8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

1/7

Indian Journal ofPsychiatry, 2001, 43(1), 25-31

A CENSUS OF LONG STAY PATIENTS IN GOVERNMENT MENTALHOSPITALS IN INDIAM. VENKATASWAMY REDDY

ABSTRACTA single day census found that long-stay patients (LSP) numbering 7,307 accounted forabout 48% of the total inpatient strength of 15,345 in g overnme nt mental hospitals in India. A loadof 2695 (37%) LSP were in two to five years duration of stay, 2782 (38%) w ere in five to fifteen

years duration of stay, and the remaining 1830 (25%) were staying for more than fifteen years.About 11% of LSP were aged sixty years and above, majority (53%) were males, non-voluntarycases constituted 80%. and m ore than two-thirds (69% ) were schizophrenics. The characteristicsdistributions associated w ith high rates of LS P at individual hospitals were identified. The load ofLSP was decreased by 9% during the period from 1993 to 1999.Key words : Censu s, long-stay patients, governm ent m ental hospitals, national indicators

distributions on duration of stay, age, gender, modeof admission and diagnoses The questionnairewas mailed to all the government mental hospitalswith a request to send the requisite information.Ail the hospitals have responded to the requestby conducting a census on a particular day andsending the informations of their respectiveinstitutions. Most of the census were conducteddur ing the year 1999 As the load andcharacteristics distributions of LSP do not grosslychange during a period of six months, it could beassumed that first July 1999 is the date of censusof the present study

Sufficient data on long-stay patients (LSP)in government mental hospitals were lacking inIndia, though certain informations about someindividual hospitals or a sma ll group of hosp italshave been repor ted (Sathyavath i andSundararaj,1996; Bhaskaran,1970; Gupta etal.,1980; Somasundaram et al ,1982) Two majorstudies (Sharma e t a l , 1996, NHRC.1999) havereported number of LSP at individual hospitals.This paper is based on data collected from allgovernment mental hospitals with the mainobject ives of determin ing the l oad ,characteristics distributions and trends of LSP.Also, each hospital indicators were comparedwith the national indicators in order to identifythe characteristics and trends associated withhigh rates of LSP at individual hospitals.MATERIAL AND METHOD

A ques t ionna i re was des igne dincorporating the number of inpatients, and thenumber of long-stay patients (staying for twoyears and above) and their characterist ics

Presentation and analysis of observationsThir ty six mental hospitals run byseventeen state governments, the cent ra lgovernment, and autonomous bodies funded bycentral/state gove rnments, constituted the mentalhealth delivery system by government mentalhospitals in India. There we re 15,345 inpatientsout of which 7,307 were staying for two years andabove Hence, 48% of inpatients were LSP. Thedistributions of these LSP according to the five

25

8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

2/7

M. VENKATASWAMY REDDYbasic characteristics are presented in table 1.It can be derived from the table that 4612

TABLE 1CHARACTE RISTIC DISTRIBUTIONS OF LONG-STAYPATIENTS IN GOVERNM ENT MENTAL HOSPITALS(N=36) IN INDIA

CharacteristicsPeriod of stav (vears)2 - 55 - 15Above 15Age (completed years)2 0 - 3940 - 5960 & aboveGender

MalesFemalesMode of admissionVoluntaryCertifiedObservationCriminalsDiaqnosesOrganic psychosesSchizophreniaAffective disordersMental retardationAll others

Total(7307)269527821830358029307973842346514374889663318

350506551267 9701

Percentage(100)3738254940115347206794

5697910(63%) of LSP have stayed for five years and above,and 1830 (25%) have stayed for more than fifteenyears About 49% of LSP were in the age groupof 20-39 years, 40% were in the age group of 40-59 years and the remaining 11 % were aged sixtyyears and above The majority (53%) were males.The ce rtified cases (67%), observation cases (9%)and patients with criminal records (4%) puttogether accounted for 80% for non-voluntary LSPAbout 5% have organic psychoses, 69% wereschizophren ics, 7% were affective disorders, 9%were mentally retarded and the remaining 10%included psychoses associated with eitherepilepsy or severe behavioural disturbances.

The num ber of inpatients, and the num berand rate of LSP for individual hospitals arepresented in table 2.There w as a wide variation in the loads ofLSP among the government mental hospitalsduring the year 1999, ranged from 2 LSP at

Calcutta IP hospital to 1848 LSP at the regionalhospital Pune. The four regional hospitals inMaharashtra state constituted 3231 LSP, andaccounted for about 44% of LSP in the wholecountry. Eleven hospitals had signif icant ly(p

8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

3/7

LO NG - STAY PATIENTS IN MENTAL HOSPITALSTABLE 2NU MB ER OF INPATIENTS (IP) AND NUMBER AND RATE OF LONG-STAY PATIENTS (LSP) ATGOVERNM ENT MENTAL HOSPITALS

States & names of hospitalsAll hospitalsAndhra Pradesh- Institute of Mental Health, Hyderabad- Institute of Mental Health, Visakha patnamAssam- LGB Institute of Mental Health, TezpurBihar- Ranchi Institute of Neuro-Psychiafr & Allied Sciences, Ranchi- Central Institute of Psychiatry, RanchiDelhi- Institute of Human Behaviour & Allied Science s, DelhiGoa- Institute of Psychiatry & Human Behaviour, PanajiGujarat

- Hospital for mental Hea lth, Ahmedabad- Hospital for mental Health, Baroda- Hospital for mental He alth, Jamnagar- Hospital for mental Health, BhujJammu& Kashmir- Psychiatric Diseases H ospital, SrinagarKarnataka- National Institute of Mental Health & N euro S ciences, Bangalore- Karnataka Institute of Mental Health, DharwadKerala- Government Mental Health Centre, Trivandrum- Government Mental Health Centre, Trissur- Government Mental Health Centre, KozhikodeMadhya Pradesh- Gwalior Mansik Arogyashala, Gwalior- Mental Hospital, IndoreMaharashtra- Regional Me ntal Hospital, Thane- Regional Me ntal Hospital, Pune- Regional Me ntal Hospital, Nagpur- Regional M ental Hospital, RatnagiriNagaland-Me ntal Hospital, KohimaPunjab- Punjab M ental Hospital, AmritsarRajasthanPsychiatric Centre. JaipurTamil Nadu- Institute of Mental Health, ChennaiUttar Pradesh- Agra Manasik Arogyashala, Agra- Mental Hospital, Varanasi- Mental H ospital, BareillyWest Bengal- Calcutta Pavlov Hospital. Cacutta- Lumbini Park M ental Hospital, Calcutta- Institute of Psychiatry, Calcutta-The Menta Hospital. Mankundu- Berhampore Mental Hospital, Berhampore- Institute for Mental Care, Purulia

P15,345

3863003535433601401504021815525100364296774382685192157

1744254078618321

415312

16574592582922511293610621497

LSP .Number7307

7120103191994480

24 713187905684

30 56138 138107

83 5184847 0789

31456

69 2142133192175602107989 |

%48187293528315361*72 *152890*1528391656 *2068*4873 *60*434376 *1842315266 *70*47693792" I

27

8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

4/7

M. VENKATASWAMY REDDYTABLE 3CHARAC TERISTIC DISTRIBUTIONS OF DURATION OF STAY, AGE AND GENDER OF L ONG STAYPATIENTS AT GOVERNM ENT MENTAL HOSPITALS (FIGURES IN %)

Hospitals at (LSP )

All hospital (7307)Hyderabad (71)Vishakapatnam (20)Tezpur (103)Ranchi(191)Ranchi CIP (99)Delhi (44)Panaji (80)Ahmedabad (247)Baroda (131)Jamnagar (8)Bhuj (7)Srmagar (90)Bangalore (56)Dharwad (84)Trivandrum (305)Trissur (61)Kozhikode (381)Gwalior (38)Indore (107)Thane (835)Pune (1848)Nagpur(470)Ratnagin (78)Kohima (9)Amntsar(314)Jaipur (56)Chennai (692)Agra (142)Varanasi (133)Bareilly (192)Calcutta CPH (175)Calcutta LPMH (60)Calcutta IP (2)Mankundu (10)Berhampore (79)Purulia (89)

2-5372570*51 *198272647*3688 *7267 *321066 *3350*37213547*3119672239231619431653*50604616

Duration of stay5-15 above1538 25

23 52*25 522 2751* 3028 64*21 52*41 3337 1632 321214 1428 536 3241 49*29 546 2146 * 455 849 3035 30*36 1734 35*45 36*3339 39*46 1543* 34 *42 42*47* 34*41 1673* 1145 25030 1035 1910 74*

20-39492555564424504757*45625791 *484562*31436164*4261 *425067234639363268*5770*5050449

Age (years)40-59402840314252*39343548384393644344449 *392844 *3242413358*434 8 '4953*30412750505156"

60 &above1147 *5131424 *1119*

87--1611

425*8814*716*9--19*111315152

23535 *

Males

53586572 *61*54525377 *57505781*255066*56 *67*424344375269 *2264*4562 *5182 *4862*6050704667 *

Assam, Bihar, Goa, Jammu & Kashmir, Kamatakaand Kerala had significantly high proportion ofvoluntary cases All the LSP in four hospitals (atBaroda, Jamnagar, Bhuj and Calcutta CPH) werecertified cases Six hospitals (at Calcutta IP, Jaipur,Agra, Thane, Panajiand Kozhikode) had significantlyhigh proportion of observation (Obs) cases Similarly,six hospitals (at Varanasi, Trivandrum, Purulia,Tezpur, Trissur and Amritsar) had significantly high

proportion of criminal (Cri) patients.Five hospitals (at Nagpur, Trissur, RanchiCIP, Kozhikode and Baroda) had significantlyhigh proportion of organic psychoses (OP) cases .Seven hospitals (at Kozhikode, Trivandrum,Ranchi CIP, Srmagar, Varanasi, Calcutta LPM Hand Bareilly) had significantly high proportion ofaffective disorders (AD) cases. Six hospitals (atIndore, Chennai, Ra tnagiri, Dha rwad, Tezpur and

28

8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

5/7

LO NG - STAY PATIENTS IN MENTAL HOSPITALSTABLE 4CHARACTERISTIC DISTRIBUTIONS OF MODE OF ADMISSION AND DIAGNOSES OF LONG-STAYPATIENTS AT GOVERNMENT MENTAL HOSPITALS (FIGURES IN %)

Hospitals at (LSP)All hospitals (7307)Hyderabad (71)Vishakapatnam (20)Tezpur (103)Ranchi(191)Ranchi CIP (99)Delhi (44)Panaji (80)Ahmeaabad (247)Baroda(131)Jamnagar(8)Bhuj(7)Snnagar (90)Bangalore (56)Dharwad (84)Trivandrum (305)Trissur(61)Kozhikode (381)Gwalior (38)lndore(107)Thane (835)Pune(1848)Nagpur(470)Ratnagiri (78)Kohima (9)Amritsar (314)Jaipur (56)Chennai (692)Agra (142)Varanasi(133)Bareilly (192)Calcutta CPH (175)Calcutta LPMH (60)Calcutta IP (2)Mankundu(10)Berhampore (79)Purulia (89)

Mode o f admissionVol2083*60 *56 *78 *75 *2574 *1---89 *98 *53 *76 *44 *66 *42*132-32212322726-55 *-70 *18-

Cer67174033192568-98*100*100*10011238-46135895*4995*99*97*7889 *-70324094"100*45-3078*84*

Obs9---1--26 *------4--18*--47 *-----77 *661 *----100*-4-

Cri4--11*2-7-1-----524*10*3-4131--10*-2-58*------16*

DiagOP5-55411*-1-9*--2---12*10*10-1519*8---7---112-.61

losesSchi6989 *507678*508080 *91*78*7510072666762704761455975*62698976 *95 *6397*4481*7062501006787

AD71110-426 *254912-25 *12327 *329 *-1712--11-1219*15*1517*--82

MR9-2018*89211-212-11119*515-2933*7814*23 *114526 *164-3-.116

Oth10-1516416352---11116-14-21*26 *113--9-3-31*-41650.84

Nagpur) had significantly h igh proportion of mentalretarded (MR ) cases.The data on the number of LSP for the year1993 were collected in a survey to study thesummary trend s of men tal health delivery systemby government mental hospitals (Reddy etal.,1996). This information is used to study thetrends of LSP during the period from 1993 to 1999,as shown in table 5.

For the group of thirty six mental hospitals,there were 7988 LSP during the year 1993. Thus,there was a decrease of 681 (9%) LSP duringthe period of seven years. It can be noted thatthe hospital at Thane had the highest number(182) of increase of LSP followed by the hospitalas Kozhikode (151). But the highest rate ofincrease was repor ted for the hospi ta l a tBerham pore followed by the hospital at Srinagar.

29

8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

6/7

M. VENKATASWAMY REDDY

TREND IN LONG-STAY PATIENTS AT GOVHospitals at 1993

Al l hospi talsH y d e r a b a dV i s h a k a p a t n a mTe zpu rR a n c h iR anch i C IPDelhiPanaj iA h m e d a b a dB a r o d aJ a m n a g a rBhujS n n a g a rBang a l o reD h a r w a dTr i vand rumT n s s u rKozh i kodeG w a l i o rIndoreT h a n ePuneN ag pu rRatnag inKohimaA m r i t s a rJa ipurC he nna iA g r aV a r a n a s iBarei l lyCalcut ta CPHCalcut ta LPMHCalcut ta IPM ankunduB e r h a m p o r ePurulia

79887 618

3073 6 32 4 3

749 8

2 1 9175

47

2 811 691

6 8 41662 3 0

3496

6 5 318 304 3 6111

63 5 36 37 0 11682 0 0135133

322

1115

11 0

Both the hospitals in Madhya Pradesh wasincreased the number of LSP during the pe riod.In conclusions, the long stay admissionsare necessary only for a small group of patientswho are non-responders to treatment or haveseveral associated disabilities For the majority,long duration of stay in the hospitals is not onlya burden on the state, but more importantlydetrimental to the patients and their fam ilies. ThePurulia centre had the highest rate of LSP. This

LE5MENTAL HOSPITALS IN INDIA DURING 1993 TO 1999

1999 Decrease (-) or increase (+)

73077120

103191

994 48 0

2 4 7131

87

9 0568 4

3 0 56 1

3 8 138

1078 3 5

18 484 7 0

789

3 1 45 66 9 2142133192175

6 02

107 98 9

N um be r- 6 8 1

- 5+ 2

- 2 0 4- 1 7 2- 1 4 4

- 3 0- 18+ 28- 44

+ 4--+ 62- 6 0- 7

- 3 7 9- 105+ 151

+ 4+ 11

+ 182+ 18+ 34- 33

+ 3- 39- 7

- 9- 26- 6 7+ 57+ 42+ 28-- 1+ 64- 21

%- 9

- 7+1 1-6 6-47-5 9- 4 1- 18+ 13- 2 5

+ 100-+ 221- 52

- 8- 5 5- 6 3+ 66+ 12+ 11+ 28

+ 1+ 8

- 3 0+ 50- 11- 11

- 1- 15- 3 4+ 42+ 32+ 88- 9

+ 427- 19

institute was started functioning after receivingmental patients from Alipore central jail. Calcutta.There after patients from the two institutes at Ranchiwere transferred to this hospital.The long-stay patients occupied m ore thanseven thousand valuable hospi ta l bedsconsuming a signif icant share of meagerresources which otherwise could be of immensehelp to many poor patients. The regional hospitalat Pune had accounted for about 25% of LSP in

30

8/3/2019 A Census of long stay patients in Government Mental Hospitals In India

7/7

LONG - STAY PATIENTS IN MENTAL HOSPITALSthe country. At this hosp ital, patients from e levendistricts were admitted and due to long distancesin time and space, patients tended to cluster inthe long-stay categories.

The 7307 LSP in this system representedabout 0.7 per one lakh population. Based on thepopulation projection of India (RGI.1996), therepresentation for the age sixty years and abovecan be worked out at 1.1. per one lakhpopulation. As in the case of general population,males were the majority in LSP in this system.The major mental hospitals at Pune (with1848 LSP), Thane (835) and Chennai (692) puttogether accounted for about 46% of the total LSPin this system. The national indicators of LSP in

this system may be unduly effected by the hospitalindicators in these three major hospitals. But noneof the hosp ital indicators was significantly high inall these three hospitals, indicating the internalstability of the national indicators.The rates of LSP were 60%, 56% and 51%for the year 1977, 1983 and 1993 respectively(Reddy et al.,1996) It was decreased to 48 %for the year 1999 means that there is a lineardecreasing trend of the rate in this mental healthcare system. This is mainly due to the

implementation of national mental health policyand mental he alth act 1987. This has given riseto development of community mental health atdistrict level in some of the states.In the absence of determin ing theoptimum indicators for LSP in this system, thenat ional indicators may serve as opt imumvalues. The hospital indicators and trends w hichwere signif icantly high may aid in planningrehabilitation facilities and se rvices, and sets theguidelines for discharge procedures in order to

make the inpatient service more effective withthe existing bed strength. This report may alsoserve as a baseline data for evaluating theservices rendered by this system at national andindividual hospital levels.ACKNOWLEDGEMENTThe author is grateful to Dr. S.M.M VENKATASWAMY REDDY. PhD, Additional ProfessorSciences (NIMHANS). Bangalore - 560 029

Channabasavanna, Professor Emer i tus inPsychiatry and former DirectorA/ice-ChancellorofNIMHANS Bangalore for his kind encouragem entand useful suggestions, and to the Directors/Superintendents/Administrators/Officer incharge ofresearch, at government mental institutions forconducting census and providing the requisiteinformations of their respective hospitals.REFERENCES

Bhaskaran.K. (1970) The unwantedpatient. Indian Journal of Psychiatry, 12, 1-12.Gupta,S.P., Yadav.B.S., Bh aradwaj.R.C.

& Sharma.R.P. (1980) Psycho-social problemsof long-stay mental patients. Indian Journal ofPsychiatry, 22, 251-255.National Human Rights Commission(1999) Quality assurance in mental health. NewDelhi : NHRC.Reddy.M.V. , Ka l iaperumal .V .G. &Channabasavanna,S.M. (1996) Mental healthdelivery system by governm ent m ental hospitalsin India : trends during 1977-1993. NIMHANSJournal, 14, 219-222 .Registrar General of India (1996)Population p rojections of India and States 1996 -2016. New Delhi : RGI.Sathyavathi.K. & Sund araraj, N. (1966)Long-stay patients in mental hospitals in India.Transactions of All India Institute of MentalHealth (NIMHANS), 6. 28-39.Sharma .S. & Chadd a.R.K. (1996) Mental

hospitals in India : current status and role inme ntal health care New Delhi : Institute ofHuman Behaviour and Allied SciencesSomasund aram.O., Jayachandran.P. &Kumar.R. (1982) Long-stay patients in a statemental hospital Indian Journal of Psychiatry, 24,346-351

Biostatistics, National Institute of Mental Health & Neuro

31