India's mentally ill are often locked away in understaffed, state-run institutions where they are stripped of basic human rights. Others are picked up by quack healers who torture them, or they get dumped in the jungle.
It is a hot, humid afternoon at Lumbini Park Mental Hospital in Kolkata. About 30 male patients in tattered clothes huddle in a dormitory. The stench from the lavatory nearby is nauseating. On the next floor, two female patients lie sprawled on the narrow corridor outside a female dormitory.
Things are no different at another state-run hospital in the city, Pavlov Mental Hospital, where about 400 patients share 250 beds. Patients at a severe stage of mental illness are locked up in 4 x 5 feet (1.2 x 1.5 meters) cells, with an Indian-style closet - they eat sitting next to it. And to kill body lice, says a hospital employee, patients are stripped and sprayed with insecticides meant to kill cockroaches.
"The funds that come to the hospital for food, clothing and mattresses are siphoned off by the officials. They even take home the bedspreads and curtains," an employee said.
Be it West Bengal, Madhya Pradesh, Uttar Pradesh or Maharashtra, most state-run mental hospitals in India are in a deplorable state. According to the National Human Rights Commission (NHRC), there are only 43 government mental hospitals in India, of which hardly half a dozen are in a "livable" condition.
Hardly any improvement
"The NHRC was asked to report on the condition of mental hospitals in the 1990s" said P. C. Sharma a member of the NHRC. "We brought out our first report in 1999; the condition of most mental hospitals was shocking. Even after a decade, it remains the same. It shows the government's attitude towards the mental health care in the country." In fact, the NHRC's reports in 1999 and 2011 look almost identical. Most hospitals lacked, and still lack, even clean water and ventilation.
At least 100 million people suffer from mental illness in India. About 10 million need hospitalization. There are only 4,000 psychiatrists in the country and 70 percent of them practice in private hospitals in urban areas. There is a severe shortage of paramedics, too. In 2008, according to an NHRC report, one single psychiatrist was found manning the 331-bed hospital in Varanasi.
There are physicians and even gynecologists who are in charge of mental hospitals. "These doctors don't understand the intricacies of a psychiatric illnesses and the comprehensive care the patients require," said a psychiatrist working in a state-run mental hospital in Uttar Pradesh.
Quack healers torture patients
With the medical system in a mess and awareness about mental disorders lacking, faith healers and quacks are making hay. According to a study by Dr Shiv Gautam, former superintendent of Jaipur Mental Hospital, 68 percent of mentally ill people are taken to faith healers before a psychiatrist.
"The reason, besides superstition, is that most general medicine doctors fail to diagnose psychiatric illness," Gautam said. "A mentally ill patient displays symptoms which superstitious people believe are paranormal," he added. "Such patients are tortured, chained and used for extracting money from their families."
Take the case of Hema. Until a few months ago, the postgraduate in English used to call herself Mrs Sonu Nigam, assuming herself to be the Bollywood singer's wife - a clear case of schizophrenia. Her family took her to Datar Sharif Dargah near Ahmedabad. They believed an evil spirit was at play. She spent a year there, chained up. And it was only when her condition deteriorated to an extent that incontinence set in, that her family brought her to Gautam. "In 15 days, Hema started improving and, now a month later, she is normal," he said.
Some are whipped or caned, some are made to inhale smoke from burnt chilli, some have chilli paste smeared into their eyes and some get branded with red hot coins. Despite laws banning the practice, many dargahs and temples keep patients chained. Some, for a lifetime. In 2001, a fire at a dargah in a coastal village, Erawadi, in Ramanathapuram district of Tamil Nadu charred to death 26 mental patients, who could not escape the blaze as they were chained.
Dumping the unwanted
Families of mentally ill people are increasingly opting for the easy way out: 'dumping.' A recent shocker came from Thrissur district in Kerala, where an illegal 'asylum' was busted. Thirty-five men and six boys from across India were rescued from inhuman conditions. Apparently, it was the stench from their unwashed bodies and excreta that made neighbours alert the health department.
As officials raided the asylum, they found naked and chained inmates, who had been dumped there by their families after paying the asylum owner. Some were found crawling in their excreta, some even consuming it. Their bodies bore marks of torture, and some had surgical scars on their backs, prompting allegations that the asylum had links with kidney thieves. Of 78 patients entered in the register, only 41 were found during the raid.
An even more shocking trend is of patients getting dumped in jungles, especially in the forest reserves of south India. Families, mostly from the north, pay lorry drivers to 'drop' these hapless victims, including children and women, in the forest ranges. Social activists in reserves such as Wayanad and Bandipur say drivers rape the female victims before dumping them at the mercy of nature.
"Before we term the families as 'cruel,' we must look at what forces them to take such extreme steps," social activist Murugan S. said, who has lost count of the number of mentally ill people he has rescued from streets, railway stations and bus-stands across Kerala. And, finally, he concludes with a statement which has become clichéd in Indian society: "The system needs a holistic change."
Gunjan Sharma has been covering health issues in India for nine years. She is a senior correspondent with India's largest English-language news magazine The Week. She was awarded the German Development Media Award for the category Asia. Her report has been shortened and edited for DW's pages.