WALK INTO Vidyasagar Amritsar Medical Hospital and you get some sense why. The hospital has 310 patients, 110 of them women. Of its 12 posts for psychiatrists, five are vacant. Of the three clinical psychologists’ posts, two are vacant. In a 2008 National Human Rights Commission (NHRC) report assessing government hospitals, it received a “poor” rating for its failure to provide treatment and rehabilitation to the patients. Sehwinder Singh, a senior doctor at the hospital had few answers. He is disposing of a stream of out-patients at a factory pace. Tall, pleasant, he spends an average of 2-5 minutes per patient. It’s been a full day’s work and people are still pouring in, including a recent bride in the throes of a manic attack. Tranquiliser injections are prescribed and the family members directed to the out-patient center. There is no counseling, no filing of case history, no human touch. “We see at least a hundred patients every day,” he says, as if he’s mind-reading. “Sometimes the system itself desensitises us.”

This is the hospital Asija had pulled his son out of, after a 13-month stay. When he had come home, Dheeraj was a medical mess: his weight had dropped by 15kg; his haemoglobin level dropped; he had swellings on his neck and legs, and Asija strongly suspected sexual abuse. “There are two kinds of patients at these places,” says Asija. “Either you get thrashed or you thrash others. My son got thrashed.”

Walk into Ashreya — the first and only government day-care facility for an estimated 66,000 mentally-ill patients in Chandigarh, and all the dread impressions are reinforced. Former Punjab Governor, Lt. General Jacob had laid the foundation stone for this center in 2002. He had even sanctioned funds to make it a resident, overnight facility. Six years later, however, the centre has failed to acquit its mandate. It now caters more to people with mental disabilities, rather than illnesses, though at least half a dozen similar facilities for the disabled already exist in the city. With only one small room and a pocket-sized lawn, barely 12 mentally ill people a day can now use Ashreya as an interim shelter.

And that’s just one example of a longoverdue initiative tripped by inscrutable and faulty government policy.

But that’s just the urban story. A casual visit to the government’s Institute of Human Behaviour and Allied Sciences (IHBAS) Institute in New Delhi — one of the most reputed in India — is a dip stick for what’s going on in rural India. Over 700 people turn up every day in the outpatient department (OPD) here. That fact that over 40 percent of these are from the countryside speaks volumes about the government-run District Mental Health Programme (DMHP) that has been in place for three decades. The individual stories of why some of these people have been compelled to make the journey to Delhi explain some of that chronic disrepair.

Mangeram, 38, is a vegetable seller from a village near Saharanpur city in western Uttar Pradesh. His teenage daughter slipped into acute depression in 2008, as had his son and sister earlier. “My life has gone in dealing with these illnesses,” he says. He spent a futile Rs 30,000 over six months on private treatment for his son in Saharanpur because there was no health centre near his village. He has finally found satisfactory treatment for both his children at IHBAS, but has spent over Rs 15,000 on medicines and travel expenses in recent months, taking a loan against his farmland and cattle.

Photo: DIVYA GUPTA ‘I Thought My Life Was Finished’ ARASHAMMA, 60, PSYCHOSIS, Farmer, rural Bengaluru LOSING ONE’S HUSBAND and a child in quick succession can crumble the bravest of hearts. Arashamma was no exception. In 2001, her husband passed away from an infected leg swelling. Two years later, her adult son, who worked in Bengaluru city, was murdered in mysterious circumstances. Arashamma slipped into an extended period of traumatic shock. Only six years later was her condition diagnosed as psychosis — an abnormal condition of the mind involving “a loss of contact with reality”. For the period inbetween, Arashamma seemed lost to the world. People in her village, Channaveerahalli, 50 km away from Bengaluru, were convinced she had been possessed by evil spirits. She often picked fights, talked to herself, packed up her clothes and ran off to different places, such as a relatives’ house or a nearby village. She stopped eating, bathing, combing her hair, farming and sleeping normally. “I’d pray at the temple, falsely believing this would cure her,” says one of her sons with whom she now lives. Villagers stopped visiting her fearing that they will “catch” her disease. “They laughed behind my back,” she says. “I felt my life is finished.” After a chance meeting with Lakshmi Dev Amma, a health worker from Basic Needs, a rural mental healthcare NGO, Arashamma began to recover. Amma arranged a consultation with a physician at the government’s primary health centre. Today, she attributes her recovery to the personal touch and regular follow-ups from Amma. “I became everything because of her,” she says, hugging her effusively. Amma was working on other health issues in rural communities. “I asked myself, why can’t we work on mental illness?” At first, Arashamma didn’t cooperate with taking medicines. “I would pretend to beat her with a stick to trick her into having the pills,” her son says. The pills induced drowsiness and slowed her down enough to keep her from running away from home. In time, signs of normalcy emerged. Arashamma began to chat up neighbours, focus on personal care, and gradually started managing both her home and the farm. For a year now, she has been taking a 10-km bus ride to the district health centre to fetch free medicines. Even the people of her village began to treat her normally. “They understood that my illness was just a medical problem,” she says. Excited at the sight of people with a camera, many in Arashamma’s village gathered inside her small hut. Many more stood outside. Clad in a purple silk sari, Arashamma emerged from her kitchen and offered us bananas. And as she sat down, her chocolate brown face broke into a shy, half-smile — the kind that can only come from a spirit that is free and not possessed.

Forty five-year-old Ishrat, cloaked from head to toe in a black burqa, is another example of faulty treatments in small-town India. Ishrat’s medical records reveal a diagnosis of bi-polar disorder, but Rs 1.5 lakh (funded by a brother working in Saudi Arabia) on private treatments near their village in Muzaffarnagar town, also in western Uttar Pradesh, yielded no benefits. Says her daughter Nusrat with relief, “Coming to IHBAS has helped, the medicines here are finally having an effect.”

Anil, the 22-year-old son of a truck driver with a monthly income of only Rs 5,000 is another example. Anil lost his ambition to be an engineer and very the will to live after he was forced ragged sexually at the Government Polytechnic in Mahoba, Uttar Pradesh. “No one at the local health centre could deal with the problems of the mind,” Anil says. IHBAS has been treating Anil since December 2008. “I am getting better now,” says he.

CLEARLY, THE DMHP has been a failure. The government admits it reaches only 125 of India’s 600- odd districts. “The way the money is being spent is not based on any efficient or evidence- based models,” says Patel. “Getting to the people is a genuine challenge,” agrees former NIMHANS psychiatrist Srinivas Murthy, who has worked with the government’s mental health programme and with the WHO. The real problem with DMHP, says he, is that it is not decentralized. One of the biggest problems is the access to psychotropic drugs. According to the WHO, there are now effective medical interventions even for diseases like chronic schizophrenia. In the US, such drugs would cost no more than two dollars a month. In India, though, these drugs are not readily available. Even in Karnataka, which is considered one of the better states for mental health infrastructure, the DMHP officially runs in only four of its 29 districts. And though the state government indents for 21 drugs for mental illnesses and epilepsy, which should be readily available at the Primary Health Centres (PHC), Mani Kalliath of Basic Needs says they never reach the PHCs.

“There are no technical barriers for any Indian to receive medicines from public health facilities and Tamil Nadu is an example,” adds Abhay Shukla, an activist with the NGO Jan Swasthya Abhiyaan. “The irony is we are the largest pharmaceutical exporter in the developing world.”

The essential DNA of conquering mental illness is realizing the art of the possible. Several excellent private and NGO initiatives across the India are emboldening proof of that. The Banyan in Chennai, which has rehabilitated over 1,500 women and their families since it began. Mani Kalliath’s Basic Needs in Banglore. The Pingalwara institute in Amritsar, begun by Bhai Puran Singh. And SCARF in Chennai, founded by Sharda Menon, a Padma Bhushan awardee.

Often, inspiration can have a ripple effect. Ask Ratna Chibber. She gave up an 18-year-old marriage to look after her brother Sushil, when her husband began to resent his presence in their home. Sushil’s mumblings and sudden idle laughter used to be a social embarrassment. “It was traumatic asking your own brother to go inside a room when a guest came. We would not do that to even a dog in the house,” says Chibber, holding back tears. “I was angry with my husband for not being more compassionate then, but I hold no grudges now,” says she. “It is true that these illnesses can destroy families.”

Sushil was a high performer and had got a mechanical engineering degree with good marks. But he had begun to show symptoms at 19 and a test at NIMHANS in Bengaluru revealed subnormal IQ. Finally, Chibber met Sharda Menon of SCARF in Chennai. That was a turning point. “She discussed his schizophrenia openly with me. I felt so soothed. It had taken ten years to get a clear diagnosis for him. Losing those precious years did a lot of harm to him,” says Chibber.