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Unit 2: Then, now
Nothing much has changed in this grim world in Mulleriyawa after seven years,discovers Kumudini Hettiarachchi

Unit 2 revisited. The first visit was seven years ago in May 1998. The second was last Thursday and tragically for all those within, nothing seems to have changed. What has changed is that some have passed on, not to the world outside, but to the grave and the world beyond if there is one. New faces have taken their place.

Women, women and more women. Young, middle-aged and old. A majority in clean clothes and some even giving off a whiff of scented powder. Some looking more ill than others. But some even looking saner than you and I.

The world, nay Sri Lanka, has passed these women by. They have fallen through the system and remain condemned to a life sentence at Unit 2 – of the Mulleriyawa Teaching Hospital housing mentally ill patients – until death releases them.

The environs just beyond the gate of Unit 2 are straight out of a picture postcard. Trees, fields and greenery everywhere, no houses or buildings in sight -- leaving one with a sense of peace and tranquillity.

In through Unit 2's unmanned, broken gate, the image is shattered. One, lonely lost-looking soul, with unkempt hair is standing in the rain a few yards from the gate. The whole place is teeming with women, while hospital staff who seem terribly outnumbered to do the work, are briskly moving around.

Desolation and despair weigh you down as hordes of women surround the vehicle and beg for a few rupees. "I want a toffee," says one, while another begs for a cake of soap. A third would like a chew of betel.

The wards though clean, are overcrowded. There are flies everywhere. There are women on beds, many on the floor and some seated along the corridors. The Sunday Times learns that this mental institution which has the capacity to house only 400 patients has more than 800.

"Have you come to take me home? I have been waiting for you so long," pleads patient M. who is seated on the floor near a bed. Look closely and you see that she is tied with a twirled cloth to the leg of the bed. Why? Eka paattama kalanthe dala vetenawa, volunteers an elderly patient explaining that M. faints without warning. M. has been here for about eight years, she claims. The silver-haired elderly patient is a veteran of Unit 2, with about 20 years inside its walls, though there are others who have broken even this record with about 30-40 years.

Several more patients are tied to the legs of beds like M.
It is mid-morning but in a corner bed of another ward, sleeps a young woman. Stop by her bed and soon a curious woman comes by and gives her a firm whack on her leg to wake her up.

"I am here for depression. It was my brother who admitted me to the hospital, from the suburbs of Colombo where I used to live. I am married but have no children. My husband is at home," says pretty 35-year-old patient X, her large eyes filling with tears. With no hope and no visitors, she is gradually coming to terms with her karme, destiny or whatever that she will spend the rest of her days sleeping, eating and idling at Unit 2.

As we walk into another ward, all the patients start waving. "Kavada balanna awe?" one asks while the others gather round us and clamour, "Maava, maava."

No one pays these hapless, helpless women a visit. They have been dumped at Unit 2, to waste away their lives and die as society's outcasts.

The crucial questions that arise are: What are the authorities doing about it? Is it the trend worldwide to tie up mentally-ill patients and treat them like sub-humans? How often is the condition of patients at Unit 2 re-evaluated? What kind of treatment should we provide to violent mentally-ill patients?

Will the authorities wake up from their slumber and take bold action to bring in a more humane system of treatment, with dignity, for these women or will they be Sri Lanka's dirty little secret, to be hidden away at Unit 2?

Next week
Unfortunately, the Director of the Mulleriyawa Teaching Hospital under which comes Unit 2, was unable to meet us at the time of going to press. Therefore, an interview with him regarding the conditions at Unit 2 will appear next Sunday.

The draft Mental Health Strategy for Sri Lanka 2005 states:

Mental illness is extremely common. It has been estimated that some 376,000 Sri Lankans suffer from serious debilitating mental illnesses including bipolar illness, major depression and schizophrenia at any given time. Serious mental illness primarily affects people when they are young.
About 10% of the population is thought to suffer from other forms of mental illness. More women than men suffer from depression.
Sri Lanka has one of the highest suicide rates in the world.
Other key issues which will affect the mental health of the population include the last 20 years of civil conflict and the recent tsunami. Between 20,000 to 40,000 people affected by the tsunami are expected to go on to develop mental illness, most notably depression and medically unexplained symptoms
The vision contained in this draft strategy is to develop a planned, comprehensive and community based mental health service organized and implemented by good co-ordination at national, province and district and community level and integrated with general health services at every level of care.
The draft strategy while acknowledging that modern mental health care services all over the world have now moved away from the use of centralized custodial asylums to less restricted community based care systems, however, states that "although Sri Lanka began to decentralize its mental health services long ago, this process has been unduly slow”.
Specifically, with regard to the three psychiatric hospitals in the Colombo area, Angoda, Mulleriyawa and Hendala, the draft strategy states that a review is being undertaken of all patients.
The draft Mental Health Strategy seems good on paper. Hopefully, the authorities will ensure that systems are in place to provide care with dignity.

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