12 November 2013

Abandoned with bedbugs in West Bengal

Please click here to read this blog post in Bengali.

Under the basking sun, 1950s cars are honking their way slowly down the streets and auto-rickshaws are putputputing in and out of the traffic. Cricket blaring from one radio, Bollywood techno from another, a Hijra claps her hands as a Dalit girl dashes through the traffic begging for a few Rupees. In the hustle and bustle of contemporary Kolkata what chance do 1,800 people locked up the city’s five mental asylums have for attention? Victims of the West Bengal government’s lazy policy of stigma and segregation, these inmates are detained indefinitely under India’s draconian mental health law. In early November I visited two of these institutions and saw how human rights were as scarce as boredom and bedbugs were plentiful. An NGO called Anjali is trying to get the detainees back to their communities, but they’re fighting against a broken system. Is there a hope in this hell?

In and around Beniapukur, a predominantly poor Muslim area of Kolkata where I visited two mental asylums 

“My father brought me here 16 years ago”, said Sanjaya, a 29-year old woman, in Bengali. Her family appear to have freaked out when, at the age of 13, she started having mental health problems. Instead of getting some support, they dumped her into the Lumbini Park institution, where she was robbed of her youth, her education, and her safety. Detained there for the past 16 years without committing any crime, she was allowed out for a day two years ago. She returned to her family who had abandoned her. “I went and cried. I wanted to stay, but my family didn’t want me”, she told me.

Sanjaya is one of 96 inmates at the Lumbini Park institution under the Kasba Police station district, a poor Muslim area of Kolkata. I use the word 'inmate' because people are detained for many years. Naveena, a 60-year old woman, told me how she had been working as a cashier, but following the death of her husband she developed depression. Her brother brought her to the institution. That was 13 years ago. “I can’t go back, so I have to adjust to the situation here”, she told me, resigned to her fate. She and many of the women I spoke to complained about the food, and about the infestation of bedbugs. All of them wanted to go home.

“I wanted to stay, but my family didn’t want me”. Lumbini Park mental institution in Kolkata. It is named after the place in Nepal where Buddha was born.

Children placed with adults

Downstairs is the male unit and I spoke with the manager. After some probing, he told me that the youngest of the inmates is 13 years old. “Let’s grab the kids and run”, I thought. Realising that this was impossible, I asked whether having children on the predominantly adult ward posed any challenges for the staff. “No”, was the ward manager’s answer. I was stunned. The answer betrayed a total lack of consideration by the management of the terrible consequences of institutionalising a child, placing them at obvious risk of physical and sexual abuse, and without a doubt directly causing mental anguish and trauma. Once in the institution they are denied the right to education, setting them on course for a life of poverty. At the macro level it was an indication that once labelled with a “mental” diagnosis, it matters not what other characteristics a person has: child, adult, woman, mother, worker, wife. No longer human, the “mental” being needs to be here in this institution, where everyone is treated the same.

Overcrowding and locked up

There are five institutions in West Bengal, housing around 1,800 people. The largest of these is Pavlov, a short cab ride away. It currently houses 420 inmates, but there are only 250 beds. We visited the male unit, a 3-story building. Each story consists of one huge bedroom, and nothing else. There, I was shown round by Deenath, a man from a wealthy family who was abandoned because of his mental illness. “They’ll make sure he stays here,” said one of the people I was with, meaning that the family can easily pay off the relevant people to keep their mad relatives locked up for good.

I visited Pavlov right after lunch. On all three storeys the bedroom consisted of a very large room with lots and lots of beds in them. I spent time on the middle floor. There, 84 inmates shared 58 beds inside the padlocked room. Most people were asleep, because of the neuroleptic medication they were forced to take. I spoke to a couple of inmates through the bars, and more and more people came to see who the curious white visitor was. During the half an hour of being on the ward I didn’t see a single staff person. I’ve never been to an institution with no visible staff: usually the opposite is the case and staff breathe down my neck, preventing me to speak to people in private.

“My name is Raja Number 2”, said a man in his early 40s who has been detained nearly 3 years. “Number 2 because there is already someone called Raja here”. He spoke to me through the padlocked bars of the door. The inmates are allowed out for an hour in the morning and an hour in the afternoon. There is nothing to do apart from lie on the thin beds and the floor. It is clear that strong medication is used: there’s otherwise no way that 58 men would be asleep in the middle of the day. Daytime snoozing, slurred words, rocking back and forth, pill-rolling - sure signs of over-medication.

After spending time in the Pavlov asylum, I can barely string a sentence together

Unlawful detentions

It is the duty of the government to get people back into the community, but there is no coherent way for this to happen. On the contrary, “the system” has created artificial barriers to rehabilitation by making family willingness to receive their relative back home a precondition to releasing an inmate. As the West Bengal government’s draft rehabilitation policy observes, the superintendents of the hospitals fear being responsible should a patient “befall any untoward situation after release”. The document says this can be justified on “safety” grounds, before observing that “our custodial nature contributes a lot for such mindset.” Apparently, “further clarification of the matter from the legal point of view is required to reach a concrete decision in this regard”.

So while the government clarifies the legal point of view at snails pace (the document was published in January 2013 and the government has not clarified anything yet), you only have to read the Mental Health Act 1987 to see that the West Bengal government’s approach is unlawful. There is no power for the superintendents to detain a person once the initial criteria for detention – mental disorder plus a risk to the person’s health and safety – no longer persist. Acceptance by a patient’s family is an extra-legal and irrelevant criterion created by the superintendents. This means that most or all of the 1,800 people are unlawfully detained, even under existing law. In these circumstances, it is surprising that no habeus corpus application has yet been made on behalf of the detainees.

A hope in hell?

My visit was organised by a mental health rights NGO Anjali, which has been working in the institution for 12 years. Anjali brings a light into the dreary lives of institutionalised people. They are battling with a system that essentially does not care. Anjali runs rehabilitation programme, and thanks to their work, in the last 6 months 14 inmates were discharged from the 3 institutions where Anjali works: no mean feat for an organisation with 35 persons including part time staff. Anjali’s primary role is to act as a watchdog inside the institutions. Without their eyes and ears the institutions would clearly be much worse, and indeed when Anjali started 13 years ago, the institutions were horrific. Still today there are numerous problems, on which Anjali pounces and provokes. In June 2013, approximately 40 of the inmates went on hunger strike, complaining about the dire food. Thanks to Anjali, their Gandhian action was covered widely in the local media, and resulted in a change in food that the inmates wanted, such as chicken, egg, mashed potato with green chillies. The inmates have gained weight and are not malnourished as they used to be; most importantly they felt heard and listen to.

Ratnaboli Ray explains why Pavlov’s inmates resorted to going on a hunger strike

West Bengal’s mental health Provocateur-in-Chief is my good friend Ratnaboli Ray, who founded Anjali in the year 2000. Her vision of inclusion is simple. Community-living doesn’t require a huge infrastructure, but you need to work with people to develop a “containing community”. She has battled against the authorities simply to get access to the institutions. Maintaining a relationship with the West Bengali government –whose performance on maintaining the institutional dumping grounds is second to none – is like walking on a tightrope. The approach is friendly enough to maintain access to the institutions, but independent enough not to become co-opted.

Inside the Anjali office

Ratnaboli is the first to admit that she spends most of her time fire-fighting: seeking redress for a woman who gave birth in an institution without any help (and was then told to clear up her mess by the staff); suing the institution for not organising emergency treatment for an inmate with head injury who died three days later; improving the hygienic conditions to a bearable standard. So MDAC and Anjali are discussing how we could collaborate to develop a litigation strategy which would force the government to support people abandoned by their families, rather than acquiesce to a silent human rights scandal.

All inmates' names have been changed to protect people’s identities.