Mental health infrastructure does not look very comforting in a country where mental health problems are predicted to surpass all other diseases. The psychiatrist-patient ratio is dismal. The picture is the same in Pune and the other three mental hospitals in Maharashtra too. However, the number of ward boys— class IV staff—at these institutions is good enough though they are bad, in general, when it comes to the manner in which they behave with patients going by the flood of “unofficial” complaints. These pertain to making patients do the work of the staff, extortion, and physical assault.
Rude ward boys
The scenes are similar at Pune’s mental hospital in Yerawada and mental hospitals in Thane, Nagpur and Ratnagiri. Class IV staff rule the hospital corridors with impunity, and their cavalier attitude is attributed to the permanence of their posts and lack of fear of any official complaint or action.
At the 1,850-bed mental health hospital in Thane, patient Govind Singh Kathayat sweeps the floors and toilets to avoid getting beaten up by ward boys. His friend Altaf Batliwala had to withstand several blows for refusing to give money to a ward boy.
Fear of official complaints
There are similar “unofficial” complaints emanating from Pune’s 2,400-bed Yerawada Mental Hospital against class IV employees.
Families of patients avoid making official complaints for fear of a backlash from the hospital staff.
“Yahan jhaadu maar, warna khana nahin denge (Sweep or else we won’t give you food),” is the threat patients receive. “Ward boys often ask us to take money from our family when they visit and hand it over to them,” said Kathayat, who was discharged from hospital two months ago.
A patient’s relative, on condition of anonymity, said, “We have to admit our relative here frequently. By complaining, we will only make matters worse for him.”
In the past, there have been reports of patients facing violence.
Few psychiatrists but ward boys abound in hospitals
Central norms for mental health institutions stipulate a psychiatrist for every 100 patients, a medical officer for every 100 patients and a ward attendant for at least five patients. There is massive shortage of psychiatrists, and the psychiatrist-patient ratio is wide off the mark. Medical officers double up as psychiatrists.
In Thane hospital, there are over 400 ward attendants, 10 for every 46 patients, and in Yerawada hospital there are 550 ward attendants, 10 for every 43 patients.
Ward boys have no special training to handle mental health patients with extra care. Yerawada hospital matron Sunita Mithe said ward boys are usually those who complete primary education, or even school dropouts. Dr Vilas Bhailume, medical superintendent at the Pune facility, said, “Ward boys are trained in handling patients and controlling any aggressive behaviour.” Dr Rajendra Shirsath, MS at Thane mental hospital, said since class IV employees serve the same posts for years, they learn to handle patients through experience.
In Pune, psychologist Sherebano Koser who has a private practice and visited the mental hospital recently said, “I could hear a ward attendant hurling abuses at a patient in the next room. The way patients are treated is sad.”
While the state government regularly rotates doctors and nurses, ward boys serve at the same post. Some attendants have spent decades in the same ward. State government officials said the reason for their authoritative behaviour is their permanent posts.
Dr Shirsath of Thane facility says, “Last year we received three complaints. I punished one attendant for demanding money and beating a patient. We are receiving complaints from the female ward these days.”
Dr Manish Renghe, who heads the mental health cell at the Directorate of Health Services (DHS), told The Indian Express, “We received unofficial complaints from Yerawada and Thane hospitals about ill treatment of patients. But the health department received no complaint. Usually, such complaints are handled by medical superintendents…”
Need for training & more infrastructure
In 2007, Bombay High Court demanded an action taken report from the state’s principal secretary for health on the four state-run mental hospitals following a PIL by a Pune resident about staffers ill-treating patients.
Following the PIL, a report was filed by the respective chief judicial magistrates (CJM) from the four cities on the conditions at the hospitals. The report highlighted major gaps in food quality, drainage, toilets and water supply in the four facilities. A senior medical officer at Yerawada Mental hospital said, “We have significantly improved infrastructure. Toilets have been renovated and a gym was set up two years ago. Our next plan is to improve roads on the premises of hospitals.”
“I suggested the hospital administration to show documentaries, specially ones made on Baba Amte, to sensitise class IV employees. Since they have no medical background or qualification, we cannot expect them to know the protocol for handling patients,” said Dr Manish Renghe head, mental health cell, DHS.
He said, “We are coming up with plans for mental health in the state like starting a helpline and redeveloping hospitals.”