Life in India is already hard for anyone who looks or acts a little different from the the norm ‒  think of the treatment given to a foreigner or an albino or a person with a stutter. Because of this, anyone born with a mental disability is condemned to a truly difficult life. And, as with anything in India, it gets worse if they are female.

A new report from Human Rights Watch describes in harrowing detail what it’s like to be a woman with a psychosocial or intellectual disability in India. The report, based on interviews with more than 260 people across four states in different corners of the country, is appropriately titled “Treated Worse Than Animals”.

While the crux of the report focuses on the abuse that women with these problems have to face in government institutions that, far from being beneficial actually make things worse, the picture it paints is one of a negligent society where everyone, from the state to you and me, is to blame.

Here’s how we are making things worse for these women.

We call them pagal and say they can’t get married
It’s not yet politically incorrect to use “pagal” or even “retarded” in India and, worse, it’s also very acceptable to discriminate against those with disabilities. Their parents are asked things like “You are so nice, why did you get a child like this?”, as in the case of the mother of a 15-year-old girl with intellectual disability who was interviewed by HRW, and insist that they will never get married.

We look down on those who treat them
Even those who choose to go into that side of medicine are stigmatised, which discourages doctors from specialising in psychiatry, leading to an acute shortage. One psychiatric nurse, who had spent nine years at a mental health hospital, told HRW that her family is still tense about her job. “If I talk too loudly or I crack a joke that my family doesn’t understand, they look at each other and say I have lost my mind working at a mental hospital.” Another staff member at a shelter said that her sister is concerned she won’t get married because she works with “mad people”.

We hide and abandon them
Children with these disabilities are often considered problems that need to be hidden. HRW documents more than 25 cases where families hid or abandoned female members with psychosocial or intellectual disabilities. In one case, a mother of a 32-year-old woman with a disability said the extended family has still not been told about it. Visits to six government institutions in five cities, meanwhile, confirmed to HRW that abandoning relatives and leaving false contact information about them is common practice.

We force our choices on them
Indian law as well as our society presumes that those with psychosocial or intellectual disabilities are not mentally fit to make decisions, so often their opinions are not taken into consideration, especially when deciding whether to institutionalise them. In one case, HRW researchers spoke to a woman named Vidya who said she had been abducted and forced into a mental home.

“My husband had taken out my two children to buy them chocolates. At around 10:30 pm, the doorbell rang. A doctor, a nurse, and a ward boy came and said they had to give compulsory vaccinations for malaria to everyone in the building… Somehow they convinced me to let them come in and before I knew it, they injected me with something that made me drowsy. The last thing I remember is being dragged out of the house and my head falling on the nurse’s shoulder in the lift. The next morning when I got up, I saw barbed wired windows and wondered where I was… Later I found out that my husband had planned it all. My mother finally got me out over a month later.”

We leave them in awful institutions
HRW’s report finds that these institutions would be scary places to send even well-adjusted people, let alone those who need medical attention. Most of them were “exceptionally” overcrowded, dirty and lacked adequate sanitation. One hospital in Delhi had patients three times its capacity, while another in Pune had just 25 working toilets for more than 1,850 patients.

We allow them to be abused, physically and sexually
The researchers found that abuse, whether verbal, physical or sexual, was rampant in these institutions. Some of it is mandated as well. Medication is routinely forced on the women, often through threats of electroconvulsive therapy ‒the technical term for shock treatment ‒  which the United Nations has called on all states to put an end to. Researchers also found that violence, physical and sexual was routine.

“Women have gone to [a mental hospital] for three months and have come back one month pregnant,” said a welfare officer at a residential care institution. “It’s happened in a lot of cases but when the woman can’t say who got her pregnant, what can we do? We found out this because…the women undergo a check-up and mandatory“ urine pregnancy test when they are re-admitted into the residential care facility.

We don’t teach them anything
One of the major problems at the institutions is that there are no meaningful activities to keep the patients occupied, leading to a deterioration of their condition. In half of the institutions that HRW visited, women and girls essentially spent their days wandering around and doing nothing. In many cases, they are not allowed to go out because caregivers don’t want to take the responsibility.

“We send children to Asha Kiran with a very heavy heart because we know whatever skills and socialisation ‒ shaking hands, basic conversation and tasks ‒ they have learned here will go [away] in a couple of weeks,” said one Child Welfare Committee member.

We don’t believe them
In cases of abuse or exploitation, those with disabilities often face major problems with law enforcement because authorities rarely believe them, an attitude “mirrored by family, caretakers and government institutions”. Rakhi, a woman with bipolar disorder, had this to say to HRW:

“I tried to tell a doctor about what happened to me but he would say I am lying. He didn’t do anything about it. He didn’t even listen to me. The police didn’t speak to me so I couldn’t tell them. They just brought me here [a custodial institution for women]. Only when someone talks to me, can I tell them, no?”

We pass counterproductive laws
The Rights of Persons with Disabilities Bill, which is before Parliament, does recognise a rights-based approach but does not guarantee the right to exercise legal capacity, leaving the door open to involuntary institutionalisation and treatment. According to HRW, it also is alarming because the clause on discrimination is dependent on proving a “legitimate aim” rather than being absolute. HRW also calls for changes to the current Mental Health Bill that recognises legal capacity and bans all forms of involuntary treatment.