Action please

Erwadi should be a wake-up call to all Governments, says Kalpana Sharma.

IF YOU are poor and ill in this country, you are doomed. But if you are poor and mentally ill, you are cursed and doomed. The tragedy in Erwadi earlier this week, when 28 mentally ill men and women were charred to death as they struggled to free themselves from their manacles, brings back images of the dark ages. It is hard to believe that a modern state can permit such primitive and inhuman conditions to exist.

While the treatment of the mentally ill in most parts of the country requires much greater attention, the tragedy in Erwadi was avoidable. Just last year, eight patients had died from gastro-enteritis in one such home in Erwadi. A 10-member inquiry committee found that the inmates had been fed contaminated food. The committee's report and its recommendations are still lying with the Tamil Nadu Government.

The Tamil Nadu Government is found wanting on another count. For decades, people deemed mentally disturbed were governed by an antiquated Indian Lunacy Act, 1913. Under the Act, a person with psychological problems had to be certified by a magistrate before he or she could be sent for treatment. This was replaced by the Mental Health Act, 1987, which came into force in April 1993. The new law requires an inspection committee, in addition to a magistrate, to determine treatment. The Tamil Nadu Government has not implemented the Act nor set up the inspection committees.

The debate about treating the mentally ill, and whether institutionalising them is the best way, is an on-going one. It has been argued that most people recover faster if they remain within their communities and families and are treated. But many families cannot bear the financial or psychological burden of caring for and treating a mentally disturbed person. The dominant attitude in our society is to regard ``mad people'' as cursed. As a result, you find hundreds of disturbed people wandering around cities, virtually left to die of neglect. The luckier ones are institutionalised. But as we know from Erwadi, there is little assurance that they will survive in some of these places. The question of treatment or a cure does not even arise.

Even if one argues that properly run institutions are the solution, there are not enough beds for the numbers needing them. Since Independence, although the number of hospitals for the mentally ill has increased from 31 to around 45, the ratio of one bed for 5,000 people has not changed. The prevalence of severe mental morbidity is estimated to be 3 to 10 per 1,000 people. Apart from formal institutional support, there is very little by way of halfway homes, or community support.

Erwadi should be a wake-up call not just to the Tamil Nadu Government, but to all State Governments and the Centre. The humaneness of a society is judged by the way it treats its most vulnerable citizens. On that count, we as a society fall very, very short.

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