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Saturday, December 14, 2019

Nagpur hospital’s prescription for mentally ill: work, wage, welfare

Most patients admitted in Maharashtra mental hospitals live there for over 10 years with no family to go to and zero employment source.

Written by Tabassum Barnagarwala | Nagpur | Updated: June 27, 2019 8:23:57 am
maharashtra, nagpur, mental hospitals, maharashtra hospitals, patients, farming, old age, mentally ill patients, agriculture, agriculture training, indian express news Pankaj Lambsonge and Ganesh Misar at the banana plantation on Nagpur Regional Mental Hospital premises.

The scorching Nagpur heat bothers Shamsur Nizamuddin little as he walks with a sickle, chopping off leaves on a two-acre stretch of a banana plantation. The daily five to eight hours of farm labour is a break from sleeping in his ward at the Nagpur Regional Mental Hospital and also earns him Rs 3,000 stipend every month. “Once I leave this hospital, I’ll buy a shirt and a pant,” he says. “And some land for farming.”

Admitted in December 2017, Nizamuddin is among the 75 mentally ill patients of the hospital to be roped in for banana, papaya and vegetable cultivation.

In a first, the hospital is selling extra produce in markets. It has also been maintaining internal accounts for patients to deposit their monthly wages and profits. Soon, bank accounts and Aadhaar will be created and linked, officials say. Nizamuddin, who has been working for almost a year now, has almost saved around Rs 36,000.

Doctors at the mental hospital had diagnosed the 32-year-old with psychosis after police had found him wandering on the streets. Pictures taken at the time show he was heavily bearded with several strings of beads strung around his neck, while medical records had labelled him as “abusive, aggressive and non-cooperative”. Counsellors think he might be from West Bengal or Bangladesh.

“When medications calmed him down, we asked if he was interested in farming,” Shubham Tandekar, who monitors patients on field, tells The Indian Express. Farming seemed to come easy to him. In fact, counsellors found that his family was engaged in rice cultivation. Soon, Nizamuddin started – first with digging holes, and then sowing and watering plants.

“I feel like spending the entire day here. This work makes me feel productive,” Nizamuddin says.

According to hospital superintendent Dr Madhuri Thorat, while medication helps calm a patient, it is the scope of employment or a productive life beyond the hospital walls that keeps them motivated.

In 2016, along with Tata Trusts, the hospital decided to explore farming as a part of skill training after it realised most patients were from a rural background. Expert agricultural institutions helped with the training and an automated watering system was introduced.

“Farming was identified as a viable source of employment and income generation, primarily because being out in the open, in the midst of nature, has an therapeutic effect,” Tasneem Raja, who leads mental health at Tata Trusts, says.

Working away from others, Pankaj Lambsonge, another patient, is focused on plucking weeds. He thinks he is four years old, his medical record says the 30-year-old is schizophrenic. His father and brother, also schizophrenic, had run away from their house.

Admitted in March 2019, after he had set a neighbour’s house on fire in Yavatmal, Lambsonge’s file states he “poses risk of harm to others and himself”. But on the field, in his blue uniform, he quietly goes about trimming leaves and weeding. “He works well, with keen interest,” Tandekar says.

Lambsonge says he feels light while working. “I like the sun. In the ward, my body gets stiff doing nothing.”

The banana plantation is spread on seven acres in the 52-acre hospital property, while papaya is grown on one acre and vegetables, like coriander, brinjal and fenugreek, on the remaining land. Last year, the hospital sold 2,795-kg vegetables cultivated on its land for Rs 1.32 lakh, and 1,476-kg bananas for Rs 1.21 lakh.

Dr Sadhana Tayade, joint director of Maharashtra Public Health Department, says a plan to deposit 30 per cent of profits in patients’ accounts is underway.

Across four mental hospitals in Maharashtra, which house 3,050 mentally ill patients, usually occupational therapy is limited to indoor activities like yoga, singing, jewellery-making, stitching and embroidery work. In 2017, the new Mental Healthcare Act made rehabilitation a major component in management of mentally ill patients. Farming, officials say, is a step in that direction.

Lakshmi Narasimhan, attached with NGO The Banyan which works to rehabilitate such patients, says in India, most mental institutions have vocational training, but access for patients remains low at 10-15 per cent. “What is important for mentally ill patients is to keep them involved in some activity, like file-keeping, house-keeping work or handicrafts. If they get training for a job that translates into income, rehabilitation gets better,” she adds.

Tata Trusts’ Tasneem Raja believes with agriculture training, rate of frequent re-admissions for a mentally ill patient will slowly decline. “We are in process of measuring this data.”

Most patients admitted in Maharashtra mental hospitals live there for over 10 years with no family to go to and zero employment source. Psychosis patient Ganesh Misar (42), admitted since June this year, knows this and expresses worry over his permanent hospitalisation. This is his third admission. He suffers from “hallucinations, insomnia, often mutters to himself and even pelts stones”, says his report. “My family may abandon me if I keep getting angry. That is why I come here on field every day. The soil soothes me,” Misar, a cotton farmer, says. As he walks past the tomato plantation at Nagpur Regional Mental Hospital, he says, the anger in him subsides while at work. “Soon I’ll return home to look after my fields during monsoon.”

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