; 14 of the 25 such hospitals do not have psychiatrists now.

WHILE something is happening in the case of the mentally ill who have been taken under the government's care, what of those sent back from the 'homes' to their families? Raghu, an inmate of a home in Erwadi, has been sent back to hsi family in Sikkil (Thanjavur district), but his father, Madhavan, does not know what to do with him. With two daughters to be married, Raghu is a burden. Madhavan neither has the money to have Raghu treated in a private hospital nor can he bear the stigma of having a mentally ill person at home. The important question is: What happens to the millions of such families with mentally ill persons to take care of, and, more important, what happens to these patients?

The State government has responded to the situation, but central to addressing the problem is the care of the patients and their integration with their families and society. According to Dr. C. Ramasubramanian, a Madurai-based psychiatrist and the founder-director of the M.S. Chellamuthu Trust and Research Foundation, changing public apathy and attitude to the mentally ill is crucial to addressing the problem. Given the enormity of the problem - considering that it has cultural, religious, economic, social and medical ramifications - the government cannot tackle it on its own. Only community-based rehabilitation, with the active participation and help of NGOs and philanthropists, can offer a lasting solution.

Medical help, vocational training, and rehabilitation with family and community support are essential for the complete treatment and cure of the mentally ill. For this, society at large should participate. This requires a mass awareness campaign - to break the myths and to educate people on the curability of the diseases. Says Dr. Ramasubramanian: "It is imperative that the government initiates the next step soon as it is an instance of now or never for the millions of the hapless mentally ill persons and their families."

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