The battle against coronavirus is, of necessity, a lonely one. In mental healthcare institutions across India, it’s lonelier and tougher still. Families don’t, or can’t, visit. The restricted movement gets in the way of recovery, it can be difficult to check for Covid until symptoms manifest in serious ways, most patients are anyway in high-risk groups and, sometimes, it is simply difficult to get a message about the pandemic and its constraints across.
“Of the 530 inmates we have, about 20% have chronic illnesses like Alzheimer’s and dementia. They can’t communicate their problems, tell us if they feel sick or if they need support. They don’t understand social distancing or why sanitisers need to be used over and over,” said Dr Siddhartha Sinha, senior consultant at the department of neuropsychiatry at the Ranchi Institute of Neuro Psychiatry and Allied Sciences (Rinpas). About 15 patients, abandoned by their families, have been living at the hospital for up to 20 years now. “These are geriatric patients who need a lot of support and help even with daily activities. They are stable on medication, but just enough to support their lives. No one comes to see them. Their world is inside the hospital,” said Dr Sinha. For the others, family visits are down to less than half since the Covid-19 outbreak. “Only those who can afford to drive up have been able to come see patients. For the rest of the patients, it’s twice the isolation.”
When Covid-19 broke out, mental healthcare institutions were quick to frame safety protocols. “Staff members are screened before they are allowed in. Sanitisers, gloves and face masks are compulsory,” said Dr Nishant Goyal, associate professor at the century-old Central Institute of Psychiatry (CIP) in Ranchi. “We have suspended family visits. Only a few designated staff come in contact with patients in the hospital, others are not allowed into the wards,” said Pramila Gaur, director of Bareilly Mental Hospital. The Institute of Mental Health & Hospital in Agra has also stopped family visits. “Attendants can come see the patient from a distance. One caretaker has been assigned for every 20 patients. All of them stay on campus. After a month of serving here, they go home for a week. The next batch of caretakers then takes over,” said Dr Dinesh S Rathore, medical superintendent of the hospital. CIP, meanwhile, has set up a triage system to admit patients for 72 hours, with a guardian, and administer medicines before releasing them. “Not all mentally ill patients need to be attended to in person. But we are careful that the protocol is followed by medical staff and paramedics at all times,” said Dr Daya Ram, director of the institute.
Two studies had earlier shown that 38% of mental hospitals in India retain the “jail-like structure that they had at the time of inception,” according to a paper, ‘Mental Hospitals in India: Reforms for the Future’, published in the ‘Indian Journal of Psychiatry’. That restrictive space can be a problem.
“Patients need to walk, eat, exercise. Managing mildly ill patients is not difficult but those with serious disorders need more attention,” said Shradha Bhair, a psychologist with the Civil Society Network for Child Rights. And the bigger challenge is that the protocol for Covid-19 safety runs contrary to the needs of mental well-being. She explained, “Isolation can be dangerous in psychiatric hospitals, particularly for those with severe depression or schizophrenia. For therapy, social interaction is mandatory. For Covid, it is banned. Likewise, alcohol-based sanitizer can be fatal if ingested. Someone has to monitor them constantly then. What all of this adds up to is this — you get one case in these institutions and you will soon have 10.”
In Bareilly, for instance, the 158-year-old mental hospital has had a string of cases over the past week. It goes back two weeks, when a 30-year-old patient lost consciousness and hit her head. She was taken to the district hospital, where she was tested for Covid-19. The report came back negative on July 15. She was moved to a hospital in Lucknow for treatment of her head injury. But one week after she was discharged, she had high fever. She was tested again and, this time, she tested positive. This was on Sunday. Soon after, the institution’s entertainment teacher (who is in charge of the inmates’ recreation activities) tested positive, and then the sweeper and an office attendant. The hospital has nearly 200 inmates.
The patient was moved to the isolation ward. But most mental healthcare institutions don’t have the means to take care of patients should there be an outbreak. “The pandemic has caused anxiety, depression and other mental disorders … When it is suspected that a patient in the OPD may have Covid, we send them for tests and only admit those with a negative report,” said Dr Sinha. “For inpatient cases, we don’t have the resources to treat for Covid and the mental illnesses at the same time. Should a case be reported — there has been none so far — we will move the patient to the Rajendra Institute of Medical Sciences, which has a psychiatric ward.”
(Additional reporting by Priyangi Agarwal & Anuja Jaiswal)


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