BESIDES making 24 recommendations for an "organised mental health care system in the State", the N. Ramadas commission, set up to inquire into the death of 28 mentally ill persons (Frontline, August 31, 2001) in a fire at a private asylum in Erwadi village in Tamil Nadu's Ramanathapuram district on August 6, 2001, has held the chaining of the patients and the failure of the fire service to provide them immediate help as factors responsible for the deaths. The report of the commission was tabled in the State Assembly on November 31.
The commission was set up following the directions of a five-Judge Bench of the Supreme Court, which, based on media reports suo motu issued notices to the State and Central governments on August 7, 2001, asking them to submit a "factual report" of the incident. The court directed the Centre to map faith-healing centres for the mentally ill and implement guidelines to maintain certain minimum standards in mental homes.
The commission noted that of the 43 patients in the asylum, 15 who had not been chained had escaped the fire (though three women among them died later of severe burns). The problem was compounded by the fact that the fire service had sent its van to Ramanathapuram town for repairs. While the commission commended the State and district administration's response in the wake of the accident, it came down heavily on the administration's indifference to the recommendations made by several committees that had studied the situation in Erwadi earlier.
The commission's recommendations include the setting up of mental hospitals in Thanjavur, Tiruchi, Madurai and Ramanathapuram, and one of them exclusively for women. Currently, the State has only one mental hospital, in Chennai, and the relatives of patients from distant places find it difficult to bring them to Chennai. The commission has recommended that a psychiatrist be posted in every district hospital; it has also stressed the need to set up a psychiatric clinic in every district headquarters and a 10-bed psychiatric ward in major hospitals. Concessions of the sort extended to the physically challenged, the commission said, should be extended to the mentally challenged too. It urged the government to monitor all places of worship that house the mentally ill and close down unlicensed private asylums.
The mental health care system in Tamil Nadu is in a deplorable state, as successive governments have failed to act on the various reports and studies that were done on the plight of the mentally ill at the various faith-healing centres. The Erwadi tragedy, which caught the attention of the world, forced the State government to act. Besides announcing some immediate measures to deal with the situation, it decided to implement, after 14 years, certain sections of the Mental Health Act, 1987. For instance, it made it mandatory for anyone setting up a mental home to obtain a licence as required by the Act, and ordered the closure of all "mental homes" functioning in thatched sheds and the "unchaining" of all inmates.
The Ramanathapuram district administration took a series of measures to deal with the situation, including the setting up of satellite mental health centres, identifying the mentally ill by organising camps in various places, and providing vocational and community-based rehabilitation. It set up a medical review team, which visits the satellite mental health centres every month to follow up on the patients identified.
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