Implication of Erwadi Tragedy on Mental Health Care System in India

The theme of the world health day 2001 was stop exclusion dare to care. The message was that there is no justification for excluding people with mental illness or brain disorder from our communitiesthere is room for every one (WHR,2001). This year marks the 10th anniversary of the rights of mentally ill for protection and care as laid by the UN a decade ago. In this very year we saw the horrific incidence at Erwadi in our country, in which 26 persons with mental illness died in a tragic fire accident. Overtly this may appear just another callous neglect in attention of policy makers in ouroverpopulated accident prone society, but the reason is more deep and multifactorial with an equal contribution from .false beliefs in the masses, faulty state policies, lack of knowledge about mental illnesses in the health care policy makers, stigma towards mental illness and beliefs about its untreatability India with population of more than a billion, houses one of the highest number of mentally ill persons who require long term care. With less than 10% availability of the inpatient care required for very ill mental patients and less than one psychiatrist available for one lac Indians, the gap between resources and requirements remains too broad. Due to this wide gap .large number of psychiatric patients do not receive adequate treatment and suffer from long standing illness and resulting disability. A large portion of the patients who do ultimately reach to the psychiatric outdoor, reach late, when the illness has already become chronic and resistant to therapy. Chronicity due to poor access to mental health care, age old beliefs about the non medical explanations of mental illnesses, widespread illiteracy and poverty combined together stigmatize both the mental illness and the mentally ill. One of the major reasons for the poor infrastructure of mental health care is that the mental health care has never been a priority area for national health policy planners. The reason for this neglect in the past may partly be explained by the fact that the health policy of any developing nation is directed more by the direct mortality rates and not by morbidity or indirect mortality. The scene is now changing with new concepts like Disability Adjusted Life Year (DALY) and global burden of disease. Parameters for measuring the impact of illness on mankind are now being revised. Already, mental disorders represent four of the ten leading causes of disability world wide and amount for approximately 12% of global burden of disease. With these facts in the background the whole basis of our mental health policy needs a revision followed by its proper implementation. Apart from the much needed physical infrastructure there is also acute shortage of the man power in the field of mental health care. The issue of less number of psychiatrists is further compounded by the striking ignorance about, and lack of adequate skills for treating mentally ill persons among the general care physicians and members of other medical subspecialities . Reason for this again is the neglected status of psychiatry as a subject in the undergraduate curriculum of the M.B.B.S(Trivedi 1998) If only these general physicians can correctly identify and treat the major mental illnesses like schizophrenia and depression, a lot of burden on the society, family and on the mental health care facilities would be prevented. This can also reduce