From hell to heaven

A long march from lunatic asylum to hospital with a heart:

by Indeewara Thilakarathne

Remodelled hospital ward

Patients engaged in creative activities at Rehabilitation Centre

Newly partitioned Seclusion Section

A severly beaten up patient , a common scene of the past

A traumatized patient hidden in a gutter

Unhygenic conditions - A scene from the past

Reminiscent of regalia of the British Empire, a tall elegant building stands in a strangely spacious land in the suburb of Colombo, Angoda. The building was constructed by the British as far back as 1929 albeit it still stands tall amidst host of other buildings that make up the Angoda Mental (Teaching) Hospital.

The spacious old, colonial style building which houses the main office of the hospital including that of its director, would have witnessed the untold sufferings that the hapless patients under went when they were often subjected to inhumane treatment at the hands of the authoritative hospital staff that earned an ill-fame not only for the hospital but also for the village of Angoda where the hospital is set up.

The construction of the hospital was commenced in 1929 by the British as a solution to the over crowding of the mental hospital at Welikada (the same premises was subsequently used for the prison). Earlier the hospital was located at Torrington Avenue at buildings which now house SLBC.

The hospital was known as the lunatic asylum and patients were handled in a rough manner, herding them into jammed packed cells and the patients had to spend, perhaps, rest of their lives in total misery, denied of basic human rights and even the right to see their relatives. It was a man-made hell where the hospital staff knew nothing about patients' care and the patients suffering from diverse mental diseases were treated as beasts.

The very name Angoda traumatise even the rehabilitated patients as it always brings back unpleasant and horrendous memories. The authoritative and arbitrary manner in which the psychiatric patients were handled had been widely condemned by the media, although little has been changed in terms of the quality of the care offered by the hospital and hospital staff's attitude towards patients.

Past Superintendents

One of the significant factors that inhibits improvements of the care provided by the hospital had been its successive heads of the hospital who were mainly drawn from non psychiatric backgrounds.

They had little or no knowledge of psychiatry or qualification in the field of Medical Psychiatry or allied fields. They were perhaps more interested in perks rather than in the development of patient care provided by the hospital.

As the hospital staff was strictly managed, they were under pressure and invariably the quality of the care was at the lowest ebb. Medical staff was confined both in number and their specialties and the sub-specialties such as rehabilitation and mental health training have been completely neglected. The staff was more or less confined to issuing medication to patients, neglecting mental nursing which is an important aspect of overall care for psychiatric patients.

Invariably, the issues relating to psychiatric care were left in the hands of the support staff who terrorised the patients and families leading to malpractices such as obtaining bribes from the patient' families for either allowing them to visit the patients or to keep the patients in hospital facilitating other members of the patients' families to rob and misuse the patients' properties.

Most of the staff consisted of non-trained personnel, supporters of the politicians and those who have been transferred on disciplinary grounds.

The staff not only mercilessly assaulted the patient but also abused the facilities meant for them. Patients' beds, toilets and TVs were used by the staff and often patients were deployed for support work.

Especially the restless patients were at the mercy of support workers who restrained the patients by mercilessly assaulting and beating them up. Patients became silent sufferers as assaults or patient's injuries were not reported.

It was a case of law unto themselves and no inquiry was held into these incidents. At worse times, patients' meals were not given to the administration for perusal. The situation was worse than in a prison and the patients were kept under appalling conditions.

Restricted visiting hours

Visiting hours for patients' families were initially restricted to two hours. There were no facilities for the visiting families and relations who were often interrupted by the Health Support workers.

There was no sitting and meeting area for the visiting families and children were not allowed in. It was not an uncommon occurrence that families bribed health support workers to prolong the visiting hours.

The prevailing circumstances compelled some of the families either to curtail the number of visits or to abandon the patients altogether, rendering some of the patients 'homeless' mentally disabled patients. At present a considerable number of 'homeless' patients are being looked after by the hospital.

Fortunately, the situation has changed for the better since the extension of visiting hours and that improved facilities are, now, provided for visiting families and relatives including sitting areas with chairs close to wards. Meetings between patients and their families are more intimate and private and the disturbances are minimal.

According to Dr. Jayan Mendis director of the hospital, the process of transformation and remodelling the hospital was a painful one. It has to be a process which is not only structural changes but also motivational and attitudinal changes on the part of the hospital staff.

A Mental Health Training Unit was set up in a closed section of an old ward in order to facilitate the much 'needed attitudinal change of the hospital staff towards patient to improve the patient's care provided by the hospital.

The training for the staff at the Mental Health Training Unit commenced in year 2004 with a medical officer and nurse being assigned to it. They were entrusted with the task of organising training programme in Mental Health for the entire staff in different categories.

The unit was not only responsible for improving the knowledge of psychiatry and mental health among the various categories of the staff but also brought about a radical change in attitudes towards patients and methods they employed to handle them.

Extension Training programmes have been introduced by the unit for the nurses and doctors, initially in the Western province and subsequently encompassing all Administrative districts of the island.

Another significant improvement in the hospital was the setting up of the Psychiatric Rehabilitating Unit with a batch of 16 nurses and two medical officers, two occupational therapists who were trained in National Institute of Mental Health in Bangalore in 'Psychiatric Rehabilitation Mental Health.'

Principle objectives of the Unit are to regain the lost capacities of the recovering patients in order to facilitate and speed up the recovery process and to impart on them life skills.

Soon the rehabilitation unit produced concrete changes as the rehabilitation activities have effectively shortened the span of time the patients spend in the hospital in addition to imparting them with life skills.

As the patient began to make various items such as candles, bed-sheets and various kinds of linen, an outlet was opened in front of the Horticultural Unit. Income generated by the patients was re-distributed to purchase raw material for rehabilitation activities.

With the initial amount of Rs. 400,000, donated by Singer Sri Lanka, Rehabilitation Fund was set up in order to carry out the activities of the unit.

Mother, Baby Unit is an addition to the existing specialised wards of the hospital. When mothers suffer from puperal depression and puberal psychosis, a post pregnancy psychiatric disease.

Mothers with milk pouring breasts were a common sight at the ward. Deviating from the previous practice of sending the new born babies to the Lady Ridgeway Hospital, the Mother-Baby Unit provides facilities for mother, their babies and even family member to stay at the ward. Mother-Baby Unit was built with financial aid from Chandra Soysa.

The Mother-Baby Unit was opened in January, 2007. Family members of the patient mothers were educated on the nature of the disorder and this education process has significantly reduced time patients spend in the hospital.

Plans are afoot to build a twenty roomed Adolescent Unit for children aged 8-13 who had been earlier boarded with other patients, often subjected to harassment (sexual and verbal abuse) at the hands of other patients.

The Unit will be constructed with the financial aid from Rotary Club of Kaduwela. The upstairs of the building will be converted into a rehabilitation centre for adolescents with exercise machines.

Dr. Jayan Mendis is expected to link the Unit with Melbourne Adolescent Unit or Pre-Psychotic Assessment Unit. The psychiatric will visit the patients and make assessment and if required medication will be provided before hand, ensuing hundred percent success in recovery without any future complications.

It has been observed, at most of the time, properties of the psychiatric patients are being used by patients, relations and pay the bribes to hospital staff to keep the patients in hospital custody. The hospital has successfully instituted cases before court of Law and won back properties of the patients which had been abused by their relations.

Unlike in the past, inquiry into cases of assault will be done by the Inquiry Division of the Ministry of Health and reports will be submitted by the Division on the findings of the inquiry.

Physical infrastructure such as doors to the toilets , staff rooms, bathing cloth supplied to women patients , the seclusion section which was a large hall where restless patients were kept, had been converted into five individual rooms to avoid fighting between patients with one another, has been substantially improved.

Other additions to the existing infrastructure are the newly constructed medical ward with a physician in charge of it and the Psycho-geriatric Ward for elderly patients. As a measure to improve medical equipments, the hospital has purchased five ECT machines.

As the ECT treatments is closely monitored, ECT treatments is being given on thorough examination. Monitoring mechanism at the place in the hospital has also been developed that all most every activity is monitored.

Changes in the administration

As a measure to improve the quality of care, Death Conference is held on each and every death that takes place in the hospital. Death Conference will examine in detail every death.

The very hierarchical and authoritative administration has been changed to a genuine system of administration which is extremely accommodative and the various process from admission, monitoring, rehabilitation and discharging of the patients have been systematised through series of administrative devices such as maintaining registers , especially in the vital sector of care giving and minimum criteria documentation.

For instance registers for seclusion, restraining, Depot preparations, difficult patients, Readmitted patients, Computerise all admissions/discharges has not only made Angoda, one of the well-monitored hospitals in Sri Lanka but also facilitate senses of vital statistics with regard to the spread at mental diseases.

Data gathering has been improved through the introduction of well-structured forms such as Structured Psychiatric Interview form, New Diagnostic Card.

The oppressive administrative environment has been changed through object lesson of being genuine from the very top of the administrative hierarchy.

According to Dr. J Mendis, hospital requires donations in terms of materials to carry on the activities of the Rehabilitation Unit and vehicles, especially for increasing number of field visits in order to provide post-treatment and to visit patients on leave and live in their respective communities pending discharges.

Currently the Directors official vehicle has also been used for field visits. Prospective donors can contact the Director of the Angoda Mental (Teaching) hospital, Dr. Jayan Mendis at 0714, 760795 or 2578234-7.

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