Persons kept in chains without authority of law allegedly ‘mentally ill’ – were burnt to death. The situation was within the knowledge of a number of public officials and the National Human Rights Commission, yet no steps were taken to remedy it. Evidently cruelty and exploitation if interlaced with religion have to be overlooked and condoned.

The question however is: what can concerned citizens do when Erwadi-like situations come to the fore. Amongst the various investigations such a general query requires, one, which necessarily needs to be raised relates to the legal management of the issue. Thus we need to know how does law deal with this situation and what remedies if any are provided under it.

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Another provision of the Mental Health Act makes improper reception of persons with mental illness in a psychiatric hospital or a nursing home punishable. Improper reception means wherein a procedure of admission other than the one provided by the statute is utilised. This offence is punishable with imprisonment up to two years or with fine up to Rs.1,000/- or with both. With such like penalty the above said offence in accordance with the classification provided by the Code of Criminal Procedure is non-cognizable. This classification means that no policing authority will investigate the above said offence without an express order from a magistrate. Once again citizen enforcement will be difficult. Furthermore a question will arise whether private custodial houses like those around Erwadi could be categorised as psychiatric hospitals and nursing homes.

A registration - licensing regime also subsists under the Persons with Disability Act, 1995. This statute requires permission to be obtained from the competent authority before an institution for persons with disability can be established. Disability has been defined to include mental illness. Consequently without obtaining such permission institutions for housing persons with mental illness cannot be established. And licenses of institutions, which breach the statutory regimen, can be revoked. Even as infringement is not criminally punishable an option of reporting to the Chief Commissioner or the State Commissioner of disability exists. These Commissioners have been empowered to take necessary steps for protecting the rights of persons with disability. These necessary steps have not been described in the statute, but should, through a process of interpretation be held to include release, rehabilitation and compensation of persons with mental illness in illegal custody. The Commissioners can themselves take note of the breach of rights of persons with disability or a complaint to this effect can be made before them by any person in the know of such infringement. The Persons with Disabilities Act is a recent statute. In the absence of express remedial procedures the possibilities of the law for persons with mental illness in need of institutional care will primarily depend upon the activism of individual Commissioners.

The treatment meted out to persons with mental illness at Erwadi and other such places comes within the definition of wrongful confinement. Criminally proceeding against the perpetrators of such like practices is perhaps the most potent of all the options mentioned above. As in contrast to enforcing licensing regulations, upholding the criminal law of the country is a non-negotiable duty of policing authorities.

Other than the above described statutory regimes the Constitution of India guarantees to all persons the right to life and liberty. This right cannot be deprived except by a procedure, which is just, fair, and reasonably contained in a duly enacted legislation. These appellate courts also have the power if they think fit to grant compensation for the inflicted deprivation. This remedy can be activated bonafide by any public-spirited person on behalf of the deprived individuals. A large number of public interest actions have been filed in several High Courts and the Supreme Court of India on the abysmal conditions prevailing in the mental hospitals in the country. Consequent to these petitions the apex court has laid down guidelines for living and treatment conditions in mental hospitals and also ordered the discharge of persons who have recovered from illness. These petitions have provided symptomatic improvement in a specific hospital or provided relief to a particular individual. However no kind of structural reform of the mental health system has happened because of the public interest actions. The one major gain of these petitions is acceptance of the premise that persons with mental illness are bearers of rights. And these rights when infringed should be redressed. Persons confined in the Erwadi custodial houses are being definitely deprived of their life and liberty and there is no legal procedure, which authorises this deprivation. Consequently both the concerned High Court or the Supreme Court can be approached to seek the release of the confined persons. The difficulty here of course is where should the persons with mental illness be housed upon release as so many of them have been abandoned in these places by their kith and kin.

The legal regime mapped out above is aimed to show that there are legal norms for the institutional care of persons with mental illness. For these legal norms to become the ground reality of persons with mental illness it is important that there is a ground swell of self advocacy backing them as it is in advocating their own rights that persons with mental illness have been most handicapped.

The NHRC is constituted of senior members of the central and state jurisdiction. It depends on the central government for funds after due allocation made for this by the parliament. Grants from the state government are also given subject to conditions. The annual report of the commission has to be sent to the central government and received by the house of parliament. These reports have also to be made at regular intervals and published.

The Commission can, among others, review factors that inhibit the enjoyment of human rights, review the safeguards provided under the Constitution or any law for protection of human rights, undertake and promote research in the field of human rights and study the living conditions of the inmates of any institution under the control of the State Government where persons are detained or lodged for the purpose of treatment, reformation or protection and make suitable recommendations for protection and promotion of human rights.

What are the ground realities that delimit these powers? The Commission functions as a searchlight, by conducting valuable investigations. However, it remains more or less an advisory body and it suffers from various limitations such as the lack of the tools required for implementation. For example, the commission cannot inquire into any matter after the expiry of one year from the date on which the act constituting violation of human rights is alleged to have been committed. Lack of enforcement power seems to be another important limitation to the powers of the commission. The fact that they are open-ended and therefore it is easy to "show" compliance with them, although valuable, might undermine recommendations of the committee. The most important limitation is that the commission deals with the cases of violation on an ad hoc basis. It deals with cases, which approach them, but does not have any mechanism to reach the needy. However, persons committed to mental institutions may not always be in a position to seek justice, and therefore may never be able to appeal the commission. The limited provisions must be used effectively while at the same time for greater recognition of the human rights of those with psychiatric disabilities.

"Malatibai was a hard taskmaster, affectionate and broad-minded. She was my teacher, my elder sister, my family friend and what not…"

"Malatibai was a crusader for justice. Unable to tolerate injustice of any kind, she always stood by the side of the wronged ones ... She instilled in us the spirit to fight against injustice."

"Only because of her dynamic presence, the team spirit was maintained in the larger interest of rehabilitation, keeping professional ethics intact and built around the core of sincerity and dedication."

These remarks made by Sudhatai Datar and G.R. Golam, both senior colleagues of Malatitai Ranade spoke volumes about Malatibai as a social worker and as a person. Malatibai Ranade was among our country’s first officially recognized psychiatric social workers who graduated from the Tata Institute of Social Sciences. From the time of joining Yerawada Mental Health Institute in 1949, mental health was her life and mission. Malatibai’s spirited presence at Yerawada spanning 24 long years of service was nothing but distilled and pure Mental Health Advocacy, even that, at a time when these words were totally unheard of.

Malatibai was appalled to see the living conditions of the mentally ill at Yerawada. She was openly critical of the Visitors’ Board appointed by statute to look into the Institute’s functioning. Most of the Board members were government officials. Instead of patient welfare, trivial issues were given top priority. Malatibai fought with the concerned authorities over many issues. Her deepest concern was with inmates’ proper treatment, right to psychosocial rehabilitation, human dignity and fundamental rights. After retirement, she filed a number of cases against the state government authorities where she felt the inmates’ human rights had been violated.

During her long career, Malatibai dealt with more than 10,000 patients. Being the only psychiatric social worker at the Institute initially, she was at times looking after over 200 patients single handedly. Malatibai had many ideas and suggestions to improve the quality of treatment and service rendered. This is amply evident in her writings, especially her book, Manorugna: Katha ani Vyatha (‘Mental illness- Stories and Miseries’) which won the State Govt. Literature Award in 1982.

Even after retirement Malatibai continued to work with those in need of help. Counseling activities were in full swing, free of cost, of course, till the very end. She was an avid reader, promptly applying newly acquired knowledge in her day-to-day work. She was lively, alert, gracious…her usual self till her last. She lived a full, long life, totally committed to mental health, which ended at the age of 86.

The highest tribute we all can pay Malatibai would be in being committed to strive for greater well-being for those labeled mentally ill in our own capacities and safeguarding their human rights.

April 2000- Diarrhea deaths at Erwadi. Recommendations made included provisions for a ward at the district hospitals in Ramanathapuram and Madurai; a training programme for doctors and paramedical staff in treatment of mental patients and for NGO’s.

6.8.2001- Death of 25 mentally ill patients at Erwadi who were chained to their beds. After their hutments caught fire, they were burnt alive. 11 women and 14 men died when the fire broke out at 5. 10 a.m. There were 43 persons housed under primitive conditions inside a thatched hut. The police suspected that the fire may have been caused by an oil lamp, which ignited the shed. The alarm raised by some inmates was ignored by the people and asylum owners, who mistook it to be their usual cries. The hostel owners charged that some ‘mysterious persons’ had set fire to the thatched building. The police took into custody four members of the family, which ran the institution.

Immediately, chief minister Jayalalitha announced a payment of Rs. 50,000/- each for the families of the deceased, Rs. 15,000/- for those who suffered serious burns and Rs. 6000/- for those who had simple burns. The Ramanathapuram DC Vijaykumar announced financial assistance of Rs. 10,000/- to the relatives of the deceased. The district administration and local MLA appealed to the State Government to regulate the private trade.

A five member team comprising of psychiatrists and social workers from the Institute of Mental Health, Chennai, visited 17 institutions for the mentally ill at Erwadi to evaluate the conditions there and an "open" offer was made to shift them to medical facilities. It was suggested to shift them to the Institute of Mental Health in Chennai or Madurai. Immediately after the visit, a psychiatrist was posted at the Erwadi PHC.

The team made a proposal to the center that it start a district mental health program at Ramanathapuram district with an outlay of 1 crore. The program would concentrate on training medical and non-medical officers, mental health care delivery systems (starting taluka level satellite clinics) and awareness building measures.

In a LS meeting, Vaiko (MDMK leader) observed that despite the mental health authority, the state government had failed to implement guidelines and terrible conditions prevailed. P. C. Thomas (Kerala Congress M) demanded that a central fact finding committee be set up for the state.

District administration drew up a contingency plan to streamline the private asylums at Erwadi. The Government imposed a ban on keeping the inmates of these homes in fetters at Erwadi. The Central Mental Health Authority also cited guidelines against cruelty. Nearly every newspaper report was strewn with mention of the Mental Health Act, the Lunacy Act, news from Mental Health Authorities, Human Rights Commission, SC Judgements and even the UN Principles for the protection of persons with mental illness.

Soon after, the Union Health Ministry decided to map out all the ‘faith healing’ centers frequented by psychiatric patients. Health Minister Dr. C. P. Thakur decided to convene a meeting of state health secretaries and district commissioners to work out the modalities for an effective implementation of guidelines issued recently for the maintenance of minimum standards in mental health set ups.

The moment a family reached Erwadi with a mentally ill patient, a swarm of brokers used to accost them offering the "best" treatment at nominal cost, ranging between Rs. 1000-2000 per month. People having no or very little idea about mental

health were running 16 mental asylums. The brokers were reported to be the "dregs" of society, constituting "hard-core" alcoholics, womanizers and marijuana addicts (8-8-2001, TOI). Only 1/3 of the fee recovered from a patient was reportedly spent. They were kept in deep misery with food very often inedible. Sometimes food was adulterated deliberately to get more money from the patient’s relatives under ‘special treatment’. Women were also sexually molested at these asylums.

Reports of very similar situations where patients are kept chained in centers of faith healing have been reported from Patiala, Bombay, Tamil Nadu and Hyderabad. In an open publicity drive, some state mental hospitals presented glowing pictures of their functioning in the newspapers! One report in Pune Times (8-8-01) read ‘No chains in Asia’s largest mental hospital’!!

The SC has since constituted a committee to enquire into the implementation of the MHA and SC orders in all the States.

Will yet another Erwadi happen? A 155 Crore question!!

move around. Moreover the inmates are either chained down or chained to a companion. The places look like cattle sheds. Contrary to human rights norms and standards, the mentally disabled people are lodged in such a pathetic condition. Much worse, even some persons thought to be troublesome at home, have been admitted to these homes and chained along with others. Thus, these homes are not only used for housing the mentally sick but also for detaining other persons with the connivance of the proprietor of the homes, as happened in the case of Murugan.

Not only hygienic conditions in these homes are bad, but also there is no proper medical attention. A person attacked by jaundice was just lying along with others in a home called New LIMRAS run by one Mr. Paneer Selvam. In the same home, a youngster allegedly having some sex abnormality is made to stand all the time by chaining his hands to a hanging chain near the lavatory, instead of being taken to a relevant medical personnel. Such is the blatant violations of human rights of these mute victims of mental disorders.

Of late, after the constitution of a Committee to oversee the running of these homes appointed by the district administration, it appears that there had been occasional interactions between the proprietors of the homes and the local government officials. Neither could the team get hold of any written documents in this regard nor could we see any palpable change in the situation of mental patients, since the first field study conducted by the PW-TN team in May 2000.

Some of the inmates have been brought over here after prolonged treatments in government mental hospitals elsewhere. In a few cases, persons getting back to normalcy have been detained in these homes under some pretext or other to carry on odd jobs free of charge in these homes.

The present pathetic incident also clearly indicated the total failure of the District administration in not responding to the systematic exploitation of the mentally challenged patients over a period of ten years by unqualified and avaricious persons.

Strangely, no one was talking about proper, scientific medical treatment of the innumerable patients. The Dargah people, however, have expressed the willingness that if the Government were to establish a mental health facility in this area, they would extend support and help.

In the light of these findings by the team, the following recommendations were made to the appropriate authorities by PW-TN.

1. There should not be any second thought about closing down the private mental asylums but then before the phasing out procedure is launched, a team of mental health professionals should be requisitioned to assess the health status of each and every individual lodged in these homes and then only they should either be handed over to their kith and kin or to any other legally sanctioned mental health centers run by government or non governmental agency for proper rehabilitation.

2. (a) In view of the traditional belief that mental disorders get cured in Erwadi Dargah, the establishment of a government mental health centre is recommended, with a task of not only treatment but also to carry on mental health education in this place.

(b) On this occasion, it would be more appropriate to initiate the above mentioned pro-active measure in other traditional religious healing centers as well.

3. Wherever such mental health centers are established, monitoring committees consisting of members of the respective religious organizations, reputed NGOs and Government officials should be appointed and given free hand to implement the various norms and standards recommended by the appropriate legal authorities.

Malati Ranade, in one of her interviews to Sree Weekly (September, 27, 1980) said that a majority of patients who are on the path of improving never recover fully because of lack of affectionate human contact and inhuman living conditions.

the ward for ‘weak patients’. Later one day, he was recorded as ‘serious’, and the next day the register recorded his expiry. There was no discussion about this death. (In a recent talk with Malati Ranade, she mentioned that authorities held what was notoriously called ‘Mortality Meetings’ to discuss these deaths.)

• Secretary, SC Legal Services Committee

• Secretary, High Court Legal Services Committee

• Member-Secretary of the State Legal Services

• Secretary of the District Legal Services

• Taluka Legal Services Committee

"The improvement schemes for mental hospitals are outlined as follows:

"It is suggested that managing bodies should be set up for all hospitals … Senior officers from the department of health, welfare, prisons, police along with a professor of psychiatry from a teaching hospital could be members. The medical superintendent of each hospital could function as member secretary of the committee.

"These committees will be under a duty to formulate schemes for improving both the living and therapeutic conditions in mental hospitals. The aim of improvement schemes however should not just be to remove the deficiencies of the old hospitals but to create and to transform these old custodial institutions into active treatment centers supportive of care in the community.

"Legal Aid: A mentally ill person shall have the right to legal representation and legal aid in involuntary commitment proceedings before a magistrate.

"Living and therapeutic environment of mental hospitals: The state shall ensure that all the mental hospitals in the state should provide a clean and healthy environment, effective care and treatment to mentally ill persons. In order to enable performance of this function all mental hospitals shall be allocated commensurate resources.

"Emergency medical aid and death in jail or mental hospital: The medical superintendent or the jail superintendent (till the mentally ill are in jails) shall be responsible for the medical needs of the inmates of the medical hospital and jail respectively. The above stated officers shall ensure that their institutions are equipped with life saving medicines and immediate medical attention is given to any inmate who needs it. The state government shall respond at once to medical superintendent’s request for life saving drugs or any other emergency medical help. If a mentally ill person in jail or mental hospital dies in unusual circumstances a post mortem shall be carried out."

The judgement exhaustively covers restoring the liberty and rights of persons with psychiatric disability illegally confined in jails and the wandering ill. It acknowledges the treatment deprivatory consequences of being committed to jails, the delay in receiving specialist help, the lack of specialized human resources and supervised care. The judgement also notes the lack of variety of treatment facilities and excessive deprivation of liberty in the jails.