It’s World Mental Health Day today, observed internationally to raise awareness about mental health issues around the world and mobilise support.

There are 7 crore mentally ill patients in our country.

India never had a reputation of taking care of the mentally ill. But even by our deplorable standards, the pictures above talk of a bleak, inhuman story.

Mentally unfit patients languishing in dingy corners, tethered for years, ridiculed, forced to live a life of despair. And the most shocking part, in many cases, the innocents have been chained by their own families.

Is it just ignorance, stigma or a total breakdown of infrastructure and the basic understanding of mental health that leaves caregivers with no choice?

State of Mental Health Infrastructure in India

WHO predicts that 20% of India’s population will suffer from some form of mental illness by the year 2020. We are woefully under-equipped to handle mental health issues on such a large scale.

For the 7 crore mentally ill patients in India, there are less than 4000 trained psychiatrists and most of these doctors are concentrated in the metros and two-tier cities. This is not even the proverbial drop in the ocean!

NIMHANS estimates that currently, at least 35 lakh Indians need hospitalisation on account of mental illnesses. But the country has only 40 institutions and less than 26,000 hospital beds.

Of these 40 institutions, only nine are equipped to treat children. Moreover, many of them are medieval-era, asylum-style institutions with high boundary walls, artificial barriers and patients kept in solitary confinement.

Barely 1-2% of the health budget is dedicated to mental health, in comparison to 10 –12% in developed countries.

So with crumbling infrastructure, abject poverty forces many families to desert the mentally ill, leaving them to rot on the streets. The administration is virtually absent. And when a family can and is willing to support their ill relatives, there is little or no medical help available in most parts of the country.

And given the huge stigma associated with any psychiatric illness, the vast majority continues to live with mental illness in the shadows, away from public view. That’s why WHO calls it the “hidden emergency”, one that the world has royally ignored.

Inside the Mental Health Institutions

The few treatment centres (read: mental institutions) that exist in big cities have deplorable conditions with little regard to patient well-being and human rights.

The Human Rights Watch (HRW) released a report in 2014, with the following shocking findings on institutions and privately run homes for the mentally ill:

• Patients in these facilities are treated worse than animals.

• They are forced medication, forced treatment with electric shocks and made to work like slaves or deprived of food.

• In many places, electric shocks are used as a threat to forcibly make them take medication.

• Most institutions are over-crowded. The government run Asha Kiran Home in Delhi has three times more patients than its capacity.

• Most women are huddled on the floors leading to a problem of lice. Instead of taking care of the hygiene, their heads are shaved off!

When the healthcare system is itself in the ICU, what does a poor or a lower middle class family, who does not want to pack away their loved ones to these homes do? Not everyone can afford to stay-at-home and look after their ill relative 24x7. Given the huge stigma, the extended family, neighbours are often unsupportive. Even a city like Mumbai has only a couple of good quality daycares for children with special needs.

By no yardstick is shackling someone a human thing to do, but when the situation is so bleak, sometimes, that’s the choice families are forced to make so that their loved ones are safe in their absence.

In 2013, India’s apex court had asked for stamping out shackling the mentally ill on priority. That’s little comfort for the country’s mentally ill, whose ranks are growing year by year