Stigma and myth about mental illness has left scores of women and men destitute, rejected and forgotten by their own families. The Sunday Observer glimpses into the lives of women at Halfway Home, in Mulleriyawa.
Women with mental illnesses are often abandoned by their families due to the stigma and the lack of mental health rehabilitation centres, Mental Health experts said.
Walking down the Hospital hallway, she stands out! Clad in a white T-shirt and cotton cloth, with greying hair tied into a bun she smiles at the nurses who greet her in return. She wears a plastic beaded necklace and plastic bangles, and one cannot miss the tarnished gold bangle on her left hand. While their hair is trimmed short, hers is left to grow.
While other patients idle unfocused, she walks with a purpose.When others start conversations with her she tries to avoid them. Among the unfocused sea of eyes hers stay focused and determined.
“Aluth avuruddhata mama wadi deyak karanne na. Missla mata aluth andum dei. Mama aluth andum walata asai (I will not do much for the upcoming year. Nurses will give me new clothes. I love to wear new clothes.),” Kamala* said, when asked about her plans for the anticipated event.
Kamala is one among the many housed at Halfway Home Mulleriyawa of the National Institute of Mental Health (NIMH), and in a state to be reconciled with families. But like hundreds of others she is abandoned by her family, and left at Halfway Home to live the rest of her life.
Her sister brought her to the NIMH in 1984, which was then called the Angoda Mental Hospital, when she was 35 years. She has never left the Institute since that day. Kamala cannot remember much of the day, either.
“I did not want to sleep on the bed with my husband anymore, and I stopped eating because it made me vomit. So my sister brought me here,” Kamala recalls.
Thereafter, she was diagnosed with Schizophrenia. Kamala left a daughter and a son, both toddlers then. The only relative who came to see her was her sister. She too stopped coming a long time ago.
According to the Directorate of Mental Health, 10 per cent of the island’s population is affected by some form of mental illness, with about two per cent having a chronic illness, such as, Schizophrenia or mood disorder. Depression, which is the most common, is estimated to affect 800,000 Sri Lankans, annually. According to the latest statistics, in 2016 over 50,000 were diagnosed with depression and hospital admissions made. However, not all the mentally ill seek medical assistance, leaving the number vague.
Social stigma
Halfway Home, where Kamala stays, houses over 400 female residents aged between 25- 86. About 150-200 of them can live in a normal home environment and lead an ordinary lifestyle. However, their families refuse to take them back. Some do not have names, memories of the past, or recorded addresses.
“They are not taken home because of the social stigma attached to mental illness,” said Director, NIMH, Dr. Kapila Wickramanayake, adding that family members of a person with a mental illness think society will look down on them. “Which shouldn’t be the case. A mental illness is a common condition like diabetes or cholesterol, with proper treatment it can be cured or controlled,” he added.
He said, the economy of a family can also lead to abandoning such patients. He believes, if families are financially stable the patient will not be abandoned.
“There are mental health units in all districts, with the facility to treat these patients. The issue is the stigma,” he said.
When families finally decide to seek help they bring the patient to the NIMH and leave them there. Some give false information such as the address and the name of the guardian, while others bribe officials to keep them in the Institute for as long as they can.
“It was really bad decades ago,when the Institute was crowded with patients,” said Consultant Psychiatrist at NIMH Dr. Pushpa Ranasinghe. The overcrowding led to the collapse of a building at the hospital premises, in 1984. This prompted the authorities to build a new facility, Halfway Home in Mulleriya, several kilometres from the NIMH in Angoda, where women patients were taken. Encouraging the families to take the treated patients home, the number was reduced from about 950 to 400 residents, though there is space for only 360.
Dr. Ranasinghe said, families tend to disappear after leaving the patient at the hospital. “Admission to the hospital was like a death sentence, with no escape, and no home to go,” she added.
Currently, the situation is not so grim with the Institute recording valid information of patients when they are admitted. Photocopies of the guardian’s National Identity Card (NIC) are taken, along with other details. However, many who were admitted years ago had no name, date of birth or a recorded past, till recently. In 2010, with the help of the Legal Aid Commission of Sri Lanka patients were provided Birth Certificates and NICs.
“We invented names for those who did not have names, and with the help of forensic pathologists we gave them determined birthdays,” Dr. Ranasinghe said. In 2015, residents who could make a calculated decision voted for the first time, at the general elections. With the aid of private institutions the NIMH attempts to help residents to go back into society in the best way possible. Elders’ Homes welcome Halfway Home residents above 60 years. Today, 18 treated residents live in a funded hostel, and set out to work and back. A few of them work in a local chocolate factory and a few at a cleaning service.
Suloma*, 48, is one such resident who has a normal nine-hour job as a cleaning person. Suloma was 34 years when she was admitted to the hospital with a Schizophrenic condition. Her only living relative is a brother, married and having children. On being treated and considered normal, she was sent home on a Sinhala and Tamil New Year day. Shortly after she was brought back, her brother claimed she was still very ill.
“I don’t want to go back to his home. They (the brother and his wife) illtreat me. They don’t want me in their home,” Suloma told the Sunday Observer.
She said, she enjoyed her work because it gave her a purpose in life. The women who work and earn a living have up to Rs. 500,000 in their bank accounts, Dr. Ranasinghe said, adding that often the first item they purchased was gold jewellery and then sometimes a mobile phone. A social worker at the Mulleriyawa Intermediate Psychiatric Unit, Rangana Dissanayake is actively involved in trying to reconcile residents who are in a position to go home to their families, with the help of the Ministry of Social Empowerment. He and a few others propose to start a program early next year, in a bid to seek living relatives of the residents in the Unit. Dissanayake said, the task is like looking for a needle in a haystack.
Most residents whose families can be traced have already been sent home. The others, over a hundred, are women whose past is an enigma. “We try to retract traces of memories of these women, such as, a school or a temple to locate their homes,” said Dissanayake. As much as the women like to help, they find it difficult, because some have lived in the Institute for 25 to 30 years with no relatives visiting them. “Another issue is, the relatives have forgotten the patients’ existence. Sometimes, their close relatives such as, parents or siblings could be already dead,” Dissanayake said, adding that it was sad to see women who can live in normal home settings spending the rest of their lives confined to the Institute.
“If they remember something of their past, we would definitely follow it up and trace their home,” he said.
Abandoned
Kamala remembers a temple near her house in Matara. She recalls going to this temple a couple of times a month. She remembers parts of the name, and Dissanayake is positive they would be able to trace her home.
The story of the forgotten does not end there. Director, National Mental Health, Directorate, Ministry of Health, Dr. Chitramalee de Silva says there could be more mentally ill patients abandoned by families in other institutes such as, Elders’ Homes. Dr. Ranasinghe of NIMH is of the view that 80 per cent of the mentally ill patients can fully recover and a large percentage of the others can live assisted lives.
“What we need to do first is, address the stigma. This way we can have better awareness and detect the illness at an early stage, which would make treatment successful,” she said. She said, the country still lacked mental health rehabilitation centres where patients could be treated effectively. She stressed the importance of having such centres that would loosen the burden of families with a mentally ill member. “Not all families abandon their loved ones for convenience. They do so because they are helpless,” she said.
As the world looks forward to a new year, women such as, Kamala look forward to being gifted a new cloth and expect nothing else.
“I like to go home and cook for my family. I cook here and everyone loves my food. My children will, too,” Kamala said.
*Names changed to protect the identity of the source.