Why housing colonies struggle to cope with residents with mental ailments

Mumbai: When sludge started flowing down a few walls and a portion of the ceiling in the living room collapsed, the ground-floor Mehtas (name changed) asked their housing society in Parel to check with the resident on the first floor who was unresponsive to them. What the inspection team found was baffling: the first-floor flat seemed like one big mud puddle, with patches of mold and dirt stains in different rooms. And, every few minutes, the 50-plus owner Naaz threw water across the room. Naaz had clearly not bathed or brushed for weeks, but the dirt on the floors bothered her so much that she frequently ‘washed’ it with water, causing structural problems for the Mehtas downstairs. “She had schizophrenia along with obsessive compulsive disorder (OCD),’’ said psychiatrist Dr Rohann Bokdawala, who was called by the housing society to check on Naaz. Schizophrenia is a serious mental illness that affects a person's thoughts, feelings and behaviour while OCD is a condition characterised by unwanted thoughts and repetitive behaviours; both severely disrupt normal life.In Mumbai, where even tiny homes cost over Rs 1 crore and families are smaller than before, the presence of a mentally ill person who has no family member around could become an acute problem for neighbours and housing societies, as Anil N found out recently. In a gated community in the suburb of Chembur, of which Anil N is the society chairman, 55-year-old Maya “scared” her immediate neighbours a fortnight back. Maya and her sister had given their land to the builder in lieu of a 2BHK flat, but both women were recluses. When the elder sister died a couple of years back, some family friends would drop food for Maya every day. Her electricity connection would often get cut, and her neighbours would pitch in to pay her bill and restore the power lines. But the frequency of her erratic behaviour increased in recent months: She filed a complaint with the society office about a neighbour wanting to assault her, she began keeping her excreta in a bag for the janitorial staff to pick up, and, one afternoon, as her immediate neighbour’s children were waiting for the lift, she brought out her 32-inch television and smashed it on the floor. When she started wandering around without any clothes, the housing society reached out to the police for help. When the police refuses to act When Anil N and other office-bearers of the housing society went to the local police station, they hit a barrier. “The police are usually the first point of contact for concerned citizens in such cases but they don’t seem sensitised,’’ he said. His society had lodged complaints and given several letters to the police station, but in vain. “Shouldn’t the local police stations know names of doctors, NGOs and registered shelters or homes with qualified staff who can help in such situations?’’ he asked. The police, felt the housing society members, believed Maya is a problem that the society or the neighbours need to resolve. mediumhttp://www.youtube.com/watch?v=K2sc_ck5BZUAnil recalled trying to help a mentally ill destitute woman he had near his building a couple of years back. “I was willing to pay for a social worker to escort her to a shelter in Ambernath, but the police wouldn't authorise it. They said they wouldn’t take the responsibility of shifting her to a home as they didn’t know where she had come from,’’ he said. Luckily for the woman, a DCP visiting the police station when Anil N was there, ordered the inspector to sign the letter and let the woman to be moved. “The police can't leave everything to neighbours or bystanders,’’ he said.According to psychiatrist Dr Sagar Mundada, in such situations, the housing society could get a psychiatrist to evaluate the patient within his/her home and in the presence of two witnesses. “The diagnosis in such cases is mostly schizophrenia,’’ he said. The psychiatrist’s signed evaluation should be taken to the police, who quickly organise a magistrate’s approval to take the patient to a mental hospital. “If the patient has a family with financial means, a private rehabilitation home could be chosen,’’ he added. (Not that these home-visits are simple; Dr Bokdawala remembers a patient who threatened to turn on the gas knobs and use a lighter to start a fire if he didn’t leave. “It took over 30 minutes to calm down him enough to trust me,’’ he said.)Policing problemsA police officer at Panvel dismissed the criticism that the police are insensitive to such issues. He said the police can recognise homeless people who need urgent mental health care. “Each police stations has a list of phone numbers of various destitute shelter homes that can be asked to pick up such patients,'' he said.The founder of Social and Evangelical Association for Love (SEAL) Ashram, pastor K M Philip, pointed out that the police cannot get a suspected patient admitted to hospitals; the law makes it mandatory for a “bystander'' to complete all the paperwork. “As such bystanders are never available, we at SEAL become their guardians to admit them to hospitals,’’ he said. medium120850706In Maya’s case, the day the society went to the police, she ran away from home and was found by the police two days later. While the police contacted a private rehabilitation centre to drop Maya to her house, her lack of finances meant she was taken to the state-run Thane Mental Hospital. A senior state govt official, though, said the mental hospital no longer keeps patients endlessly like in the past that had led to overcrowded facilities: “We only keep such patients for a month, with an extension of one month at a time for six months’’ he said. A social worker has, in the meanwhile, been helping Maya and the housing society with the paperwork and treatment at the mental hospital.What happens with patients who have no family?Private charitable organisations often step in to help patients who have no kith or kin. In the case of Naaz, a religious organisation of her faith, spends Rs 25,000 per month to keep her in a private rehabilitation home. “Even though she has improved, she prefers to stay in the rehab home where someone feeds her on time and ensures she doesn’t miss her daily medicines,’’ said Dr Bokdawala. Every six months, she signs papers to continue her stay at the rehab home.“Schizophrenia patients are easy to treat as they are guaranteed to improve after a few months, but the same cannot be predicted about depression patients,’’ he said.Organisations such as SEAL Ashram help unite destitute patients with their families. Take the case of 40-year-old Uzma Bahed, who was found as a destitute eight months ago, but has since been reunited with her family in Madhya Pradesh.Pastor Philip said Uzma’s story has played out many times in the past 25 years. “Many homeless people suffer from schizophrenia or dementia and are unable to recall their home address or seek help from others while wandering the streets in their ragged clothes and unkempt appearances,’’ he said. If they are lucky, a sensitive citizen reaches out to organisations such as SEAL. medium120851116Uzma was referred to SEAL Ashram by the Pantnagar police in Ghatkopar. “When Uzma reached our shelter, the maggots from her head wounds kept falling off like an army of little worms. She could have died on the streets as an ‘unknown person’ if there was any further delay in rescuing her,'' said a SEAL social worker. As she improved and remembered her address, SEAL connected with her husband who soon arrived to take her back.‘The Mumbai Problems’There are certain issues that are peculiar to the city—such as expensive real estate. Senior psychiatrist Dr Harish Shetty, who filed a PIL in the high court about the implementation of the new Mental Health Act after he came across a woman languishing in Thane Mental Hospital for 12 years despite certified as normal 10 years back, said calls to rescue a schizophrenia patient at home or on the road is not uncommon for psychiatrists in Mumbai. The new Mental Health Act, which was passed in 2017, has laid down the steps to treat such patients. A problem that arises in Mumbai, according to Dr Shetty, is when the patient is the sole owner of property that he or she is not mentally fit to keep track of. “In Mumbai, when a patient has a home but has no immediate family, I advise the society officials to ensure his/her house papers are kept safe. Once such patients get into a hospital, people claiming distant relationship turn up to claim the house,’’ said Dr Shetty. If honest people are involved, the house itself could be used to raise money for the patient’s long-term treatment.There also is the issue of involuntary admission into mental hospitals. A public hospital doctor said that involuntary admissions are allowed only for a month, with a provision to extend it (with the magistrate’s sign) for one month at a time till six months. 120851708According to a senior state health department official, the new Mental Health Act and the state infrastructure are adequate to handle people with schizophrenia and other mental illnesses. “We don’t need private organisations that charge up to Rs 50,000 a month to keep such patients in their fancy rehabilitation homes,’’ he said. However, practical issues remain: as most schizophrenia patients need at least five weeks of medication to get better, how do short-staffed govt hospitals manage the paperwork for extended stays?SEAL’s chief patron Dr Abraham Mathai, a former vice chairperson of the Maharashtra State Minorities Commission, said the new Mental Healthcare Act helps patients get better access and support, but added, “social organisations like ours are needed to rescue the homeless, medically treat them and then reunite them with their families.''Pastor Philip suggested creating a data bank of human biometrics using Aadhaar so that when a mentally ill homeless person is rescued, his/her biometrics can be matched and his or her family traced. Vashi-based social activist Yatin Bansal wants a special helpline number for mental health rescues. “At present, citizens call the police emergency number (100). A dedicated helpline would encourage more people to report cases,” he said.Navi Mumbai-based psychologist Dr Amitabh Karmakar said homeless persons with mental issues are either violent or passive and introverted, often seen talking to themselves, adding the violent types have to be retrained by social workers in order to start their mental health care. “The police or citizens in general must not dismiss them as ‘mad’, but instead help find medical support and save their lives.”