There are 46 state-run psychiatric hospitals in India. It is common for women with mental health issues to live in these institutions for very long periods. They are called “dumped women” given their long-term stays in mental hospitals due to lack of family support. A new study was conducted by Anindita Bhattacharya, David Camacho, and Ellen Lukens, which investigates the reasons behind the long-term stays. The researchers found that gender disadvantages, lack of familial support, poverty, and family violence often lead to women’s admission to psychiatric institutions. Further, these factors also act as barriers to their re-entry within the community.
Most hospital admissions of women are involuntary. This is not just an Indian scenario but also one that has been reported in New York. Families admit women without their consent due to a variety of reasons. Some of these reasons include initiating divorces, denying them child custody, and taking away their property. After admitting them to hospitals, families also tend to provide wrong phone numbers and addresses to ensure no contact with the woman. In some cases, women who run away from abusive households as well as trafficking traps were arrested by police and put into a psychiatric institution.
The researchers found that among the eleven women interviewed in the study:
“Participants were admitted to the mental hospital by their natal family, marital family, or the police. Two women escaped abusive families, and one escaped human trafficking; these three participants reported months of homelessness before admission to the hospital by the police.”
Those admitted to government hospitals by families were pushed to do so due to poverty, as affording private psychiatric treatment was a luxury for them. After admitting them to the hospital, the family members rarely came to meet the women. Although the women did not express rage at the forced admissions, family members turning away from meeting them resulted in feelings of deep hurt and betrayal for the women.
Additionally, per the recent Indian Mental Health Care Act, police are responsible for tracing the person’s family. They are not authorized to admit them at a psychiatric institution. However, the consent of women was never asked for by the police or the hospital staff.
The Indian Mental Health Care Act also makes provision for people living in psychiatric hospitals without family support to be transferred to rehabilitative halfway homes. The study presents women’s experiences living in a halfway home, focusing on their journey of being admitted to the hospital and facing challenges in returning to their communities.
Experiences of Living at the Hospital
All participants in the study talked about the pathetic and inhuman living conditions at the hospital. With overcrowded wards and inadequate access to food, clothing, and toilet facilities – living conditions at the hospital were terrible. Participants also shared that they lived a monotonous life where most of their day involved sitting idle. Additionally, patients perceived to be ‘violent’ and ‘agitated’ were given punishments of seclusion and restraint. A participant shared,
At the hospital, there were no classes [comparing her experiences to the halfway home where there were occupational and recreational therapy classes]. They [ward nurses] would give us a lot of work to do and if we did it well, they would provide us with better food. Sometimes, nurses would hit patients who were ‘violent.’ At the hospital, we did not know or understand if we were on the right medications. Around 500 women would line up daily for their pills. But we did not know what pills they were giving us…it was all a big mystery. Sometimes the doctors would come on their rounds and tell me that I was cured, and it was unfortunate that despite doing well, my family was not taking me home.
Several women continue to stay at the hospital despite being cured due to the lack of support from families. Additionally, it is important to note that, like their involuntary admission into the hospital, the women had no say in their discharge decisions, too.
Barriers to Community Re-entry
The halfway home hoped to reintegrate women within their community during nine months of their stay at the institution. The staff repeatedly tried to trace the families of the women through collaboration with the police. However, they faced multiple challenges. This led to many residents overstaying at the institution.
The residents mentioned various factors that prevented them from re-entering their communities. This included lack of familial support, lack of alternative community spaces, poverty, lack of education and skills to get employment, and their own fear of returning to their communities.
Talking about the lack of family support, a few residents shared that they experienced violence and abuse as women. This further increased their distress and decreased their chances of staying within their family. A participant shared,
No one has come to see me here or at the mental hospital. So, think about my situation. I had told them [halfway home] that I can stay here forever but I did not know that they [the halfway home] will not keep us after nine months. I am worried and experience tension because after nine months if they send me home, my husband will beat me again. This is the reason why I wanted to study and work. I am in dire need of money.
For residents who had contact with their families, support from them was still missing as they constantly expressed their unwillingness to take the women back home. Apart from a lack of family support, their own socio-economic disadvantages also became a barrier. On needing money to live an independent life, a participant shared,
The classes that happen here (be it stitching or music), these are for our therapy, but it will not help us find employment. The classes are nice but not relevant. It will not help girls become independent and self- reliant. Education is very important. I want to study. I want to graduate and complete my bachelor’s degree irrespective of whether I get a job later or not.
In addition to these factors, participants also have their own fears regarding re-entering their communities. From lacking the skills to navigate conflict at home to losing access to medications as their homes are geographically far away from the halfway homes – their fears of going back to their communities were significant and undeniable.
Women’s Intersectional Identities
Women’s identities often put them at a disadvantage. In addition to their gendered identity, a history of living at a psychiatric hospital and the stigma of living with mental health issues impact their sense of self, as similarly reported by another study. They also believe that their illness prevents them from fulfilling their roles as mothers, daughters, and wives. This is one of the main reasons why families often look at women living with mental health issues as a burden and choose to “dump” them.
Additionally, their families’ inability to afford treatment made them subject to inhuman living conditions at the hospital. In such a situation, the participants of the study mentioned that employment is essential to achieve financial independence, move away from abusive families, and build their own lives.
Conclusion
Although the Indian Mental Health Care Act provides care transfer from one institution to another, the study showed that the participants’ lives did not improve when they moved from the government hospitals to halfway home. The residents were left feeling more discouraged about the possibility of getting back home. The authors describe how institutions can be safer spaces and emphasize,
It is also important to acknowledge that institutions often are safer spaces for women escaping human trafficking, homelessness, and abusive families and relationships. Considering this, there is a need for ongoing conversations on how institutions can be reimagined and transformed as healing, empowering, and emancipatory spaces for women who are abandoned by their families.
Lastly, it is worth reminding ourselves that centering the voices of users is one of the significant ways of bringing change in how minoritized communities are treated by psychiatry.
Research Article Citation: Bhattacharya, A., Camacho, D., & Lukens, E. (2024). “These Places are easy to get into but Impossible to get out of”: Women’s Pathways to Psychiatric Institutions and Barriers to Community Reentry in India. Community Mental Health Journal, 60(2), 317-329.
Link to Study: https://link.springer.com/article/10.1007/s10597-023-01173-3
Researcher Contact Info: Anindita Bhattacharya ([email protected])
Neha Jain
Neha Jain is a doctoral scholar at the Department of Humanities and Social Sciences, IIT Kanpur. In her doctoral work, she is exploring institutionalized and de-institutionalized mental healthcare settings in India to understand the nature of care and recovery in mental health through the experiences of various stakeholders. She is also a counseling psychologist trained in trauma-informed therapy and works through an attachment lens with people in their early adulthood years. Apart from therapy and research, she loves reading personal newsletters and listening to Desi rap music.