India's millions of mentally ill hidden behind taboo

Many of the patients at the Sanjali rehabilitation centre in New Delhi cannot explain why they are there or how they lived before chronic mental illness took over their lives.

They are among the lucky few in India to receive regular treatment in a country where mental illness carries a huge stigma and psychiatric hospitals can be severe and frightening institutions.

Experts estimate around 20 million Indians suffer serious mental disorders, with most hidden from public view by their families.

For many Indians, their first instinct when symptoms of mental illness begin to manifest themselves in their relatives is to seek a spiritual explanation for the sudden change in behaviour.

Families in denial will often take their loved ones to temples or faith healers, both of which abound across the country.

India does have some half-way houses that serve as temporary shelters for destitute and homeless mentally ill people, but there are few long-term options for families who are unable to look after their kin.

Nimesh Desai, head of psychiatry at the New Delhi-based Institute of Human Behaviour and Allied Sciences, estimates India has fewer than 4,000 psychiatrists, and even fewer general mental health professionals.

"The lack of psychiatrists is bad and the shortage of psychologists, social workers and counsellors is even more alarming," said Desai. "It meets about five to seven percent of the projected need."

One reason is a reluctance among young medical students to pursue a career in mental health. While India prides itself on churning out thousands of world-class doctors and surgeons, there is no prestige in psychiatry.

"The shame and stigma that is attached to mental illness is also attached to a mental health doctor," said Naveen Kumar from the Manas Foundation, a mental health charity.

"Though we have one of the largest pools of medical professionals, they are not geared toward dealing with mental health problems.

"It leaves mental patients at the mercy of the faith healers who exist on every street corner and in every village of India who are supposed to have magic healing powers."

Common treatments include inducing the patient into a trance or even physical abuse, said Kumar.

While many mental health problems can be easily treated at the primary care level, general practitioners are not adequately trained to tackle them -- and are unable to refer patients to specialists.

Kumar said only five to 10 percent of Indians are "psychologically aware" enough to seek help in the first place, and many families believe going to a doctor for mental illnesses is a sign of weakness.

Instead, age-old religious rituals and superstitions that have passed through generations are often relied on, and religious shrines are regularly packed with devotees looking to rid a family member of a "curse".

"Only when you find that the person is not improving or there are other complications will you even consider going to a general practitioner," said Kumar.

"Tomorrow when the families are no longer there to look after them at home, what happens to these people?"

A black panther cub is seen in the grass at the Tierpark zoo in Berlin. AP Photo/Maya Hitij