On January 12, 2003, a young woman's life changed forever because she was raped within the precincts of the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore.

The victim was a 17-year-old schizophrenic girl (an in-patient at that time), and the perpetrator, an HIV positive young man who is an out-patient undergoing treatment for alcohol abuse. The heinous incident occurred in the afternoon when the girl was sitting in the hospital grounds reading a magazine, while her mother, her "guardian", was in the ward. The girl, though severely bruised, was alert enough to inform her mother about her trauma. Her mother got in touch with the hospital authorities immediately, but they made no effort to register a police complaint against the rapist.

Matters would have remained at status quo but for the intervention of the office of the Commissioner for Disabilities of the Government of Karnataka, who swung into action the next day as soon as it heard about the rape. A case was registered suo moto under the Disabilities Act, on the strength of which the criminal was apprehended. NIMHANS registered the case almost a fortnight later after pressure was put on the hospital authorities by the Commissioner's Office. Investigations are now under way. That the rapist was an HIV positive man increases the seriousness of the crime and its ramifications for the responsibilities of mental health institutions in protecting vulnerable girls in similar situations.

Even today, NIMHANS refuses to take the blame for the crime. Their contention is that it is the responsibility of the guardian to look after the ward while she is undergoing treatment as an in-patient. In this particular case, the patient and her mother had travelled to Bangalore from Kolkata (West Bengal) since the facilities there were inadequate for the girl's treatment and because NIMHANS is rated as the premier institution for mental health in the country.

That many patients from different parts of the country come for psychiatric treatment to NIMHANS bears testimony to this fact. Many outstation families confirmed that facilities in other cities are a great deal worse. Many families were reluctant to talk because a mentally ill patient needs lifelong treatment and the families are at the mercy of the doctors who monitor the treatment. However, several confirmed that incidents of rape and ill treatment of patients are not uncommon even in private nursing homes.

"It is most unfortunate that legislation permits inspection teams to monitor what is happening in private hospitals but not in government-run institutions."
Pradeep Kumar, Assistant Commissioner for Disabilities, Government of Karnataka, says the constitutional rights of a mentally ill person are the same as that of a 'normal' person and a hospital is duty bound to respect these. The Mental Health Act of 1987 has introduced several provisos to protect these rights. "It is most unfortunate that legislation permits inspection teams to monitor what is happening in private hospitals but not in government-run institutions."

Kumar says this should change now and government institutions should also be brought under the purview of the Central or state Government with regard to inspections that should be permitted at frequent intervals. Inspection teams could comprise family members, experts in the field and voluntary sector workers who should be allowed to talk to inmates and freely move around the hospital premises. "There is a need to beef up security in the hospitals as it is humanly impossible for a guardian to watch her/his ward 24 hours a day," adds Kumar.

The appointment of an Office of the Commissioner for Disabilities goes a long way in helping to take up cudgels on behalf of the mentally ill or otherwise disabled. However, there is a dire need for officials filling these positions to be sensitised to the problems of the mentally challenged. In most states, an officer of the Indian Administrative Service holds this post as an additional charge. The Disabilities Act has a provision that recommends that a person trained or involved in the field hold this post. But as of today, only the state of Jharkhand has implemented this recommendation by appointing a visually impaired person from the voluntary sector to this post. The Chief Commissioner for Disabilities in New Delhi is a woman with many years of experience in the voluntary sector. It would be in the fitness of things if other state governments demonstrate their involvement and support to the disabled by appointing a trained person to the post of Commissioner for Disabilities.

"Parents need to be counselled with regard to speaking the truth when it comes to facing problems in mental institutions so that matters can be investigated and set right," says Kumar. In the NIMHANS case, the mother of the victim was very reluctant to reveal the facts because the doctors had said this would affect the treatment of her daughter. Fortunately, that has changed. The victim's mother is now determined to see the case through.

Chapter VII of the Mental Health Act deals with the liability of the psychiatric hospital or nursing home with regard to the care of mentally ill persons who are staying within its premises. In the case of this rape victim, NIMHANS subjected her to a series of tests both within and outside the hospital that the family was made to pay for. The Commissioner's office intends to use the provisions of this act to make the hospital compensate the family.

While the Mental Health Act may come in useful to take action against errant hospitals, it is equally important for the people in general to move away from the stigma associated with mental illness and be more sensitive to the needs of the mentally ill. In most Indian families mental illness within the family is kept under wraps for fear of jeopardising the matrimonial prospects of marriageable young men and women. At a recent seminar organised by the Disability Commissioner's Office and Rotary in Bangalore, a courageous mentally ill young man said, "Every day I get up and need to motivate myself to go to work. Most days I succeed, some days I don't, but I don't give up." His employer spoke after him and vouched for his efforts. According to the Superintendent of a halfway home in Bangalore, "The attitude to mental illness can only change if we accept the illness and the treatment for it just as we would for diabetes or blood pressure."

With work pressures, nuclear families and the hectic pace of life, mental illness may well end up being the number one malaise of the 21st century. As always, women and girls are the most vulnerable among the mentally ill. The trauma of this young woman clearly indicates that it is time for NIMHANS to set its house in order.