This reply is in response to issues raised by Kumar on retaliatory aggression on psychiatric patients. Psychiatry should articulate science and humanism in its practice and psychiatrists should be the torch bearers for this noble ideal. The reports of assaults on the poor and helpless patients from various parts of the country is very disturbing. The conditions prevailing in some of the mental hospitals or mental health centres in India are appealing. We the members of Indian Psychiatric Society must not only be care taker's and physicians, but also protectors and guardians of the persons with mental illness.
In the first week of August 2012, Satnam Singh Mann, a 24 year old man died at the Mental Health Centre Trivandrum, in tragic circumstances. Indian Psychiatric Society had enquired into this incident. There were lapses in several places. At the very outset, the poor and hapless mentally ill person Satnam Singh was charged with “attempt to murder” by the police. This led to his admission in the Forensic (or “criminal ward”) at the Trivandrum hospital, where more than 82 patients were kept in 24 “cells”. This points to severe infrastructural deficiency. Having more than one excited patient in a single closed room often leads to fights among them and is dangerous. In Satnam's case, the clash apparently had started with his fellow patient. Others who intervened have apparently brutually assaulted him. Let the ongoing police investigation bring out the truth and the guilty must be given exemplary punishment.
Varghese P Punnoose, Secretary, IPS Kerala branch who had enquired into the matter has written, “There is a big media and public out cry over this incident. So the government is under great pressure to take'some’ action to calm down the situation. They have to find scape goats. The real problem lies with deficiencies in providing acute care in GMHC trivandrum, infrastructural and man power deficiencies in government hospitals and lack of training for paramedical staff. Doctors have to bear the brunt of all these deficiencies. Everyone is eager to believe that the attack happened inside the hospital. The Superintendent of the hospital (a non- psychiatrist doctor) readily admitted to the media that the assault has happened inside the hospital!”.
Following the incident, many public spirited persons too had written to Indian Psychiatric Society. Nirmala Srinivasan of Action for Mental Illness (ACMI), a Bangalore based NGO wrote, “The greatest contribution IPS can do is to evaluate the clinical merits and demerits of Closed wards and Cells. If it really helps the user/patients, then it should have an evidence base for the same, just as for de-merits. The above initiative is critical in view of the fact that neither the MHA 1987 nor the proposed MHC Bill 2010 provide a legal justification for Closed wards and cells”.
On August 18, 2012, IPS President had appointed G Bhagya Rao and Sailen Deuri to look into the matter and submit a report within two weeks. This report has been submitted on September 1, 2012 and in its conclusion reads, “Abolishing Closed wards had been the biggest issue as proposed by the various sections of persons involved with the care of mentally ill. In fact it is a huge responsibility which is taken up by the mental hospitals while treating the mentally ill persons by indirectly owning up the full responsibility of the patient during their stay in the facility. Somehow we feel that there is a wrong notion among most activists that it serves the purpose of the professionals to connive with the unwilling relatives of the patients for prolonged incarcerations. Actually it is a provision for helping out the harassed relatives of the patients who due to various reasons are not in a position to stay, supervise, care or monitor their wards during prolonged treatment of the patients in the hospitals. To keep and treat psychiatric patients in the closed wards is a legal procedure followed by professional prudence”. This report will be examined in detail by the Executive Council of IPS and forwarded to Govt of India and State Governments for urgent action.
Retaliatory aggression against psychiatric patients should never happen. A patient who is liable to be violent and excited should never be provoked or threatened. In most instances a compassionate and caring approach will calm the disturbed person. This needs training and reassurance for the entire staff. Indian Psychiatric Society will initiate such training programs and promote psycho-education in collaboration with NGOs and media to ensure, such incidents like the death of Satnam will not be repeated. IPS has already submitted comprehensive recommendations and suggestion on the draft Mental Health Care Bill (2011). Closed wards with adequate facilities, where the human rights of the patients are safe-guarded may be necessary for some more time. And the Governments’ at the Centre and States need to fullfil their responsibilty to provide adequate infrastructural facilities and resources for mental health.
1. Kumar KA. Retaliatory aggression on psychiatric patients Indian J Psychiatry. 2013;55:92–3
2. Mezzich JE. Psychiatry for the person: Articulating science and humanism World Psychiatry. 2007;6:65–7
3. Punnoose VP. Report by IPS Kerala on MHC Trivandrum incident 2012
4. Srinivasan N. ACMI note on closed wards (personal communication) 2012
5. BhagyaRao G, Deuri SK. Report from IPS Mental Hospitals Committee 2012
6. . Govt of India, Ministry of Health and Family Welfare 2011 New Delhi Mental Health Care Bill Draft
Source of Support: Nil
Conflict of Interest: None declared