Mentally ill destitute women constitute one of the most vulnerable categories of the Indian population. Living on the streets is dangerous in any circumstance but these women lack an adequate sense of reality and cannot fend for themselves. Sometimes they are unable to manage their most basic food and hygiene needs. This increases the risk of physical, sexual and emotional abuse many times over. And they have practically no recourse.
The government makes no provision for them whether legal, logistical or financial. In fact, it doesn’t even have a policy on them. Mentally ill destitute women are so completely ignored, it’s like they exist for no one except for a handful of activists and NGOs.
Sudinalay is an NGO which runs a shelter home for mentally ill destitute women. It is located in North Delhi’s Kabir Basti and can accommodate thirty residents. It is the first facility of its kind in India and regrettably the only such home in Delhi. It was started by Sreerupa Mitra Chaudhary, a women’s rights activist and senior policy advisor to the national government on gender issues. Sudinalay is a pioneering organization but receives minimal help from the government – the Delhi administration has provided its premises after persistent lobbying. It also supplies free electricity, water and security. All other expenses, save medical ones, are met through voluntary donations.
Sudinalay’s residents receive treatment free of cost at IHBAS (Institute of Human Behavioural and Allied Sciences), a public psychiatric hospital. A typically routine admission to Sudinalay begins with the receipt of information about a possibly mentally ill destitute woman from either the police or other NGOs. Once she has been rescued from the streets, she is admitted to IHBAS. When her condition is no longer acute she is taken to Sudinalay. There she receives outpatient treatment till she is stable. Medical treatment, however, is only one aspect of an extremely complex situation.
Tarun Monga is Sudinalay’s Executive Director who works on an honorary basis. A clinical psychologist, he is currently employed at Lok Nayak hospital as a counselor to HIV-affected widows and children. He identifies patriarchy and rural poverty as the starting point of the chain of events which lead to mental illness in women and their consequent abandonment. He cites the routine abuse the rural woman is
subjected to in her conjugal home as the key triggering factor. If the woman in question is unable to cope with her marital situation her condition becomes extremely precarious.
Monga gave the example of Sheela (name changed) who was rescued off the highway in Haryana having suffered the sexual abuse of the most bestial kind, probably at the hands of truckers. She was rescued in a semi amnesic state and after piecing together the scraps of information, it seems that she became depressive in her conjugal home.
“I used to cry all day,” she said. As a result of this she was typically sent back to her maternal home where her presence was tolerated till the death of her parents. After that she left her maternal home either on her own or was made to do so by her brother and bhabhi.
Sheela is on antidepressant treatment. The residents like her cooking and she cooks sixty plus meals a day. She could function out of Sudinalay but has nowhere to go. “My brother must think I am dead,” she said in a matter of fact tone. She’s been in Sudinalay for eight years. “This is one of our biggest problems,” said Monga. “One of the most heartbreaking moments in Sudinalay is when a resident has recovered enough to want to go home. They keep saying Bhaiyya ghar jana hai. But many don’t know where they come from.” The government has passed the buck to IHBAS giving them crores to trace the families. But they lie unused. “Money is just one thing,” said Monga, “but who will conceive of the mechanism.” He gave the example of a woman from Orissa who had been branded a witch and thrown out of her village. She found her way to Kolkata and from there to Delhi. “It is next to impossible for IHBAS or any of us to trace her family. You need to create a police and NGO network to gather information from the lowest level and pass it on to authorities in the metro.
You need to create a database and ensure the system works.” Once the family is traced, however, there is no guarantee that the women will be accepted back. Stigma, fear and economic factors make it hard to restore destitute mentally ill women to their families. Preeti (name
changed), for example, has been at Sudinalay for five years. Subjected to tension and humiliation after her husband took a second wife, she left her native Nagpur for Delhi and was found in Najafgarh in a state of depression. She is now stable. She is educated with an M.A. in Economics and is capable of holding down a job.
A brother has been traced to Nagpur and another one to U.S.A. but they are unwilling to offer her even money let alone a home. Is there a legal framework to deal with such a situation? “No,” says Monga.
Stigmatization plays a huge role in how mental illness is perceived in our society, which in turn conditions our treatment of the mentally ill. Monga identifies two approaches – institutionalization and rehabilitation. Institutionalization presupposes two distinct mental states, one normal and the other abnormal. Viewed from this perspective mental illness is an absolute condition and stigmatization is a natural corollary. Taking responsibility for an ill family member is one thing, but if the illness is considered a permanently abnormal state, the patient will be seen as a burden. This is why Monga stresses the rehabilitation approach. “‘Madness’ is relative,” he says.
“It is a state of extreme emotional distress which can be relieved and when it is, it becomes the duty of the state to see that the patient is rehabilitated as a functional and dignified member of society.” Monga cited the case of Maya (name changed). Maya is a graduate. She is intelligent, articulate and alert.
Her main symptom is aggression. But then she was raised in an aggressive environment, in a joint family where her father and uncles fought regularly. She also underwent abuse in her conjugal home. Her husband used to hit and kick her. “I threw a pair of shoes at him once,” she said. Maya was ‘sent back’ to her maternal home. After her father’s death, she was taken to a home for widows in Brindaban from where she was referred to Sudinalay.
She has been treated, her aggression has been brought under control but her uncles will not have her back. “It’s been four years since she’s been here with nothing to do,” said Monga. “She relapses now and then which is sad.”
“My uncles have my money,” Maya suddenly butted in. “My father left me a makaan. He said it was worth 5 lakhs. They don’t want to give it to me.” What would she do with it if she had it?
“I would go back to Ambala to my children. I would buy a place right in front of where they live and set up a crèche.” A crèche? “Yes,” she said with a twinkle in her eye. “I love children.” Rehabilitation, however, requires governmental intervention at the infrastructural, institutional and attitudinal levels. An entire mental health care system needs to be set up. The women in Sudinalay are all on maintenance doses of psychiatric medication. These would need to be made regularly available at rural dispensaries. A psychiatrist should also be accessible at the district level at least in case of relapse. Sensitization campaigns should be undertaken on a vast scale at the rural level. This would support not only patients but their families too. In this way they might be less likely to abandon their relative. There is, however, a severe shortage of mental health practitioners and workers in India. It is estimated that there are only five psychiatrists available per one lakh Indians.
There is mounting evidence that mental illness is the result of discrimination, abuse, and violence, which are routinely experienced by women. The condition of Sudinalay’s residents is proof of this. It’s like the entire range of India’s ills such as poverty, rural/urban divide, illiteracy, superstition, health, gender, law, and economics have converged to bear down on them – a very heavy burden to bear. The last major governmental initiative on the issue of mentally ill destitute women was a national seminar held in Delhi in 2007. It was a high profile event involving the National Commission for Women and the Ministries of Women and Child Welfare and Social Justice and Empowerment and then President Abul Kalam Azad. A variety of proposals were mooted but not much has come of them. It’s time the state took its responsibilities seriously and the concerned ministries and officials did their job.