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(ARCHIVE) Vol. XX No. 21, February 16-28, 2011
The Institute of Mental Health
– its remarkable history
(By Shobha Menon)

(continued from last fortnight)

In 1949, with Dr. A.S. Johnson in charge, the hospital occupancy had gone up from the authorised 800 to about double that number! To reform the then existing arrangements, he divided the hospital into 13 sections, nine for men and four for women. Each section was to have limited autonomy, had a medical officer-in-charge and its own nurses, etc. and was to be considered a small and separate hospital in itself. The medical staff at the time consisted of the Superintendent, the Deputy Superintendent and 13 medical officers.

The bed-strength was officially regularised at 1800, the figure which the overcrowding had led to by then, and although no additional buildings were forthcoming, a substantial gain was the increased budget provision for expenditure on drugs, medical equipment, linen etc. Dr. T. George returned from England after training at the Maudsley Hospital to take charge as Deputy Superintendent.

Dr. M. Sarada Menon.

Government at that point of time went ahead with a scheme of appointing ‘Lay Secretaries’ to hospitals to help relieve the Superintendents of some of the administrative burden. The ‘Open hospital’ system initiated meant that no physical restraints were to be used and the doors of the wards were kept open all day. There was provision for just one closed ward in each of the Admission, Criminal and Epileptic sections. Written orders were required in the medical case files if a medical officer wanted a particular patient to be kept locked in a single room. Patients, in any part of the hospital, could be visited on any day of the week in the mornings whereas, previously, they could be visited only once a week. A laboratory was set up and efforts were made to do good work with the available manpower and material.

The subject of psychiatry was taken out of the mental hospital for the first time in this part of the country when psychiatric clinics, with provision for admitting a limited number of patients into wards, were opened in two city medical college hospitals in 1949 and 1954.

In 1954, the Mental Hospital housed about 170 criminal patients and was almost like an annexe of the Central Prison though manned by the hospital staff. The earliest of them had come to the hospital in 1924 from all over the Presidency.

During Dr. George’s term as Superintendent (1957-1961), two new buildings were added for the tuberculosis patients, and sections increased from nine for men and four for women to ten and five respectively. For the first time the services of a psychologist were made available. One of the medical officers was asked to be in charge of the medical journals and the collection of reference books, and so began the Library in the hospital – to which I am indebted.

Meanwhile, increasing admission rates, despite an 1800 sanctioned bed-strength, meant an actual occupancy of about 2800! Dr. M. Sarada Menon took over as Superintendent in January 1961, when this was the state of affairs. In the next 17 years, she transformed the hospital into a mental health centre, changing mindsets about the illness, both inside and outside its walls. Her expertise in internal medicine and psychiatry meant that increasing importance was given to diagnostic procedures. She remembers, “Admissions into the hospital then were made under the provision of the Indian Lunacy Act of 1912, through the magistrate or the police, or on a voluntary basis. We had just four psychiatrists in the hospital, only one new drug had been discovered, and there were no drugs for depression or schizophrenia. In those days the only option was counselling. It was very, very difficult. There was no separate outpatient department and a senior medical officer would take the responsibility of seeing all the new patients and recording their names and addresses in a register, and most of them were admitted.” Many of the addresses were wrong.

The outpatient services at the Institute had been first started on a small scale in 1947 and witnessed expansion in 1962. For the first time, a day hospital facility was offered at the outpatient department.

In a far-reaching plan, Dr. Sarada Menon introduced professional social workers, who would manage the mentally ill, counsel family members and trace families that tried to abandon them. She also vacated an old ward near the Superintendent’s quarters for an Outpatient Department for patients within a 5-km radius.

Many who were disturbed and violent were placed in the Day Hospital; they would be adequately sedated for the day and sent home in the evening with necessary instructions to the relatives for continuing medication. One week’s treatment in this manner obviated the need for admission and the patient continued on an outpatient basis, coming for review as often as advised by the doctor. “Restrict admission, increase discharges” became the goal!

Eventually, following this success, a new Outpatient Block was opened in 1966 adjoining the hospital, with six wings and a 20-bed ward for new, acutely ill patients.

An Advisory Committee of non-officials then came into being and its help was invaluable in getting new buildings for the Outpatient Department, which was steadily increasing in popularity, and for the men’s Tuberculosis Wards. With this approach, the number of inpatients came down to the sanctioned bed-strength of 1800.

The administration till this point had been on the ‘vertical system’ pattern. The Superintendent was the legal guardian for all the patients and had to take direct professional responsibility for anything and everything relating to each and every patient in the hospital. A change for the better was made by introducing the ‘unit system’ prevalent in all big mental hospitals in the world. The three senior specialists, Dr. Sarada Menon, Dr. Bushanam and Dr. Somasundaram, who were also the Professors in the three city medical colleges, were each given consultation responsibility for two days of the week in the outpatient and admission departments, in an arrangement that led to better professional management.

Another change the hospital saw in this period was the surrender of the Superintendent’s residence within the hospital. The earlier Superintendents’ quarters were situated in a strategic part of the campus, from where all the wards could be supervised. This was converted into an Administrative Office with rooms to accommodate the Superintendent, Deputy Superintendent, Resident Medical Officer, Lay Secretary and Administrative Staff. A small room was allocated for the Library. When parts of this imposing building started collapsing in the early 1980s, it was declared ‘unsafe’ and demolished. The existing office of the Superintendent was converted into an X-ray and EEG room and the room above became a Psychologist’s room.

A feature of this period was the assignment of teaching work to medical officers who did not hold teaching appointments, but who had a special interest in some aspects of the speciality.

(To be concluded)




In this issue

Senate House to become a museum
Monstrous Stations – will Metro learn from
MRTS?
From Port Trust to Cambridge
Once bustling, Pulicat now dozes
The Institute of Mental Health –
its remarkable history
Other stories

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