Let Us Learn the Right Lessons from Erwadi

The horrific tragedy at Erwadi has kindled some long overdue discussion (UP, Vol.43: No.4, 2001) on the plight of chronic psychotics in our society. The specific questions to be addressed are: 1. Why do 'patient-care facilities' like the ones at Erwadi come up at all? 2. Could mere strong-arm tactics like forcible closing down of these places, whenever there is a hue and cry in the media solve this vexed problem? Now a little history: Henderson and Batchelor (1962) tells about four distinct periods in the history of psychiatry from the end of eighteenth century, namely: 1 .The period of humane reforms 2.The period of introduction of non-restraint 3.The hospital period and finally, 4. The social and community period. Mental health care all over the world has attained the present overall acceptable level, thanks to the progress made during each one of these four periods. Pinel quite poignantly inaugurated humane reforms in 1794. During the subsequent periods the legacy of Pinel was carried forward. After Conolly's authoritative book in 1856, 'The Treatment of the Insane without Mechanical Restraint', mechanical fetters ceased to have any place in the practice of psychiatry. A 'hospital period' had its beginnings all over the developed world from early twentieth century. In this era ideals in humane reforms as well as abolition of restraints were translated to action. Every single aspect of mental hospitals was influenced by the two previous periods. In their architecture, administration, staffing, social milieu, everything. Old mental hospitals were extensively reconstructed. Many new ones with patient-friendly ambience were built. Laws like the National Health Service Act (1948) in England, ensured that government funds were made available for a mammoth infrastructure development, quite liberally. With even hairdressers and chiropodists added to the staff of mental hospitals, inmates were assured of a dignified life, like everybody else. Mental hospitals were no more viewed as bad places, as they used to be. The mentally sick and their families could now trust these places to get the needed support and care. On the minus side, the census in mental hospitals went up steeply. It was in this context the 'social and community period' commenced. The doors of mental hospitals were opened and a whole lot of out-reach services developed. The emphasis was on providing better alternatives, so that hospital admission could be minimized. Querido's 'Psychiatric Consultative Bureau' in Amsterdam started in the early years of Community …