NEW DELHI — Women and girls with intellectual disabilities or mental illness in India are subject to forced institutionalization in sometimes overcrowded and unsanitary conditions, verbal and physical abuse, and medication without consent, according to a report released by Human Rights Watch on Wednesday.
The group interviewed 52 women and girls who had been institutionalized because of mental disabilities in the past two years, as well as their families, staff members at the facilities where the patients were treated, and doctors in four Indian states. The report found 31 cases of electroconvulsive therapy administered “without consent,” though in many cases familial consent replaces patient consent, said Dr. Sanjeev Jain, a psychiatrist in New Delhi.
The report found 38 cases of physical abuse, with many patients reporting that they were beaten with sticks; the group’s researchers witnessed this in three institutions where patients were beaten if they did not walk fast enough. Researchers found four cases of sexual abuse reported in residential institutions.
Estimates of the numbers of people in India living with mental disabilities vary. According to the 2011 census, more than 2 million Indians suffer either from developmental disabilities such as Down syndrome or mental illnesses like schizophrenia or catatonia. But the Human Rights Watch report estimates that the numbers are higher — with 1.5 million people suffering from intellectual disabilities and 70 million from mental illness. There are only 43 state-run mental hospitals in the country, and an unknown number of private facilities.
Jain, a professor at New Delhi’s National Institute of Mental Health and Neurosciences, said the capacity of the mental health system in India was inadequate to care for the population in need.
“The obvious situation is that the services as they exist are very archaic,” he said. “Most of the institutions were built 100 years ago. They were on a very, very shoestring budget without any gradual increase in the quality or the quantity of manpower.”
The report details overburdened hospital staff members caring for women who have inadequate access to baths and fresh clothes. The overcrowded facilities are often unmonitored. Human Rights Watch cites a government-run institution in New Delhi operating at nearly three times its capacity. At Pune Mental Hospital, there were just 25 working toilets for more than 1,850 patients.
“Open defecation is the norm,” Dr. Vilas Bhailume, the hospital’s superintendent, said in the report.
The report recommends a transfer from state and privately run institutions to community-based care. But some mental health professionals say that institutionalized care must be upgraded.
“We need more doctors, more psychologists, more social workers, more provisions for a safety net for living situations,” said Jain.
The problem, he said, is that there is no comprehensive regulatory mechanism to ensure that the private and public residential facilities for those with mental disabilities meet minimum standards.
A new mental health bill that calls for more standardized oversight of facilities in India is currently before the winter session of Parliament.