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| Sunday, 2 November 2003 |
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Features |  |
| News Business Features Editorial
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Angoda Mental Hospital: Crime and punishment? Sri Lanka's archaic Mental Health Act mandates persons suffering from mental illness to be in custody - virtually under lock and key at the place specially built to keep them away from society, violating all three UN principles on protection and care of the mentally ill - the right to equal treatment, not to be discriminated against on the grounds of mental illness; the right to be treated and cared for in his or her own community and the right to be treated in the least restrictive environment. by Vimukthi Fernando Sitting quietly in a room, looking out between the window bars is an old man whose eyes light up when you look in his direction. He's been 'behind bars' for 45 years.
Sumanadasa is an inmate of the Angoda Mental Hospital. "What brought you here?" we ask him and find out that it was the aftermath of a burst of anger, trying to run with a knife in his hand after an angry neighbour who scolded him. His sentence seems to be a lifetime's imprisonment. In a country where perpetrators of rape and murder walk out of prison on special pardons offered by the head of state, from time to time, sometimes within the very next year after starting to serve their sentences, the judgment meted out to Sumanadasa is extreme. And yet, there he is in a forgotten corner of a forgotten 'asylum' - an 'inmate' in the Department of Forensic Psychiatry of the Mental Hospital Angoda since 1958. Though healed of his temper tantrums long years ago, Sumanadasa has no opportunity to leave the premises of the hospital. He is practically confined to the 1st floor of a building old, sturdy and gloomy with high walls and every opening secured with thick wooden bars be it windows or doors. What is his real crime? Mental illness. stigma The 'stigma' attached to mental illness leaves Sumanadasa forsaken by friends, family and the whole of society. Moreover, the Sunday Observer's visit to Mental Hospital Angoda (MHA) revealed that mentally ill patients are a cast off lot, treated as sub-human by the very people who are entrusted with their care, the health authorities of Sri Lanka as well.
It was not a kindly face that greeted us at the entrance of the hospital. But, a stern one with questions abounding. Answering the queries we were allowed in to a long pathway, leading to a majestic looking building. Walls thick and high and corridors long, empty and echoing seemed to be the signature of the old and the 'secured' section of the hospital. In contrast, the new wing teemed with patients - on the beds, under the beds and spilling over to benches along the narrow corridors. Patient care has become the primary issue of the hospital say Dr. Jayan Mendis, Psychiatrist, Director MHA and Dr. Harishchandra Gambheera Psychiatrist, Secretary of the College of Psychiatrists. Overcrowding is the main obstacle in its pathway. Reintegration Nearly 50 percent of resident patients do not need in-house medical treatment, says Dr. Mendis. They could be re-integrated with society. They only need a place for respectable living and drugs to be administered under good living conditions, says Dr. Gambheera. Due to overcrowding resources are not sufficient to treat those who need acute care. While stigma behind mental illness is the main reason for abandoning patients another major factor is the patients from remote areas. Over 40 percent are from areas such as Hambantota, Anuradhapura, Trincomalee, Nuwara Eliya and so on says Dr. Gambheera. It costs a minimum of about Rs. 6,000 to bring a patient down to the hospital from these areas. Since many cannot afford this expense, their fear of relapse and the need to bring the patient back to Colombo prevents them from taking patients home, he points out. Other areas which needs improvement include space for patients to move around, rehabilitation facilities, more beds and special care units such as a psychogeriatric unit for the elderly patients. The hospital also lacks equipment such as stretchers, wheel chairs and fridges to store drugs says Dr. Mendis. Only two stretchers and two wheel chairs are there for the use of 26 wards! Human resources is another area they lack, adds Dr. Gambheera. Only five Occupational Therapists serve the hospital helping patients learn basic living skills while the number necessary amounts to 30! Out of the required 352 nursing staff, they barely have half (178) with only 25 trained psychiatric nurses. Staff problems Another issue the hospital faces is the improvement of knowledge and understanding of mental illness among the staff, says Dr. Mendis. An attitudinal change is needed especially where the minor staff is concerned, he says citing a recent finding. The hospital administration had recently found out that out of 40 or 50 beds in each ward, four are reserved for minor staff to sleep in the night. The nursing staff is also reluctant to take action against this malpractice. When the administration banned the reservation of beds, the workers threatened to take union action, saying that the reservation of beds had been going on for the past 25 years, says Dr. Gambheera. In a hospital where there are about 80 to 90 patients in a ward, this in itself shows the attitude of the staff towards the patients. Physical assault of patients especially on admittance, smuggling cigarettes and other banned items, stealing money and belongings of patients are some other allegations against the minor staff. However, corrective measures are being taken with additional security initially to be kept in the male wards, says Dr. Mendis. Lack of concern and negligence of patients are the outcomes of the erroneous attitude of the nursing and some of the medical staff, says Dr. Gambheera. Until recently, only one medical doctor was on call after 4.00 p.m. to treat 1,300 patients! Now, the number had increased to eight. Out of the 50 medical doctors attached to the hospital only 14 are training to be psychiatrists, he adds. Though there is a dire need of psychiatric nurses, rules and regulations of the nurses trade unions restricts the recruitment of suitable nursing staff, laments Dr. Gambheera. It is the senior nurses, mostly over 40 years of age who undergo psychiatric training as a requirement for further promotion! Awareness In psychiatry, the main machines are human beings, explains Dr. Mendis. He proposes to educate and increase awareness of the hospital staff through different programmes, including exchange and exposure programmes within the region. Compared to the region, Sri Lanka lags behind in the decentralisation of psychiatric units and the availability of psychiatric drugs, says Dr. Mendis. Though some drugs are available, they are not available continually. It is interesting to note that while a paradigm shift has taken place world over in caring for the mentally ill from that of institutionalisation of individuals to a community care approach, Sri Lanka still holds on to the 'asylum' concept. Sri Lanka's archaic Mental Health Act mandates persons suffering from mental illness to be in custody - virtually under lock and key at the place specially built to keep them away, to protect society from patients, violating all three UN principles on protection and care of the mentally ill - the right to equal treatment, not to be discriminated against on the grounds of mental illness; the right to be treated and cared for in his or her own community and the right to be treated in the least restrictive environment. It is also interesting to note the attitude of the authoritative officials. When the Sunday Observer finally contacted the officer responsible Dr. Hiranthi De Silva, Director of Mental Health after several attempts, she refused to answer any questions stating that journalists should not get involved in "administrative matters." ***** How they dared to care "Stop exclusion - Dare to care" was WHO's theme for the World Health Day 2001 where care for the mentally ill was emphasised. It is fascinating to note how the Sri Lankan health authorities cared. The Mental Hospital Angoda had a motor car (Registration No. 65-9745) donated by the 'Nations of Mental Health' (an NGO) through WHO, which was used to transport patients who do not need medical attention back to their respective homes. However, it is alleged that on December 18, 2001 when the vehicle was taken to the Ministry of Health (MoH) one of the Additional Directors had verbally ordered the driver to handover its keys and tools to one of the drivers in the Ministry supposedly for the use of the Minister's Coordinating Secretary. Through the letter dated December 21, 2001 (MH/TRA) had informed the hospital that the Director General of Health Services had taken over the vehicle. Repeated requests to the MoH for the past two years to return the vehicle for the use of patients had not been adhered to says Dr. Jayan Mendis, Director of the hospital. And now the vehicle is in dilapidated condition and would be of no use for the patients even if it is returned, says Dr. Mendis. However, there is a directive ordering the hospital to renew the vehicle licence and insurance! ***** How you can help The Mental Hospital Angoda houses over 1,300 patients in 26 wards. But, has only 02 wheel chairs, 02 stretchers, 12 refrigeration units to store drugs and no facilities to wash clothes of the patients who are left unattended, unlike those in other hospitals says hospital director, Dr. Jayan Mendis. There are plans drawn to equip each ward with a stretcher, wheelchair, washing machine and a small refrigeration unit. Public assistance is sought to meet these needs. The hospital's venture to improve the diet of the patients seeks public support in the form of 'Dane' (alms). There are simple menus prepared for the five days - to include fish and eggs in the diet to supply them with animal protein. Provisions for one ward (usually housing about 80 patients) or more could be handed over to the hospital. Contact: 2578237 for more information. |
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| Editorial | Security Produced by Lake House |
We
will call him Sumanadasa. A septuagenarian, sporting a thick head of
silver grey hair, a wonderful smile which lights up his eyes, fair
complexion and mild manners, one would feel he is the best grandfather one
could ever have. In an abode secured with walls thick as well as high, and
behind chained and padlocked doors with wooden bars two inches thick he
radiates cheer and reminisces about the time he spent with his friends and
siblings in the open fields. It was a happy life - growing up in a large
family in a remote village close to Kandy.
