End Forced Institutionalization, Sexual and Physical Violence, Involuntary Treatment

A resident sits on the floor in the women’s ward of Thane Mental Hospital, a 1,857-bed facility in the suburbs of Mumbai.
© 2013 Shantha Rau Barriga/Human Rights Watch

by HRW

New Delhi: Women and girls with disabilities in India are forced into mental hospitals and institutions, where they face unsanitary conditions, risk physical and sexual violence, and experience involuntary treatment, including electroshock therapy. As one woman put it, they are “treated worse than animals.”

In a new report released today, Human Rights Watch found that women forcibly admitted to government institutions and mental hospitals suffer grave abuses and called for the government to take prompt steps to shift from forced institutional care to voluntary community-based services and support for people with disabilities.

“Women and girls with disabilities are dumped in institutions by their family members or police in part because the government is failing to provide appropriate support and servaices,” said Kriti Sharma, researcher at Human Rights Watch. “And once they’re locked up, their lives are often rife with isolation, fear, and abuse, with no hope of escape.”

The Indian government should immediately order inspections and regular monitoring of all residential facilities – private and government-run – for women and girls with psychosocial or intellectual disabilities, Human Rights Watch said. India should also take steps to ensure people with psychosocial or intellectual disabilities can make decisions about their lives and receive treatment on the basis of informed consent.

The 106-page report, “‘Treated Worse than Animals’: Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India,” documents involuntary admission and arbitrary detention in mental hospitals and residential care institutions across India, where women and girls with psychosocial or intellectual disabilities experience overcrowding and lack of hygiene, inadequate access to general healthcare, forced treatment – including electroconvulsive therapy – as well as physical, verbal, and sexual violence. In one case, a woman with both intellectual and psychosocial disabilities was sexually assaulted by a male staff member in a mental hospital in Kolkata. The report also examines the multiple barriers that prevent women and girls with psychosocial or intellectual disabilities from reporting abuses and accessing justice.

The Indian government should pursue urgent legal reforms, including amending two bills currently before parliament, to address these abuses and protect the rights of women and girls with intellectual or psychosocial disabilities, Human Rights Watch said.

The report analyzes the situation of women and girls with disabilities in six cities across India. Research was conducted from December 2012 through November 2014 in New Delhi, Kolkata, Mumbai, Pune, Bengaluru, and Mysore, and is based on more than 200 interviews with women and girls with psychosocial or intellectual disabilities, their families, caretakers, mental health professionals, service providers, government officials, and the police.  Human Rights Watch visited 24 mental hospitals or general hospitals with psychiatric beds, rehabilitation centers, and residential care facilities.

There are no clear official government records or estimates of the prevalence of psychosocial or intellectual disabilities in India. The 2011 census estimates that only 2.21 percent of the Indian population has a disability – including 1.5 million people (0.1 percent of the population) with intellectual disabilities and a mere 722,826 people (0.05 percent of the population) with psychosocial disabilities (such as schizophrenia or bipolar condition). These figures are strikingly lower than international estimates by the United Nations and World Health Organization which estimate that 15 percent of the world’s population lives with a disability. The Indian Ministry of Health and Family Welfare claims much higher percentage of the Indian population is affected by psychosocial disabilities with 6-7 percent (74.2 – 86.5 million) affected by “mental disorders” and 1-2 percent (12.4 – 24.7 million) by “serious mental disorders.”

India’s government launched the National Mental Health Programme in 1982 to provide community-based services, but its reach is limited and implementation is seriously flawed in the absence of monitoring mechanisms. The District Mental Health Programme is only present in 123 of India’s 650 districts and faces a number of limitations including lack of accessibility and manpower, integration with primary healthcare services, and lack of standardized training.

In a country where gender-based discrimination is pervasive, women and girls with psychosocial or intellectual disabilities in particular face multiple layers of discrimination – on account of  their disability and gender – and are thus among the most marginalized and vulnerable to abuse and violence. Often shunned by families unable to take care of them, many end up forcibly institutionalized. The process for institutionalizing women and men in India is the same. But women and girls with disabilities face unique challenges – including sexual violence and denial of access to reproductive health – that men do not.

“Without appropriate community support and a lack of awareness, people with psychosocial disabilities are ridiculed, feared, and stigmatized in India,” Sharma said.

Families, legal guardians, and child welfare committees can admit women and girls with psychosocial or intellectual disabilities to institutions without their consent. If found wandering in the streets, they may also be picked up by the police and admitted to these institutions through court orders. If no family member comes to take them home, they can often stay there for decades. None of the women and girls interviewed by Human Rights Watch currently or formerly living in institutions were admitted with their consent. Among the 128 cases of institutional abuse that Human Rights Watch documented, none of the women or girls had successfully been able to access redress mechanisms for being institutionalized against their will or facing abuse within the institution. Most of the women and girls interviewed were not even aware of mechanisms for redress.

“Long-term warehousing of women and girls with disabilities is simply not the answer,” Sharma said. “Even in the most serious cases, there are ways to find out what kind of services they want.”

In some of the facilities visited by Human Rights Watch, overcrowding and lack of hygiene were a serious concern. For instance, as of November 2014, close to 900 people live in Asha Kiran, a government institution for people with intellectual disabilities in Delhi – nearly three times the hospital’s capacity. In Pune Mental Hospital, the superintendent, Dr. Vilas Bhailume, told Human Rights Watch: “We only have 100 toilets for more than 1,850 patients – out of which only 25 are functional; the others keep getting blocked. Open defecation is the norm.”

Human Rights Watch documented cases of 20 women and 11 girls who are currently or were recently given electroconvulsive therapy (ECT) without their consent in 4 mental hospitals. Vidya [not her real name], a 45-year-old woman with a psychosocial disability, was institutionalized by her husband and underwent ECT for months. “ECT was like a death tunnel,” she told Human Rights Watch. “I would get a headache for days…. When my medication was reduced, I started asking questions. Til then I was like a vegetable. It was only many months later that I found out that I was being given ECT.”

India ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007. Under the treaty, governments must respect and protect the right to legal capacity of people with disabilities and their right to live in the community on an equal basis as others. Forced institutionalization is prohibited. However, India’s laws allow courts to appoint guardians to take decisions on behalf of people with psychosocial or intellectual disabilities, without the their free and informed consent, and India perpetuates a healthcare system where people with such disabilities are segregated in institutions instead of having access to support and services in the community.

In an attempt to bring its national legislation in line with the CRPD, in 2013, the government has introduced two bills in parliament, the Mental Health Bill and the Rights of Persons with Disabilities Bill. However, they do not fully guarantee women and girls with psychosocial or intellectual disabilities the right to legal capacity and the right to independent living, as required by the treaty.

The central government in India should immediately order an evaluation and take steps to end abusive practices and inhumane conditions in mental hospitals and state and NGO-run residential care institutions by organizing effective monitoring of such facilities, Human Rights Watch said. India should further undertake without delay a comprehensive legal reform to abolish guardianship and recognize the legal capacity of all persons with disabilities on an equal basis with others, while developing a comprehensive, time-bound plan to develop alternatives to long-term residential-based care. The few local community support and independent living initiatives available in India are run by NGOs, such as Anjali: Mental Health Rights Organization (Kolkata), The Banyan (Chennai), Bapu Trust for Research on Mind and Discourse (Pune) and Iswar Sankalpa (Kolkata).

“India has an opportunity to move away from a system of isolation and abuse and instead build a system of support and independence,” Sharma said. “The lives of millions of women with psychosocial or intellectual disabilities are at stake.”