Healing ways: Contours of mental health landscape of Bengaluru
A panel discussion on ‘How Can Bangalore Do Better for the Mental Health of Its Residents?’ held at the BIC, Domlur, looked at a range of issues like the history and evolution of NIMHANS, the positive effect of green spaces on mental health, the role of family in caregiving, the limitations of legislation, and the treatment gap in mental health
Sometime in the 1980s, a man barged into the cockpit of an Indian airliner, brandishing a plastic gun, claiming that it was being hijacked. “The plane was forced to land in Bengaluru,” recalled renowned psychiatrist Dr Sanjeev Jain at a panel discussion titled “Minding the City: How Can Bangalore Do Better for the Mental Health of Its Residents?” held at the Bangalore International Centre (BIC) in Domlur. When the man, a patient of the National Institute of Mental Health and NeuroSciences (NIMHANS) who was having a manic episode, came out of the plane, he pulled out his NIMHANS card, almost as if the document provided some indemnity.
He was brought to the institute, continued the Bengalurubased clinician and teacher, who shared the stage with sociologist and mental health rights activist Dr Nirmala Srinivasan and writer and editor Kavya Murthy at the event.
“NIMHANS had become part of the local ecology of the whole city,” he said, recalling a time when simply showing a NIMHANS OPD slip was enough to get one a free bus fare to the institute. “You didn’t need a disability card or stamps from various authorities,” he said. According to him, even though we are a more open, technologicallysavvy society today, this kind of graciousness for people coming to the hospital and their families has reduced over the years.
Mental health
Anecdotes such as this constantly popped up during the panel discussion, furthering a nuanced, complex discussion on mental health, which veered from the history and evolution of the institute to the positive effect of green spaces on mental health, the role of family in caregiving, the limitations of legislation, the treatment gap in mental health and so much more. “There is a lot of noise about mental health,” pointed out Dr Srinivasan. She said she saw this as a positive development as was the increased sensitivity towards mental health. “I look forward to a bright and positive future for mental health.”
However, one thing that disturbs her is the tendency to ignore the distinction between the broad spectrum of mental health and mental health disorders within it.
“That is not happening. I look forward to that taking place, and I am sure that the trend is towards that,” she said, adding that accessibility is another important thing that needs to be addressed. “There should be distributive justice of services,” she stated.
About NIMHANS
Murthy, who was moderating the session, started by asking about the landscapes important for mental healthcare to work, the unique infrastructure of open pavilions and trees at NIMHANS and its close relationship with Bengaluru. “Could you tell us about what you have explored in your work and how you look at the individual, society and institution?” she asked.
Dr Jain responded by briefly tracing the institution’s journey. “It starts off at the Hospital for Peons, Paupers and Soldiers in the Cantonment, and it moves to another side of the city, what is now the State Bank of Mysore,” he said. In the 1930s or so, as that part of town became more crowded, the asylum moved to a hillock between Lal Bagh and Basavangudi, close to the Victoria Hospital.
“Indian psychiatrists were trained in the UK and felt that there is a need for better asylums matching those of the UK,” said Dr Jain, adding that a lot of planning went into choosing a site that would be even more salubrious than the larger city of Bengaluru in the 19th century.
Dr Jain also mentioned how Dr Francis (Frank) ◣avier Noronha, the first superintendent of this new facility, played a pivotal role in creating the institute’s lush campus. Dr Noronha was a passionate gardener, which led to the planting of many semidecorative and medicinal trees on the 125acre campus, a fact that no doubt contributed to better management of the mental health of its patients, going by recent studies that indicate a positive correlation between proximity to green spaces and mental wellbeing. “That healing space was created for the district of Bangalore, and they wanted to replicate these in every district in Karnataka,” he said, adding that there were around 350 patients back then, in keeping with the idea that 56 people needed an acre of land to spend their lives on. And while the city has grown exponentially since then, “these kinds of spaces haven’t been created anywhere else,” he says. So what has worked and not worked, asked Murthy. “Success lies in the eyes of the beholder,” laughed Dr Jain. NIMHANS – which had a staff of 6 when it was established in 1954 as the All India Institute of Mental Health –today has a staff of 200. “We used to see about 1000 admissions a year. Now we have around 12,000 in psychiatry and another 8000 in neurology,” he said. These numbers, the institute gets around half a million patient visits annually, he says, put immense pressure on NIMHANS.
While the service provision has improved, it doesn’t always answer the needs of the people efficiently, he admitted. “Every morning, you get 1,000 patients.
“No matter how many staff you have, and if you need to spend at least half an hour per person, there is simply no time.”
A family matter
Family and their role in the management of mental health was another thing that came up in the discussion. Dr Srinivasan, for instance, shared her first impression of NIMHANS when she walked into it “as a 6year daughter of a mother who was admitted there,” she said, recalling the beautiful park and courtyard of the institute, the trees and buildings and acres of land surrounding the cottage her mother was housed in.
“I didn’t find anything odd,” said Dr Srinivasan, adding that her tryst with mental illness was a long journey, starting when she was a 3yearold baby born in Victoria Hospital.” It is a beautiful experience to understand mental illness,” said Dr Srinivasan, who played a pivotal role in enabling an ambulance service for psychiatric emergencies in the city.
Dr Jain talked about the establishment of the mental hospital in Amritsar and how it started from tents, with families playing a key role in the caregiving process, something that was also seen in the family wards of CMC Vellore.
“With that came the assumption that the families can be engaged in treatment and longterm outcome of the patient,” he said. Unfortunately, however, caregiving has become more complicated with shrinking family units. “The average size of family has dropped to four. If one person is ill, the other three cannot afford to look after another person,” he said, pointing out that the question of who will look after a person with mental illness after their primary caregiver’s time is a very high concern in the Indian context. “Family members need to share the care, but that should not reduce or make the government insensitive to providing care.”
Srinivasan offered a slightly different take on the matter. “I don’t separate the family from the individual the way mental health experts look at it. How can you use ‘burden of care’; it is my fleshandblood.” In her opinion, the words chosen by doctors matter a lot since they influence the family’s thinking, attitude and behaviour. “I wish that we banish this expression, the burden of care,” she said.
Dr Jain added that the term “burden” in relation to mental illness was specifically formulated in Nazi Germany. “They killed people in mental hospitals in Germany because of this concept of burden,” he said. He also noted that the word was often only applied only mental illness. “No one talks about the burden of cancer, hypertension, heart diseases. It is a problem to be solved,” he said. “The word burden has unfortunate connotations.”
This event is part of the ‘Listening to Voices’ project that documents audio stories about mental health in Bangalore. A pilot installation, inspired by Itaru Sasuki’s windphone, will be open to the public from Feb 29th (5 pm) to March 5th (8 pm) at the BIC Garden area.
I don’t separate the family from the individual the way mental health experts look at it. How can you use ‘burden of care’; it is my fleshandblood.
NIRMALA SRINIVASAN
mental health rights activist