Rehabilitation of mentally ill in a novel way

Occupational therapy seems to have improved mental health of inmates

Rehabilitation of the mentally ill has continued to throw up opportunities and challenges in Kerala. Expe­rts on mental health have tried to address the critical transition of the patient – from the phase of full-fledged treatment to one of active involvement in his social surro­undings – through various disciplines under occupational therapy. At the gover­nment mental health centre in Thrissur, agriculture is doubling as therapy for some of its inmates.

About 15 inmates of the centre, abandoned or left roaming the streets, had their first harvest of bananas last week at the centre. The Thrissur unit of ATMA (Agricultural Technology Management Agency) partnered with the mental health centre on the initiative that saw fruit on 70 plants at the first harvest. The cheer around the harvest has not settled down at the centre but the authorities have already moved on to new initiatives to build on the success.

The mental health centre stands on a 14-acre property with 1.8 acres dedicated to agricultural activities under the supervision of the local Krishi Bhavan officials. The banana plants take 80 cents while yam cultivation is being taken up in one acre.

During the first phase of the agriculture therapy project, 1,000 yam seeds were planted at the centre. The agricultural activities at the mental health centre have been taken up on a drip irrigation model.

Dr Sreedevi, superintendent of the mental health centre, told Deccan Herald that the trigger to the project was a vegetable cultivation project taken up by the ATMA team at the Thrissur district collectorate. As the paperwork commenced, the centre authorities identified about 20 inmates who were at an advanced stage of treatment and set the project in motion in February this year.

“The inmates were involved in all stages of the cultivation up to the harvest while the ATMA and Krishi Bhavan teams closely monitored their progress. The project that was implemented by the occupational therapy wing has shown to improve the mental balance of these inmates apart from considerably enhancing their cognitive abilities,” Dr Sreedevi said.

Through the cultivation period, inmates have moved out and new inmates have joined in but enthusiasm for the progra­mme has not dipped, according to the
authorities. The coordinators of the programme said the initiative had helped building a spirit of togetherness in the team and improved the inmates’ ability to take up activities that demanded dedication and focus. The harvest yield has instilled a new confidence and a sense of achievement among the inmates. Inmates aged below 40 years were identified for the occupational therapy project that also had marginal participation of women and inmates lodged in the family wards. Authorities at the centre have expanded the project by starting cabbage and cauliflower cultivation that already has smaller vegetable gardens operating under different units. The vegetables are entirely being used for food to the inmates. The mental health centre has 305 inmates.

Most of the inmates are brought to the centre by people and social activist groups who pick them up from the streets, in abysmal conditions. Over the past couple of years, the centre has added to its series of occupational therapy programmes that involve close to 90 inmates everyday.

Jayakumar V, occupational therapist at the centre, said a leader was also chosen from among the inmates to head the team of 15. Once the plan was on paper, the centre officials started to identify inmates who showed negative symptoms – those who remained largely inactive and unresponsive to their surroundings – for the progr­amme. “As we progressed, we could tackle issues of judgment that we spotted among the inmates. For instance, some of them would continue to pour water into the cans even after they filled them up.

This inability to make a decision – on when to stop and not – was one of the issu­es we were able to address soon,” Jayakumar told Deccan Herald. The experience was refreshing for many inmates as they lined up for the programme also to break away from the monotony of their routines.

Jayakumar, however, said some of the inmates involved in the programme could have done these activities earlier and the project only helped them use that experience to good effect. Apart from initiating agriculture therapy and opening vegetable gardens to meet the inmates’ dietary needs, the Thrissur mental health centre operates 14 units run by inmates that make bread and other products. The inmates also man candle-making, goat-farming, piggery, tailoring, tea-vending and book-making units, stationery stores and stalls that supply soaps and detergents for the centre.

The bread-making unit that opened in 2009 has close to eight female inmates and two staff members working in it. The book-binding unit at the mental health centre makes files and registers for the centre with close to 15 inmates involved in the unit. More than 10 inmates are also involved in craft and broom-making units, apart from the flour mill at the centre. The tailoring unit, run exclusively by female inmates, provides clothes to inmates at the centre. The Society for Occupational Therapy and Rehabilitation has partnered with the centre on these units. Based on a performance-based pay scale, the inmates who work in these projects are also paid between Rs 20 and 70 everyday.