MAR 19 - This week, I visited a few psychiatric wards in Kathmandu, both in public and private hospitals including the Mental Hospital in Patan. Some revelations of the psychiatric wards are quite awful. Private hospitals are providing relatively better service to mental patients, but what I saw at the Mental Hospital in Patan is horrible. When I entered the inpatient ward, the sharp smell of urine, dirty rooms, patients lying on dirty beds as if they had not been cleaned for months and as if they had been hungry and sleepless for days - the caretakers sitting helplessly next to the patients, stinking toilets and the mismanagement at the hospital shocked me. I did not last two minutes in the ward and came out. This is where mental patients have to spend months to be cured of their mental health problems.
In despair and humiliation, I spent over two hours at the hospital. I could see semi-naked patients taking a bath publicly as there was no bathroom in the hospital. I talked with a few caretakers and their patients, who had been regular customers of the hospital for the last 14-20 years as if they were visiting a big super mall. A mental hospital is the last resort to seek mental health support for the poorest and the most vulnerable sections of the population.
In the last two decades, there has been much talk about human rights, health care, social emancipation, poverty eradication and development in Nepal. This country has many development princes and princesses who are able to lead a luxurious life at least for themselves at the expense of popular slogans. But after visiting the mental hospital, everyone can get disillusioned by all the talk about democracy, human rights and development.
Even though it is tragic, there are many lessons that the Mental Hospital can teach us in these socially, politically and economically turbulent times. The Mental Hospital is a case that shows the potential fate of the whole country in the absence of honest leadership and effective management of the problems. Therefore, for the sake of our collective dignity, it is important for us to rescue the Mental Hospital to make it a humane treatment centre.
After visiting the Mental Hospital, people may blame the hospital management for creating evils in the hospital. Yes, definitely, the unhygienic hospital atmosphere demonstrates the irresponsibility of the hospital management towards the wellbeing of the patients, who in fact are paid by the government for their job. But the reality of the Mental Hospital goes well beyond the control of health professionals, and sadly, they are always reluctant to speak about their professional limitations in dealing with the human rights of the mental patients, their disability rights, and the social factors that intensify mental health problems in the population.
The Mental Hospital admits only serious cases, mostly acutely psychotic patients or those in a severely chronic state. Patients generally stay up to one month. Treatment includes medication and electroconvulsive therapy (ECT). These are inadequate and often outdated treatment systems that don’t always account for a patient’s human rights while recieving treatment. Even though the hospital may claim they do, I don’t believe that they provide any psycho-social counselling and other rehabilitation services. I can argue that people treated in poorly managed mental hospitals like this are least likely to overcome their problems. Spending a month in such a hospital is enough to make one chronically ill, often both mentally and physically, in contrast to achieving a healthy outcome. I guess the mental health professionals also suffer from infections amid the ill environment.
I have a few questions for our development princes and princesses. Why has mental health been ignored? Why is there no resource for mental health? Why are mentally ill people treated like animals in terms of meeting their human needs in the health care system? Do you not know that people with mental illness have human rights too? How can you talk about development, human rights, social justice and gender equality without understanding the mental health outcomes of these components? Injustice towards mental health is not tolerable. We need to find the answers to these questions.
Psychiatrists, who are the dominant group in the mental health system, also share the blame for paralysing the mental health system. There is a wrong impression in society that only psychiatrists can control the mental health of the population and mental health is their concern. Most psychiatrists are now aware of their limitations in terms of preventing mental disorders and assuring a positive social outcome to their clients. The regular patients who have been visiting the Mental Hospital for the last 20 years are the best example of how ineffective mental health service can be in the absence of basic needs and social support.
Therefore, I urge psychiatrists to gather the courage to come out from their traditional comfort zone and tell this truth to society: “Mental health is no longer a medical concern alone. Even though there exists effective mental health services, without social support and care, such services cannot function. Ethical health practices and human rights are the key pillars of mental health service. Therefore, call on civil society to engage actively for the promotion of mental health.” If the psychiatrists yet do not tell the truth, if they do not act to create space for civil society to promote mental health, the existing disaster in the mental health system will not ease.
(The author is a global mental health activist)
Posted on: 2010-03-19 12:00