The Institute of Mental Health (IMH) in Kilpauk, Chennai is one of the oldest and largest centres offering psychiatric care in South Asia.
Surrounded by a thick blanket of trees and greenery amid the concrete jungle of Chennai, the IMH, which is spread over 60 acres, offers more than what meets the eye. It has adopted various new techniques and initiated many schemes for the wellness of its residents.
Dr M Malaiappan, professor of psychiatry at Madras Medical College and currently the director of IMH, said they are planning to turn the institute into a centre of excellence in psychiatric care.
“New proposals are sanctioned by the government for developing manpower in the area of mental health. In the future, it will be an integrated centre for primary psychiatric care, acute hospital care, and community care in psychiatry. In addition, it will be a centre for rehabilitation also. So, all the facets of psychiatric care will be under one roof and the IMH will be a nodal centre for psychiatric care in Tamil Nadu,” he said.
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Dr P Poorna Chandrika, former IMH director and currently a professor at the institute, said the over two-century-old institute was founded by the East India Company in 1795, as “a place for keeping people of unsound minds. It was more like an asylum, a custodial care.”
She noted that the progress in mental health management has been the biggest takeaway for her. She also talked about how even the usage of terminologies like inmates and warders has changed over the years.
“Warders are found in prison. Here, they are not referred to as warders anymore, they are called ‘attenders’. Also, patients are not referred to as inmates, which is again a term used in prison. Here they are called either residents or patients as we don’t want them to get a feeling that they are in custodial care,” she said.
Dr Chandrika added that the Mental Health Act of 2017 spurred them to adopt various schemes and projects.
“The Act insisted on one point – rehabilitation – so that they (mentally challenged people) can be placed into the community, they can sustain themselves along with the support from us. This made us do more projects. The first step was to send a few of our patients/residents/clients, who improved with treatment, to work in the DMS (Directorate of Medical and Rural Health Services) on a contract basis. They enjoyed the work so much that they never took leave. They told me they like going to work.
“So later, we picked some of these people from their previous wards which had chronic patients and placed them in a ward that constituted only working patients. So it became more of a hostel wherein they had their TV, mobile phones, and even independence to send money to their relatives. Those things made them feel good. Even when we ask them why they wish to send money to someone who turned them away, they say that they still see that person as their brother or sister and they still have to look after them,” she said.
The institute has 24 wards for men and women. Currently, it has close to 800-900 residents but the number may change depending on the ‘floating population’ count. On an average day, the IMH gets about 20-30 patients. It has a facility guarded by armed personnel in which people with criminal backgrounds are lodged. There is also an alcohol-deaddiction ward. The institute has facilities near the outpatient ward for attendees to stay with the patient.
The IMH has about 19 medical officers (assistant professors), six professors, 140 staff nurses, 90 male attendees, 30 female attendees, and seven social welfare officers, apart from staff employed on a contractual basis.
Further, interns and volunteers from NGOs also chip in from time to time to take care of the residents. The institute has a functioning yoga unit. After morning medications, the residents are encouraged to spend time at the yoga class as well. For those interested in gardening, there is a separate space.
Saravanan, who has been working as a gardener for close to 16 years, said the residents work with dedication, and once they get a hang of some work, they tend to finish it with perfection. Cassava, plantain, bottle gourd, snake gourd, and a couple of fruits are some of the varieties grown here in large numbers.
“There are about five gardeners here. We try to bring patients who are capable of doing outside work. First, I try to befriend them. I will sip tea or coffee with them, show them compassion, and make them believe that I am their friend and not some instructor. Slowly, I try to teach them some light work and send them back in time for lunch. I have been doing this for almost 16 years now. I feel really happy when I get to hear that the person who worked with me a day before has been discharged and he is back with his family,” he said.
The residents also have an art therapist to help them. Porkodi Pazhaniappan, a certified art therapist who has been with the institute for close to three years, said they use art as a means of treatment.
“We bring art as a modality of treatment. We do this twice a week; we use all kinds of art therapy like painting, movement therapy, singing, storytelling, drumming circle, etc. We see a lot of progress happening even during these sessions,” she noted.
Further, those interested in sports are encouraged to participate in games like running, shot put, and long jump. Dr Sangeetha, a dental surgeon, along with her team are working day in and out to prepare the residents to take part in competitions. Close to 15 residents from the IMH participated in the 17th state-level Para Athletics Championship for adults in 2021 and nine of them won medals.
RVIVE Café, voting process and a marriage
Among the many projects initiated for the well-being of the residents, RVIVE Café is one. The café is a collaborative initiative of the IMH and the Hot Breads and is located in the institute’s outpatient wing.
“During Covid-19, as you may know, everything stopped. There was no transport for our residents to go to work and come back. On one occasion, M Mahadevan (founder of Hot Breads) said why can’t we set up a café here so residents can work and stay here. We started the process and the health minister (Ma Subramanian) inaugurated the café,” Chandrika said.
Another initiative of the IMH was facilitating the residents to exercise their democratic rights. Chandrika said many NGOs including the Disability Rights Alliance (DRA) came together for this cause. The institute helped its residents to vote in the 2019 Lok Sabha and 2021 Tamil Nadu Assembly polls.
“It was a huge exercise; a lot of paperwork was involved. After a screening process was conducted to ascertain their decision-making capacity, around 156 residents were declared eligible to vote. They got a separate booth. Various organisations volunteered to educate the residents about their rights and explained to them how an EVM machine works, etc. The Chennai civic body also conducted a mock demo. They all got their voter IDs with the IMH as their residential address, which they can change once they move out of this place,” she added.
In the first such case at the IMH, a wedding of two residents also took place during the directorship of Dr Chandrika.
P Mahendran, 42, and Deepa, 36, two strangers who were admitted to the institute about two years ago, formed a bond and shared a dream of living together. In October 2022, the duo got married at a local temple. The wedding was widely celebrated both inside and outside the campus as caretakers and workers at the hospital were all excited and dressed up for the occasion. The media also spread the news across the country.
“I think Mahendran was working in Daycare while Deepa was in RVIVE Café. After I came to know that two of our patients are always together, I called Deepa and spoke to her. She said there is no one for them and she wants to marry Mahendran. She had clarity and said with conviction that she wishes to have Mahendran as her life partner. I believed her and thought we should fulfill their wish. But we didn’t know how to proceed with this… There are a lot of protocols, right?
“They wanted their marriage to happen as per the Hindu tradition. As they say, when you wish to make a good thing happen, the whole universe will come together. People helped us get the mangal sutra and the wedding dress. From the health minister to the local MLA, everyone came together to wish them… In all my years here, I had never seen such a thing, even a special buffet lunch was arranged for everyone here at the auditorium,” she added. As per the health minister’s order, Mahendran is now employed as a ward manager, taking care of insurance and other paper-related works of residents.
Talking about the IMH’s halfway home, a centre for residents whose families are not ready to take them back, Chandrika said there are about four other halfway homes across the state.
To further provide employment opportunities to its residents, the institute partnered with Crystal, an outsourcing agency, and some of the residents (as many as 18) who were staying at the TMH for several years have been employed by the company. All such residents have individual bank accounts.
“Once we give them financial independence, we can see how they change. Some of our female residents went shopping and purchased some gold earrings… We are happy for them but at the same time keep telling them to save their money,” Chandrika said.
The residents are encouraged to showcase their talent and numerous paintings and products made by them like jute bags, purses, holders, and cloth bags, have been kept near the entrance of the institute. The residents are trained by instructors and some of their works are even showcased in exhibitions.
In August 2021, as a step to promote inclusivity, the institute employed members from the transgender community.
“During an interaction with them (members of the transgender community), they said if they are provided with a job, they wouldn’t have to get involved in commercial sex work. So we spoke with our outsourcing agency and they agreed and soon we provided a job to two people and till now we haven’t received any complaints from residents or others whatsoever. When we appointed them, I was asked whether we should keep them in the inpatient ward as there will be less interaction with the public but I was not okay with that idea. We employed them in the outpatient ward as it will provide them with the confidence to face the public not just here but even in other places,” Chandrika said.
Also, after learning that patients and their attendees have to take a long walk and cross the road to take printouts for various purposes, an NGO donated a printer and a photocopier to the TMH – which are now manned by a recovered patient of the institute.
The institute is also part of the Paravai (Personal Attitude Reformation Assistance Venture Affirming Identity) Project, a joint initiative of the Greater Chennai police, social welfare and prison departments to rehabilitate young first-time offenders in the city. The institute offers necessary treatment and counselling to young offenders.
When asked how they react in situations wherein the family doesn’t want to take back the residents even after the latter got cured, Dr Chandrika said she used to initially get angry.
“But now, with all the programmes and initiatives, I know I can accommodate this person (resident) somewhere safe. Even now, many patients, who got cured and were sent along with a family member, turn up again at the gates of the IMH, saying their family didn’t take care of them well. We then follow due procedure, get the approval from the family and accommodate these people here… The government has come up with many facilities, and treatment methods have changed. I wish to see more shelter, residential, and halfway homes, and greater awareness among the public regarding mental health,” she said.