BHARGAVI DAVAR

India,

Bhargavi Davar aims to restore the dignity and autonomy of persons with mental illness by reforming outdated laws and failed institutions, and by establishing centers that prove the healing power of self-reliance and community support.

This profile below was prepared when Bhargavi Davar was elected to the Ashoka Fellowship in 2005.

INTRODUCTION

Bhargavi Davar aims to restore the dignity and autonomy of persons with mental illness by reforming outdated laws and failed institutions, and by establishing centers that prove the healing power of self-reliance and community support.




THE NEW IDEA

Bhargavi Davar established Bapu Trust in 1999 as the first national-level organization in India entirely devoted to challenging the values, principles, and practices of the Indian mental health system. Drawing on years of work as an academic researcher, she operates on the conviction that medical interventions to manage the mentally ill have excluded attempts to address the social and structural causes of disease, and have resulted in a failed, paternalistic model of care. Bhargavi has for a number of years been at the forefront of initiatives to confront and address the problems of her country’s mental health system. For instance, Bapu Trust aims to regulate the overgrown authority of mental health institutions in India, which currently deny patients any role in making decisions about their treatment. The trust works with judges, government officers, and citizen groups to establish laws and regulations that protect the basic rights of people who suffer from mental illness.

Bhargavi balances her work for legal reform with action-oriented research and developing and publicizing alternatives to the dominant model of mental health care. Her Center for Advocacy in Mental Health, the research and public advocacy wing of Bapu Trust, is building and assessing a unique recuperative community based on research that incorporates modern understandings with traditional practices of healing. The new community will stand as a model for safe and effective recovery, while defying both convention and legal precedent by refusing to function as a custodial psychiatric institution. The trust runs a similar program for women with common mental health problems, which places anxiety, depression, or phobia in the context of home and community, and refers clients to general practitioners and lawyers rather than psychiatrists.

Through Bapu Trust, Bhargavi ultimately aims to overturn the single-strategy model of medical intervention that continues to dominate the mental health field in India and replace it with a diverse, comprehensive system of rehabilitation alternatives that pay respect to the integrity and dignity of all involved.




THE PROBLEM

What does it mean to be treated for mental illness in India? This portrait from Bapu Trust echoes the experience of countless others:

The approach to the shock room was through a bathroom. The patients were waiting in line outside the bathroom door. They wore dirty white gowns, open fully at the sides. They were squirming with shame, trying to hold their gowns together … Between 50 and 60 patients were given shocks in this time, one after the other. No injections were given. The attendants quickly stuffed the mouth of the patient, and held her down with full force. The shock was applied. After that, the patient was taken off the table and laid down on the floor. After about 20 minutes, an attendant rudely shook the bodies lying on the floor, and herded them back to the ward. If someone died on the table, the body was kept separately.

Shock doctors running factory-line services, toilets without doors, bathrooms without soap, taps without water, floors brown with excreta, inmates white with lice, walls red with bedbugs: these are only a few representative images from India’s overcrowded and understaffed mental health institutions. Clearly, things have gone wrong.

For Bhargavi, the root problem driving the abuses described above is the denial of legal capacity to persons labelled as mentally ill. On the determination of a psychiatrist, a person can be denied rights to vote, marry, have a child, or even own property. The Mental Health Act of 1987, introduced as a reform, has in fact served the interests of the professionals running the mental health system rather than the people who find themselves in it. Worse, no independent body exists to monitor the treatment of mental health patients, monitoring occurs only at the pleasure of medical boards with deep investments in the status quo.

In the hands of psychiatrists, mental health care in India has been reduced to a single strategy: the quick relief of symptoms through medical intervention. This approach does not recognize the complexities in a person’s life that may cause her to be anguished or depressed and fuels a drug-based culture of dependency. The Indian authorities reject traditional healing methods as superstitious and unscientific and malign the temples and other places where they are practiced. Authorities label these institutions as disorganized, unregulated hazards and shut them down, transferring the residents to state institutions. The nurturing role of faith and ritual has vanished almost entirely from the management of mental health in India, despite the proven success of many traditional healing centers.

Another symptom of the failure of the current mental health system is that common mental health problems are more prevalent among women than among men. The gap between the needs of women and the expectations of society is large in India, as it is in many places. Mental health problems often stem from the stresses of social oppression much more than from any physical or genetic root. Most women are burdened with great responsibilities and very little leisure time, having to draw water, work in the fields, bear children, and take care of old and ill people. They receive little appreciation for their efforts and often endure beatings and abuse. They need better lives for more than any quick-fix medication. One of the easiest ways to obtain a divorce is to claim that one’s spouse is “mentally ill”. Women are very often unaware of their husbands’ intentions when they are taken to a psychiatrist for examination; by the time legal documents have been issued and they are thrown out on the street, it is already too late.

Groups that should be rising to meet these challenges have not done so. The women’s movement has not been responsive to mental illness. Feminists have focused their advocacy on the issues of “normal” mothers and daughters, often reinforcing the prejudice and stigma of the wider society. Organizations that run shelters and rehabilitation centers, though they may provide needed services within their narrow domain, too often fail to take on the regulations and policies that keep the national system ineffective and inhumane.




THE STRATEGY

Bhargavi Davar established Bapu Trust in 1999 and founded the Center for Advocacy in Mental Health a year later. Since then, these organizations have been at the forefront of public and professional debate on mental health reforms at the state and national level. In particular, Bapu Trust has been remarkably successful in crafting new state government policies for the mental health sector. In Gujarat, the Trust has worked alongside patients, psychologists, management professionals, civic groups, judges, and lawyers to produce authoritative reports that name systematic problems and propose comprehensive solutions. Bhargavi was one of the three key authors of a final strategy document—the first of its kind in India—and helped craft a mental health policy that is awaiting approval now. The strategy document has been widely distributed and cited by groups including the World Health Organization.

Bapu Trust is capitalizing on its work in Gujarat by holding awareness programs for members of the state judiciary and legal experts and undertaking further research on existing institutions and users’ perspectives. In Maharashtra, it is pressing the state government to change onerous laws that turn shelters intended for the poor into de facto custodial psychiatric facilities. Under these laws, homeless persons—many of whom are mentally ill—can be arrested without a warrant and put into a home at random. Bapu Trust fights for changes to the court system, and to the homes themselves, that would secure the rights of homeless persons throughout the state. Drawing from its successes in Maharashtra, the Trust runs a similar campaign in Andhra Pradesh.

Bhargavi pursues nationwide reforms through the Center for Advocacy in Mental Health. After 28 people died in a fire while chained to their beds at a Tamil Nadu mental health institution in 2001, India’s Supreme Court ordered all state governments to present reports on facilities in their respective jurisdictions, but did not require any investigation of the experiences of mental health patients. Bapu Trust filed an intervention with the court, calling for state governments to extend their focus beyond narrow questions of physical conditions and open their consideration to the people who spend their days in mental health institutions. Through its Oral History Archive, the trust has submitted hundreds of stories that illustrate the structural and ethical failings of the Indian mental health system.

The center has also challenged the Supreme Court’s stand against traditional healing centers, and has urged the court to guide the writing of new legislation for disabled persons in accordance with the draft UN Convention for the Rights of Persons with Disabilities. However, Bhargavi has no illusions that dramatic change can be brought about simply by arguing for new legal arrangements; therefore, she is devising complementary programs geared toward change on the ground.

Disturbed that the Mental Health Act enables a failed model of psychiatric hospitals and makes it nearly impossible to create meaningful alternative interventions for the mentally ill, Bhargavi has taken to the law head-on with a program called Setu. This program, whose name translates to “Bridge,” will create a distinctive therapeutic community for the wandering mentally ill—not a service program or psychiatric facility, but an organized community built on values of self-reliance and shared ownership. The residents at Setu will be of two types: persons with severe mental health problems that require long-term care and recovered persons with nowhere else to go. The site will resemble a normal village, but the program will direct all activities towards healing, providing healthy food, good relationships, self-help work, creative arts, and exercise. This healing center is designed for immediate replication, supported by constant documentation and advocacy.

Another leading project in the Bapu Trust network is Seher, a psychotherapy program for women with common mental health problems that attends to poverty and family violence as well as standard inputs for mental illness. Women coming to Seher with complaints of depression receive an assessment of her physical condition, social circumstances, and other known factors. When the roots of an illness can be traced to such factors, the problem becomes much easier for women’s families to discuss and address. Like its sister program Setu, Seher is geared for replication, drawing on a partnership with Safe Harbor, an alternative mental health agency based in the United States.

Bhargavi has planned media campaigns, resource centers, residential study programs on mental health, and numerous other activities to broaden and deepen the work of Bapu Trust. She helped the trust to design a three-year research program on 20 traditional healing centers in the west of Maharashtra, and an assessment of the impact that midwives and other traditional healers have on recovery from psychologically stressful events. The trust is also planning to establish a legal aid division.

As Bapu Trust expands, its contacts and partners multiply and mature. It is still firmly connected to the women’s groups that were its first collaborators, but its network now reaches dozens of groups including governments, citizen sector organizations, students, and professionals in the mental health field. As the organization grows, Bhargavi is careful not to overlook some of the most important people of all: her own staff. Accordingly, Bapu Trust is characterized by a strong concern for the well-being of its workers, and a powerful sense of the need to create leadership by nurturing sound personal growth—all too often neglected in social and development work.




THE PERSON

When Bhargavi Davar was six years old, her mother Bapu left home, selling a few things from the house and catching a train to a healing temple in the south. Her family brought her back by force. Over the next five years, Bapu ran away, was chased, tied up, dragged back, and institutionalized countless times. Bhargavi’s memories are full of such events: she recalls “a mother dazed after shock treatment, a mother chained in a mental hospital, a mother tied to her cot, a mother fondled by her psychoanalyst.” But she also has fonder recollections: “A mother teaching her impatient friends how to make paper roses and draw, a mother singing loudly in her ward in protest of the residing consultant, a mother who happily adopted the posture of a goddess.” Finally, Bapu’s own mother rented her a small room near the temple, where she stayed for around 12 years, painting, preaching, and writing poems; some of her spiritual verses were published and are read with reverence to this day. For her part, Bhargavi read, painted, and wrote like her mother, and balanced such academic pastimes with outdoor pursuits, becoming a medal-winning ace rifle shooter and leader of the national cadet corps.

When Bhargavi finished her undergraduate studies in 1983, her father wanted her to seek a career in medicine. However, after years of watching doctors destroy her mother, she had little taste for the field. She chose philosophy instead, seeking to understand why humans were systemically debased this way. Her father refused to pay the university fees, but Bhargavi persisted, working diligently to save the money to re-enroll. She soon earned a scholarship and began doctoral studies on theories of mental health. When she found that sexual harassment of female students was rife at her prestigious institution, she initiated a campaign to end it. As she gained success despite her father’s disapproval, Bhargavi gained an appreciation for her strong and growing self-reliance. She made the bold decision to bring her mother to stay with their family. Bapu settled and lived peacefully for another eight years.

The next challenge Bhargavi faced was perhaps more intense than any before: in 1993, she gave birth to a baby girl named Aysha, who suffered from grave illness. Despite Bhargavi’s heroic efforts, Aysha finally succumbed to multiple birth defects. “She was in endless and unendurable pain through her short life,” Bhargavi recalls. “I spent every minute of my waking time with her, at her bedside.” Aysha’s passing caused Bhargavi to fall into a deep depression for almost two years. “I had daily nightmares of mutilated children. I cried endlessly with grief and guilt. I screamed in my sleep. I stopped working,” she says. “I went mad after she died.”

Despite the extreme stress of her loss, Bhargavi was determined to overcome the mental illness that now assailed her. She refused to enter the system or take drugs. She exercised, meditated, gardened; she kept herself mentally and physically fit. She avoided unnecessary contact with other people and spent time in introspection. Eventually, she drew inspiration from the event; in her words, “I believe Aysha taught me about the priceless value of life. I want to use the little time I have well.”

After her personal experience with mental illness, Bhargavi became even more concerned with the situation of women in India’s mental health system. She joined women’s groups and engaged with feminist literature. She studied policy and law, and deepened her knowledge about the role of mental health institutions in society. She published two groundbreaking books on psychiatric treatment in India, which were widely read among students and professionals but virtually unknown to the wider public. Finding academic success to be hollow, Bhargavi decided to put her insights to work. She spoke with a close colleague in the hopes of working with existing groups, but after a careful survey, they agreed that none of the mental health organizations were designed to pursue the structural changes. Bapu Trust was the answer; a year after its inauguration in 1999, it began its first national projects.

Bhargavi now lives in the city of Pune with her second daughter, Netra Prabha, whose name translates to “light of the eyes.”