When the tall, burly man spewing abuses heaved a huge rock at Dhruv Badekar and his colleagues, they ran away. But they returned soon, dodging smaller projectiles as they tried reasoning with him. Despite this, he kept shouting at the top of his lungs about his own greatness and power. Eventually, they drove up to him, bundled him into their vehicle and drove 200 kilometres from Maharashtra’s Chiplun to Karjat.
This was no abduction but a rescue mission. Badekar is a psychiatric social worker with Shraddha Rehabilitation Foundation, an organisation established and headed by Mumbai psychiatrist Dr Bharat Vatwani. Vatwani was awarded the Ramon Magsaysay Award on Friday for rescuing thousands of mentally ill homeless people and, where possible, reuniting them with their families.
Badekar had spotted the angry Chiplun man in his filthy clothing and identified his delusions as markers of schizophrenia. Once inside the vehicle, which was actually an ambulance, the man quietened down while Badekar’s colleagues comforted him with food and soothing words.
“We never, ever tie up a patient,” said Badekar.
Shraddha Rehabilitation Foundation distinguishes itself from other mental health organisations by actively seeking homeless people who are mentally ill and rehabilitating them. Most of the foundation’s patients suffer from schizophrenia, bipolar disorder and depression. Since 2005, when the the foundation set up its Karjat campus, it has admitted 5,553 patients. Seventeen new patients were admitted in the first three weeks of August alone.
“Every month, we get 90-100 calls from locals, policemen and mental health institutes from all over India, about a person in their area who needs our help,” said Badekar.
Rescue operation
The foundation’s workers ask a caller for a photograph of the person to be rescued before despatching a team of three or fours social workers and assistants in an ambulance. Since Shraddha’s mandate is restricted to rescuing the mentally ill, a photograph can help determine whether the person being reported has such an illness or some other affliction like drug addiction.
Mental hospitals across the country transfer unclaimed patients to the foundation. Social workers on their way back from reuniting patients with their families have sometimes found other mentally ill people on roadsides and rescued them. On rare occasions that its 120-bed center is less than full, the foundation’s social workers check the streets of Mumbai, Pune and surrounding areas for anyone who might need help and shelter.
Badekar says that India’s tradition of feeding and clothing the poor ensures that many mentally ill and wandering men and women get food and drink. Hotel-owners and tea sellers who often help the homeless make the best informants about a patient’s history. The homeless wander but never too far from their source of nutrition and are not difficult to locate. The social workers can identify them by physical signs like overgrown hair, unclipped nails, and unwashed and soiled clothes, as well as psychiatric manifestations like talking and laughing to oneself, hitting oneself, incomprehensible gesturing and refusal to respond.
Shraddha’s psychiatric social workers are recruited from diverse linguistic regions to ensure that at least one person can speak the patient’s language. A social worker approaches a patient with an offer of a meal, a job or a chance to meet his family. If this fails, the worker may pretend to be a policeman or local strongman to convince the patient but without using force. Most of Shraddha’s workers have been hit by patients during rescues. Only if a patient starts breaking ambulance windows or attempts to jump out does the accompanying nurse administer a sedative. Picking up a patient can take an hour or more.
After tending to any wounds the patient may have, he is brought back to Shraddha’s 6.5 acre in the village of Vengaon, Karjat, 65 kilometres from Mumbai. The campus has a large administrative building that is called the Central Unit that also houses a ward for patients. Also on the campus are a two more buildings with two male wards and two female wards, a meditation center, plots of land where rice and vegetables are grown, and a cattle-shed with Gir cows.
The windows of each ward are large with widely spaced bars, not unlike the windows in a regular house. The central courtyard is surrounded by a verandah open to the sky and lets in sunlight and fresh air. If not for the yellow T-shirts worn by every patient, printed with the word ‘Shraddha’ and the symbols of five religions, the campus could be mistaken for a yoga camp.
Every new patient is tested for diabetes, anaemia, HIV and TB. Assisted by the psychiatric social workers, a clinical psychologist administers a Mental Status Examination to ascertain his or her mental illness – schizophrenia, depression, bipolar disorder or something else. Resident doctor Shrinivas More reports that the most common non-psychiatric afflictions of the patients are multiple injuries, fungal infections and maggot infestations. Most patients stay at the foundation for between 45 days and three months.
Most of the 22 psychiatric social workers live on campus. Each worker establishes a rapport with a patient and shadows him all day, helping him bathe, eat and dress, even tucking a restless patient into bed. By following a schedule, they reintroduce habits into the lives of these patients who have had no pattern to their days. Nurses distribute medicines, but the psychiatric social workers make sure they swallow them.
Going home
Many patients at Shraddha have mental illnesses that do not cause memory loss. As these patients recover, they become homesick and many of them recall the addresses of their homes even though they may not have stayed at these addresses for years or even decades.
“It may be just the name of a village, district or nearest police station but it helps us plan a reunion,” said Badekar. “Sometimes, we can match their details with the information in the police’s list of missing persons.”
Once Dr Vatwani certifies that a patient has recovered, the foundation books train tickets for the patient and and accompanying social worker to the railway station nearest the patient’s home. Shraddha social worker Shahneer Akhtar says that most patients cannot wait to meet their loved ones. “Only some, who remember having an altercation before leaving home, may be reluctant,” he said. “Women who have been missing from home for a long time, are sometimes apprehensive about how they will be received”.
Once they team reaches the patient’s locality, locals or the patient himself may point the way to the house. Reunions are a mixture of shock, joy and tears. Akhtar whips out his cellphone and shows a photo of a recent reunion.
“It took eight days to reach this man’s village on the China border. He had run away at the age of 10 and was coming back home after 52 years.”
Most of Shraddha’s patients are welcomed back by their families, but not all. The foundation’s social workers find that poor households are more likely to accept their kin than the rich, who are more concerned about the stigma of mental illness in the family. In difficult cases, they enlist the support of the village sarpanch, policemen or local leader to help convince the family.
Every patient needs to continue taking Dr Vatwani’s prescribed course of psychiatric medication for at least two years after he is discharged. For those who cannot afford or cannot access these drugs, Shraddha sends a month’s course by post, tailoring the dosage according to any side-effects reported by the patient or his family. From rescue to reunion, the entire process is free for the patient, sustained by the Vatwanis’ private practice and by donations.
Committed team
Dr Vatwani and his psychiatrist wife Dr Smitha Vatwani travel twice a week from their Borivali residence 90 kilometres away to diagnose, treat and monitor each patient at the centre in Karjat. But the Magsaysay awardee said that the team manages fine even in the absence of the founders. “The Shraddha Team is committed,” said Vatwani. “They manage appropriately, with a sense of dignity and purpose, without any inputs from me.”
This is borne out by ambulance driver Nilesh Ghadge, who spent Saturday facilitating reunions in Dhule, Bhusawal, Nashik and Aurangabad. The next morning, he left for another in Vapi. Ghadge prefers spending his rare free hours on the Shraddha campus itself.
Then there is twenty one-year-old Nitiesh Sharma who is in his third year of his Bachelor’s in Management Studies and attends his classes in the morning and works as a psychiatric social worker at Shraddha for the rest of his day. He has reunited patients with families as far away as Assam. Aniruddha Kuwadekar, who has worked as a customer service executive in an automobile company for 16 years, started helping with reunions at Shraddha and never left, because, he said, “never before in my life have I seen so much ecstasy in a person’s face”.
Shraddha’s staff sometimes get rewards from patients themselves. Amol Mirzankar is a little over 40 years old and a long-time patient at the centre who tells a rambling and confused story involving childhood ostracism, training as a police constable and selling a flat before he was picked up from the streets of Mumbai. Nurse Poonam Patil, who has a soft corner for him, said, “He is very nice and always speaks respectfully. Before Raksha Bandhan, he came and said he wants me to tie him a Rakhi.”
