committee on public accounts (2006-2008)twelfth kerala legislative assembly committee on public...

TWELFTH KERALA LEGISLATIVE ASSEMBLY

COMMITTEEON

PUBLIC ACCOUNTS(2006-2008)

SEVENTY NINTH REPORT

(Presented on 17th December, 2008)

SECRETARIAT OF THE KERALA LEGISLATURETHIRUVANANTHAPURAM

2008

TWELFTH KERALA LEGISLATIVE ASSEMBLY

COMMITTEEON

PUBLIC ACCOUNTS(2006-2008)

SEVENTY NINTH REPORT

On

Action taken by Government on the Recommendationscontained in the Eighth Report of the Committee

on Public Accounts 2001-2004

32/2009.

CONTENTS

Page

Composition of the Committee .. v

Introduction .. vii

Report .. 1

Appendices :

I Summary of Main Conclusions/Recommendations .. 36

II Staff Position as on 22-9-2004 of Govt. Mental .. 42Health Centre, Thrissur

III Note No. 89/04 SNB dated 24-9-2004 of State .. 44Nutrition Bureau addressed in the Director ofHealth Services

COMMITTEE ON PUBLIC ACCOUNTS (2006-2008)

Chairman :

Shri Aryadan Muhammed

Members :

Shri C. T. Ahammed Ali ” Alphons Kannanthanam ” P. Jayarajan ” K. M. Mani ” K. P. Mohanan ” C. K. P. Padmanabhan ” M. Prakashan Master ” Thiruvanchoor Radhakrishnan ” N. Rajan ” A. K. Saseendran

Legislature Secretariat :

DR. N. K. Jayakumar, SecretarySmt. V. Jayalekshmi Amma, Additional Secretary

,, D. Kumari Girija, Deputy Secretary,, A. Achamma, Under Secretary

INTRODUCTION

I, the Chairman, Committee on Public Accounts having been authorised bythe Committee to present this Report on their behalf, present the 79th Report onAction Taken by Government on the Recommendations contained in the 8thReport of the Committee on Public Accounts (2001-2004).

The Committee considered and finalised this Report at the meeting held on11th December, 2008.

ARYADAN MUHAMMED,Thiruvananthapuram, Chairman,17th December, 2008. Committee on Public Accounts.

REPORT

This Report deals with the action taken by Government on therecommendations contained in the Eighth Report of the Committee on PublicAccounts (2001-2004).

The Eighth Report of the Committee on Public Accounts (2001-04) waspresented to the House on December 5, 2001. The Report contained Twenty Eightrecommendations relating to Health and Family Welfare Department. Governmentwere addressed on January 2, 2002 to furnish the statement of action taken on therecommendations contained in the Report and the final replies were received onSeptember 22, 2006.

The Committee examined the statements at its meeting held on November 14,2007.

The Committee was not satisfied with the action taken by Government onrecommendation Nos. 1, 3, 5, 6, 7, 8, 9, 10, 11, 14, 15, 17, 20, 21, 22, 23, 25and 28 (Para Nos. 61, 63, 65, 66, 67, 68, 69, 70, 71, 74, 75, 77, 80, 81, 82, 83, 85and 88) and decided to pursue them further. The recommendations, its repliesthereon and further recommendations of the Committee are included in Chapter I ofthis Report.

The Committee decided not to pursue further on the remainingrecommendations, in the light of the replies furnished by Government. Thoserecommendations and their replies are incorporated in Chapter II of this Report.

32/2009.

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CHAPTER I

Recommendations in respect of which the action taken by Government is notsatisfactory and which requires reiteration

HEALTH AND FAMILY WELFARE DEPARTMENT

Recommendation

(Sl . No. 1, Para No. 61)

1.1 The Committee note that five Commissions/Committees viz., (i) HighPower Committee headed by Dr. K. N. Pai, (ii) V. Krishnamoorthi Commission, (iii)Justice K. K. Narendran Commission, (iv) Estimates Committee and (v) SpecialLegislature Committee set up during 1979 to 1991 have studied and submitted reportson the conditions of the Mental Health Centres in the State. Though they werenot set up with the same terms of reference the main objectives of theseCommissions/Committees were to recommend on the improvement to be broughtout in the working conditions of Mental Health Centres. The Committee wereinformed that most of the recommendations of these Commissions/Committees havebeen implemented. The Committee, however, find that only fifty per cent of therecommendations were implemented. During the visit to Mental Health Centre,Thiruvananthapuram the Committee noticed that even those recommendations whichthe department claimed to have been implemented were not fully carried out.

Action Taken

1.2 The high power committee headed by Dr. K. N. Pai reviewed the workingof the hospital system under Health Services Department and suggested measuresfor the rational development. It is a general report on hospitals. As far as mentalhealth is concerned suggestions of that Committee follows :

1.3 Improvement and maintenance of existing building, construction ofadditional building, establishing of convalescent homes, upgradation of MentalHealth Centre, Thiruvananthapuram, additional facilities in Mental Health Centres,Thrissur and Kozhikode, establishing psychiatric units in district level hospitalswith 15 beds and in Taluk level hospitals with 5 beds.

1.4 Extract of suggestion of the Krishnamoorthy Commission are attachedseparately.

1.5 Justice. K. K. Narendran Commission had made similar observation asthat in the Krishnamoorthy Commission Report.

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Abstract of the Recommendations ofKrishnamoorthy Commission

Following Recommendations have beencarried out

Escape of patients from the MentalHospital, Thiruvananthapuram

1. Environmental determination,degeneration of living conditions ofpatients and administrative lapses havebeen the major causes for the escape ofpatients from the Mental Hospital,Thiruvananthapuram. It has beenfound that Shri K. Madhavan, NursingAssistant who is the person directlyresponsible for safeguarding thepatients in Ward No. 2 on the night of13-1-1983 was negligent in theperformance of his duties. There havealso been administrative lapses at thelevel of the Superintendent of theHospital. However in the absence ofclear Government order entrusting theresponsibility of safe custody ofpatients to Nursing Assistants, anydisciplinary action against Sri K.Madhavan, Nursing Assistant, is likelyto be challenged. It is also not able toinitiate disciplinary action against Dr. N.Prabhakaran since escape of patients isfound to be the result of a series of actsof omissions and commissions over along period of time. It is therefore,recommended that the whole HospitalStaff be replaced in stages by postingnew hands right from the top to thebottom level subject to administrativeconvenience. (Para 3-9 to 3-11)

1. Escape of patients : Implemented.Staff referred to in the report have beenchanged. None of the staff memberspresent at that time are there now.

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Environmental improvements

2. A Scientifically formulated masterplan may be prepared for the MentalHospitals in the State for the gradualphasing out of old structure, cons-truction of new building on modernlines, aesthetic spatial planning etc.The master plan may be implemented ona time—bound basis. (Para 4-1)

2. Partially implemented: Master plan forMental Health Centres, Thiruvanan-thapuram and Kozhikode have beenprepared and submitted. No Master Planprepared for Mental Health Centre,Thrissur.

3. Urgent repairs may be done to watersupply and drainage system, oldbuildings, compound walls etc. and newlatrines, ceiling fans etc. provided in allthe wards. Additional wards, dininghalls, mini-theatres and new kitchens (inTrivandrum and Trichur) may also bepresently constructed. Construction ofadministrative blocks, buildings forOccupational Therapy and Rehab-ilitation quarters for B.M.O. Nursingand Paramedical Staff, Family Therapywards, Day Care Centres etc. may beundertaken according to a phasedprogramme.

3. Implemented : Most of the wards inMental Health Centres, Tvpm., Thrissurand Kozhikode have been renovated.

Kitchen of all centres have also beenmodified.

Water supply and drainage systemensured in all the Centres.

Occupational therapy unit is functioningat all Centres. At Mental Health CentreKozhikode it is attached to IMHANSKozhikode.

RMO Quarters available in all Centres.

Nursing Hostel available at Thiruvanan-thapuram and Kozhikode only.

Administrative Block proposed forThiruvananthapuram and Kozhikode.New Administrative block constructed atMental Health Centre, Thrissur.

Family Therapy, Rehabilitation Wardsavailable in all the Centres.

4. Good interior roads, lightingarrangements and gardens may beprovided in the Hospital Compoundsand an Intercom system installed in theHospital Offices and Wards. (Para 4-3)

4. Implemented : Interior Roads andlighting arranged and Garden are availablein all the three centres. Intercom facilityprovided in all centres but functioning inThrissur only.

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Patient Welfare

5. Water seal closets should beprovided in all wards and open drainsdispensed with, Wards should havemosaic flooring and walls should be tile.Facilities such as fans, drinking wateretc. should be provided in wards.(Para 5-2)

5. Partly implemented : Latrine with waterseal closets and open drains available inall the wards in the above Centres.

Marble/Mosaic flooring of wards aredone at Thiruvananthapuram andKozhikode only.

Facilities for Drinking Water and Fan inall wards are provided.

6. All patients should be given cots andmattresses to sleep on and three sets ofhospital uniform a year. (Para 5-2)

6. Implemented: Cots and Mattresses andsufficient clothes are supplied in all thecentres.

7. Soaps, oil, tooth powder etc. shouldbe regularly supplied to patients. Theyshould be given shelves to keep theirbelongings. Barber’s services should bearranged for them regularly. (Para 5-2)

7. Implemented: Soap, Oil, Toothpowder and Barber’s services areprovided in all the centres. Shelvesprovided in each ward.

8. Radio sets in the Hospitals should berepaired and kept in working condition.(Para 5-3)

8. Implemented: T. V. sets provided in allwards.

9. The new dining halls to beconstructed may be used as recreationrooms during day time and facilities forindoor games provided there. (Para 5-3)

9. Implemented: Facilities for indoorgames and dining rooms are provided inall the centres.

10. A T. V. set may be installed in eachrecreation room. This may be limited toTrivandrum Hospital at the initial stage.(Para 5-3)

10. Implemented: T.V. sets installed inrecreation rooms in all the centres.

11. The provision of recreationalfacilities can be arranged with the helpof voluntary agencies. HospitalWelfare Committees may be entrustedwith the task of mobilising publicco-operation in the matter. (Para 5-3)

11. Recreation facilities available :Voluntary agencies, Hospital WelfareCommittee involved in Mental HealthCentre, Thiruvananthapuram and MentalHealth Centre, Thrissur. At MentalHealth Centre Kozhikode HDS is notfunctioning.

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12. A mini-theatre for film shows andstaging entertainment programmes maybe constructed in each of the Hospitals.(Para 5-3)

12. Implemented: Entertainmentprogrammes are conducted.

13. Facilities for outdoor games maybe provided and regular competitions insports, games, drawing, music etc.among the patients may be conductedregularly. (Para 5-3)

13. Implemented: Open air auditorium, outdoor games facilities provided. Sports andarts competition conducted occasionally.

14. A regular lending library andreading room may be established withthe help of State Central Library andother Public Libraries. (Para 5-3)

14. Implemented: Library facilitiesavailable only at Mental Health Centre,Thiruvananthapuram and Mental HealthCentre, Kozhikode.

15. The Medical Records Library maybe thoroughly modernised to verify oldcase records on admission. Admissionshould be regulated through a systemcontaining wall-in-clinics, O. P. Wardsand Observation Wards. Beforeadmission relatives should be closelyquestioned by the doctor concerned andthey should be asked to produceidentification records in order to checkaddress and malpractices. (Para 5-4)

15. Partially implemented: ModernisedMedical Record library available atMental Health Centre, Thiruvanan-thapuram only. In Mental Health CentreKozhikode, computerisation is on theprocess. In Mental Health CentreThrissur Modernised. Medical RecordLibrary is not available.

16. A team of experts may be appointedto examine the adequacy of presentmethods of treatment in the MentalHospitals and to suggest, if necessary,a new regimen of therapy. (Para 5-4)

16. Not implemented: Team of expertsto examine the treatment methods in thecentres are not implemented becausemajority of the Doctors are specialists.

17. Only modified E.C.T. should beadministered in Mental Hospital. (Para 5-4)

17. Implemented.

18. A well-equipped Emergency Wardand an Observation Ward may beconstructed in each of the 3 mentalhospitals. (Para 5-4)

18. Intensive Behaviour care unit isunder construction at Mental HealthCentre, Thiruvananthapuram, Kozhikodeand Thrissur.

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19. The patients should be examinedby an inter disciplinary team ofPsychiatrists, Clinical Psychologist,Psychiatric Social Worker andPsychiatric Nurse. The services ofclinical Psychologist and PsychiatricSocial Worker should be adequatelymade use of in clinical activities ( Para 5-4)

19. Implemented : Patients are exa-mined by Inter disciplinary team servicesof Clinical Psychologists and PsychiatricSocial Workers utilised adequately.

20. Only properly trained Nursing andpara-medical staff should be posted inMental Hospitals. Arrangements shouldbe made to train adequate number ofNurses in Psychiatry and short-termcourses should be arranged forpara-medical staff. (Para 5-4)

20. Partially implemented: All theNursing and Paramedical staff postedthrough Public Service Commission andEmployment Exchange are not properlytrained in Psychiatry. In service traininggiven to them later. Qualified PsychiatricNurses are not available (DPN Nurses).They are insufficient in numbers.

21. The practice of making use of thecured patients to administer medicinesshould be stopped forthwith. Onlynursing staff should be made res-ponsible for administering medicines.(Para 5-4)

21. Implemented: Cured patients arenot permitted to administer medicines.

22. Adequate and timely supply ofmedicines and drugs in requiredpsychiatric doses to the Mentalhospitals should be ensured. TheK.S.D.P. Ltd. may be requested tomanufacture medicines and drugs inpsychiatric doses. (Para 5-4)

22. Implemented : Frequent shortageof Medicines not reported in all thecentres. K.S.D.P. is not manufacturingpsychiatric Medicines and drugs.Emergency drugs and Psychiatric drugsare available in the three Mental HealthCentres. Purchase is being done throughCPC firms.

23. In the place of present sick wardsgeneral wards with all specialityservices and operating on an emergencybasis, 24 hours a day should beestablished in the Hospitals (Para 5-4)

23. Partially implemented: GeneralWards are available at Mental HealthCentre, Tvpm. and Mental Health Centre,Kozhikode.

24. An ambulance each may besupplied to all three hospitals urgently(Para 5-4)

24. Implemented: Ambulance Serviceavailable.

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25. New types of therapy such asFamily Therapy, Occupational therapy,Counselling etc. should be introducedin the Hospitals. (Para 5-4)

25. Implemented: Family Therapy,Occupational Therapy and Counsellingintroduced.

26. All Cellular Wards should beabolished and replaced by pavilion typestructures. (Para 5-4)

26. Partially implemented: Few CellularWards still available in all the centres tomanage the acutely disturbed patients.

27. Unit System should be introducedand strictly enforced in the Hospitals.(Para 5-4)

27. Implemented : Unit system.

Diet

28. Implemented : Food served in dininghalls.

28. Practice of serving food in open airor in verandahs may be stoppedforthwith and construction of dininghalls may be expedited. (Para 6-3)

29. Practice of serving food in olddamaged buckets or vessels may bestopped. Good steel vessels may besupplied for serving food. New steelplates and glasses may be given topatients for eating and drinkingpurposes. (Para 6-3)

29. Implemented : New Steel Vessels,Steel plates and Glasses provided.

30. The Practice of utilising theservices of patients in supplying foodmay be discontinued. Mess Attendersmay be posted for the purposes. (Para 6-3)

30. Implemented: Patients are notsupplying foods.

31. Three or four closed food trolleyseach, for carrying food from Kitchentowards dining hall may be supplied tothe Hospitals. (Para 6-3)

31. Partially implemented: Closed FoodTrolleys available at Mental HealthCentre, Thiruvananthapuram and MentalHealth Centre, Kozhikode.

32. The practice of serving night foodbefore 5 p.m. in the evening should bestopped immediately. Arrangementsshould be made to serve night foodbetween 7.30 p. m. and 8.30 p.m. andadequate Mess Attenders may beposted for night duty. (Para 6-3)

32. Partially implemented: Night foodserved between 6.30 p. m. and 7 p. m.

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33. New Kitchens may be constructedin Trivandrum and Trichur Hospitals.(Para 6-3)

33. Implemented: New Kitchensconstructed.

34. Efforts should be made to preparefood in greater variety to suit differenttastes. (Para 6-3)

34. Implemented: Variety of foodsprovided.

35. One post each of dietician may becreated in Trichur and Calicut Hospital.(Para 6-3)

35. Implemented: Post of dieticiancreated and filled up.

36. The system of supply of foodmaterials may be reviewed. It may beexamined whether supply can bearranged through Civil SuppliesCorporation or Co-operative Sectorundertakings eliminating the middle-man. (Para 6-3)

36. Implemented : Supply of foodmaterial is through Civil SuppliesCorporation and Co-operative sector.

Administrative Changes Administrative Changes

37. A Separate Department of MentalHealth may be formed and all MentalHospitals brought under its control inorder to end the present system of dualcontrol over these institutions. Whenthe new department if formed MedicalOfficers now working in the MentalHospitals belonging in MedicalColleges and Health Services may begiven opportunities to exercise optionto come over in the new department orto remain in their parent departments.An eminent Medical Scientist workingin the field of Mental Health may bebrought in from outside the State tohead the new department during theinitial years. (Para 7-3 to 7-7)

37. Dual control of Mental HealthCentres stopped. Now all the threeMental Health Centres are under thecontrol of Director of Health Services.

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32/2009.

38. The requirements of staff inMental Hospitals may be reassessedtaking into account the specializednature of work in them and steps maybe taken to appoint additional personnelif required. Posts of specialists such asM. R. Librarian, Lab Technician, X-rayAttenders etc. should be created in allHospitals and recruitments made tothem urgently. (Para 7-8)

38. Requirement of staff in MentalHealth Centres reassessed and proposalsubmitted to Government MedicalRecords Librarian, Laboratory Techni-cians are posted in all the Centres.X-ray attender not posted in MentalHealth Centre, Thrissur and MentalHealth Centre, Kozhikode (No X-rayunits).

39. Post of an Administration Officermay be created in each of the threeHospitals and Senior Officers, eitherfrom Police or Military, may be draftedfor the purpose urgently to ease theadministrative burden of theSuperintendent and to enforcediscipline and order in the hospitals.(Para 7-9)

39. Not Implemented : Post ofAdministrative Officer not created. Notfound necessary as the Superintendent ofeach institution with his ministerial staffare executing the administrative worksincluding enforcement of discipline andorder.

40. A Watch and Ward staff may alsobe created in all the Hospitals forreinforcing the security arrangements.(Para 7-10)

40. Implemented : Security staff posted.

41. Orders may be issued specifyingduties and responsibilities of eachcategory of staff in the MentalHospitals. (Para 7-11)

41. Implemented : Orders specifyingduties and responsibilities of eachcategory issued.

42. The Financial Powers of theSuperintendents of Mental Hospitalsmay be enhanced to enable them topurchase adequate stock of medicinesin emergencies. The question ofenhancing the delegation of powers inother respects may also be examined.(Para 7)

42. Implemented : Financial Powers ofthe Superintendent enhanced.

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43. The task of providing securityarrangements in respect of the criminallunatics may be made the responsibilityof Jail authorities. They should alsobear the cost of providing food to thecriminal lunatics. (Para 7-15)

43. Not implemented.

44. Criminal lunatics and wanderinglunatics should be medically examinedat frequent intervals with a view toexpediting their trial or release. DistrictJudges may be requested to review thecases of old criminal lunatics committedto the Hospitals by the courts withintheir jurisdictions. Periodical meetingbetween Judicial, Jail and Hospitalauthorities may also be arranged toreview the cases and to expedite thetrial or release of criminal andwandering lunatics. (Para 7-15)

44. Implemented : Criminal Lunatics andWandering lunatics are cared properlyand their condition reported to the Courtperiodically.

45. Private practice of the doctors in theMental Hospitals may be stoppedforthwith after providing them withattractive non-practicing allowance.(Para 7-16)

45. Not Implemented : Private practiceof doctors of Mental Health Centres notstopped because private practice is notbanned in Health Services Department.

RehabilitationRehabilitation

46. A comprehensive programme forrehabilitation of mental patients may beformulated and implemented with thefollowing elements.

46. Partially Implemented : Compre-hensive programme for Rehabilitation ofMentally ill.

(i) A Rehabilitation clinic to examineand assess the aptitude andpotentialities of patients.

(ii) A State level RehabilitationCommittee to organise and Co-ordinateresources for the RehabilitationProgramme.

(i) Aptitude and potentialities of thepatients assessed.

(ii) State level RehabilitationCommittee to organise and co-ordinateresources for rehabilitation programme –not constituted.

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(x) Arrangements to market theproducts of rehabilitation units with theassistance of Public Sector Under-takings, Nationalised Banks and PrivateIndustrial and Commercial estab-lishments. (Para 8-8)

47. Not Implemented: Proposal formonthly pension to chronically mentallyill persons have been considered byGovernment. Government could notimplement the scheme due to financialconstraints.

(iii) Starting of Vocational units in theHospitals in a number of trades.

(iv) Training and deployment ofsupervisory personnel for impartingtraining to patients.

(v) Opening of Rehabilitation wardswhere patients will be allowed to workwith least control and in home likeconditions.

(vi) Half-way-Homes to increasepsychological competence of patientsto take up outside assignments.

(vii) Day-care-service to train the outpatients.

(viii) Self employment projects fortrained patients with grant and loanassistance.

(ix) Steps for placement of adequatelyand qualified patients in suitable jobswith the help of GovernmentDepartments, Public Sector Undertakings, Nationalised Banks etc.

(iii) Vocational units started.

(iv) Occupational therapists are postedin all the three Mental Health Centres.

(v) Implemented.

(vi) Not Implemented.

(vii) Implemented in Tvpm. only.

(viii) Not Implemented.

(ix) Not Implemented.

(x) Arrangement to market the productsof Rehabilitation units implemented atIMHANS.

Pension to mental patients47. A monthly Pension of Rs. 50 perhead may be paid to discharged mentalpatients to support themselves and tothe cost of follow-up treatment.(Para 8-9)

Pension to mental patients

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A Mental Health andRehabilitation Fund

48. A Mental Health andRehabilitation fund may be constitutedby sale of special stamps for thepurpose and by way of voluntarycontributions. (Para 8-10)

48. Not Implemented.

A Mental Health andRehabilitation Fund

Board of Visitors Board of Visitors

49. The Board of Visitors in all the threeHospitals may be reconstituted withCompetent Qualified and Willing PublicMan and Social Workers of variedexperience. (Para 9-4)

49. Implemented in Trivandrum.

Mental Health Bill, 1981

50. State Government may recommendto Government of India to incorporatein the Mental Health Bill, 1981,provisions regarding rehabilitation ofMental patients. (Para 10-2)

Mental Health Bill

Mental Health Manual

51. A Comprehensive Mental HealthManual containing detailed instructionsregarding admission to treatment andmaintenance in, and discharge fromMental Hospital of patients. A specialcell may be constituted for the purpose.(Para 10-3)


50. The Central Government have alreadyissued State Mental Health Rule 1990.

Mental Health Manual

Re-organisation of MentalHealth Institution

Re-organisation of MentalHealth Institution

52. The Mental Health Institutions inthe State may be reorganised within aperiod of 5 years on a three tier patternconsisting of (a) Acute Treatment Units,(b) Intermediate Care Unit and (c) Long


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Further Recommendations

1.6 While considering the action taken statement on Para No. 61 theCommittee could not find justification for the non-implementation of some of therecommendations of Krishnamoorthy Commission. The Committee, therefore,strongly recommends that the Department should implement the followingrecommendations without further delay.

53.

(i) Not done

(ii) Not done

(iii) Implemented, Psychiatry unitsestablished in all the DistrictHospitals.

(iv) Not done–Field staff collectingstatistics.

Term Care Units. A competent SeniorMedical Officer may be authorised toformulate a detailed plan of action forthe purpose. (Para 11-3 and 11-4)

National Mental Health Programme National Mental Health Programme53. The newly formulated NationalMental Health Programme may beimplemented by the State incorporatingthe following additional proposals

(i) The names of dischargedpatients may be registered inPrimary Health Centres andRegistration Cards issued tothem.

(ii) Free medicines and drugs forfollow up treatment may be givento such of the registered patientswhose annual income does notexceed Rs. 2,500. To othersmedicines may be supplied atcost prices.

(iii) Mental Health Centres may beestablished in District Hospitalsfor periodical check–up ofdischarged patients.

(iv) The field staff of National MentalHealth programme may beentrusted with the task ofcollecting statistics regardingmental Health arrangementsshould also be made at State levelto compile and periodicallypublish such date.

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Item No. 16

A team of experts should be appointed to examine the methods of treatmentin the Mental Hospitals and the same should be implemented urgently.

Item No. 20

If temporary Nursing and Paramedical Staff are appointed in unavoidablecircumstances they should be given adequate in-service training.

Item No. 26

All Cellular Wards must be given modern facilities so that the patient shouldnot feel a lonely atmosphere.

Item No. 37

The Three Mental Health Centres should be brought under the control of aJoint Director.

Item No. 46

(vi) Half Way-Homes to increase psychological competence of patientsto be started urgently.

(vii) Day Care Service to be provided at Kozhikode and Thrissur.

(viii) Self employment projects for trained patients should be implementedwith grant and loan assistance.

(ix) Self employment projects and placement for qualified patients insuitable jobs with the help of various Government Departments, Public SectorUndertakings and Nationalised Banks should also be implemented urgently.

Item No. 47

Government should include Mental Patients also under the coverage of thephysically handicapped persons Pensions Scheme.

Item No. 48

Should take necessary steps to introduce a Mental Health and RehabilitationFund for the Welfare of the Mental Patients.

Item No. 49

Board of visitors in the Mental Hospitals of Kozhikode and Thrissur shouldalso be reconstituted immediately with Competent Qualified and Willing Public Menand Social Workers of varied experience.

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Item No. 50

The Committee would like to be informed whether Government hadimplemented the State Mental Health Rule, 1990 and how far it is practicable.

Item No. 51

A special cell should be constituted for implementing the Mental HeathManual.

Item No. 52

The Mental Health Institutions should be re-organised on a three tier pattern.The Committee expressed displeasure in not having implemented therecommendation.

Item No. 53

The National Mental Health Programme should be implemented in the Stateurgently incorporating the following additional proposals Sl. No. (1). The names ofdischarged patients may be registered in Primary Health Centres and RegistrationCards issued to them and (Sl. No. 4). The field staff of National Mental Healthprogramme may be entrusted with the task of collecting statistics regarding mentalhealth. Arrangements should also be made at state level to compile and periodicallypublish such data.

Recommendation

(Sl. No. 3, Para No. 63)

1.7 From the replies to audit observations and to the questions put forthby the Committee, as well as from the evidence tendered by the witnesses and duringthe visit to Mental Health Centre, Thiruvananthapuram the Committee could notfind justification for the non-implementation of the recommendations of theCommissions/Committees. The Committee, therefore, strongly urge the departmentto implement all the recommendations of the Commissions/Committees withoutfurther delay.

Action Taken

1.8 Mental Health Centre, Thiruvananthapuram has improved very muchduring the last few years. Details furnished against Para 61 above.

Further Recommendation

1.9 The Committee opines that even in cases where no financial commitmentis involved, no action is seen taken for the implementation of the recommendationsof the Commissions/Committees, for the welfare of the mental patients. TheCommittee suggests that all such recommendations should be implemented urgently.

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Recommendation


1.10 The Committee find that funds provided for Mental Health Centresunder plan and non-plan sections during 1989-1990 to 1993-94 was insufficient tomeet the requirements. The Committee also find that even the limited funds allottedwas not utilised by the department and the major portion of the funds allotted wasutilised for disbursement of pay and allowances to the staff, which constituted 68%of the total expenditure. The reasons for the short utilistion of funds adduced bythe department are non-sanctioning of new posts, delay in getting administrativesanction for works/purchase etc. The Committee are not convinced of the validityof the reasons and records their dissatisfaction over the lapses on the part of thedepartment in the proper utilisation of funds.

Action Taken

1.11 Pay and allowances to staff is met from the salary provision under non-plan head. Now sufficient funds are being allotted by the Director of Health Servicesunder materials and supplies (Non-Plan). The funds allotted under each head shouldbe utilised for the purpose allotted and that fund cannot be diverted to any otherpurpose. Therefore, the fund allotted under some heads can’t be utilised fully.


1.12 Funds are provided according to the requirements proposed by theDepartment. The funds allotted under each head should be utilised for the purposefor which it is allotted and that funds cannot be diverted to any other purpose.The Committee express displeasure on the reply received from Government.

Recommendation


1.13 The Committee were informed that about three lakh peopleconstituting one per cent of the total population in Kerala are having mentaldisorders. It was also informed that the sanctioned bed strength in theMental Health Centres in the State is 1,342 and that in the district hospitals wherepsychiatric treatment is available is 102. The Committee feel that the existing facilitiesfor the treatment of mental patients are far from actual requirement.

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Action Taken

1.14 There exist 1,714 beds for mentally ill in Government sector as follows:

3 Mental Health Centres 1342

Medical College Psychiatry Units 216

Government General Hospitals & District Hospitals 156,

Total 1714

1.15 Besides 109 private Psychiatric Hospitals/Nursing Homes haveapplied for license. Total bed strength of the private Institutions is about2,250. There are also Private Institutions which conducts De-addictionservices, counselling services etc. Further the District Mental Health Programmeunder National Mental Health Programme with the assistance of the CentralGovernment is functioning in Thiruvananthapuram and Thrissur.The District Mental Health Programme, Thiruvananthapuram is attending about2,000 patients every month. A proposal for enhancing the treatment facilities atthe three Mental Health Centres and five Medical College Psychiatry Units withadditional Central Assistance has been forwarded to the Central Government.


1.16 The Committee recommends that Government should take necessaryfollow up steps to get the additional Central Government Assistance for enhancingthe mental treatment facilities to the Mental Health Centres and Medical CollegePsychiatry Units.

Recommendation


1.17 The Committee, during their visit found that more than nine hundredpatients were admitted in the Mental Hospital, Thiruvananthapuram againstthe sanctioned bed strength of 507. The Committee noticed that the patientsadmitted in excess of the sanctioned bed strength are being accommodatedby providing mats. The Committee found that despite the large scaleover crowding of patients, six out of the 28 wards were not being utilised by theHospital for want of renovation. The Committee understand that similar situation isprevailing in other Mental Health Centres also. The Committeeare distressed to note that the departmental officers are responsible for thenon-utilisation of even the available space in these hospitals for want oftimely renovation of wards using the funds allotted. The Committee,therefore, desire to be furnished with the details of the delinquent officers who were

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responsible for the lapses in this regard. The Committee also desired to be furnishedwith the details of showing the present position of construction of buildings,renovation of cell type building taken up in 1985 for which an expenditure ofRs. 4.48 lakhs had been incurred and the proposals submitted in January 1993 forthe completion of work.

Action Taken

1.18 Mental Health Centre, Thiruvananthapuram –There is no overcrowdingat present.

Year Average Inpatients

1998 827.40

1999 748.01

2000 723.00

2001 740.00

2002 724.71

2003 618.42

2004 529.86

2005 526.95

All 28 wards are being utilised.The following buildings are under construction.

(i) Modern Psychiatry Ward – Open Ward for females.(ii) New Forensic Ward – for male judicial admission.(iii) Building for expansion of Medical Record Library.

1.19 Mental Health Centre, Kozhicode: —Two pavilion type wards100 patients each for male and female opened in 1997. Renovating works have beencompleted in all wards.

Following buildings are under construction :—(i) Behavioural Intensive Care Ward.(ii) Forensic Ward.(iii) New Block for Ward 2.(iv) Rehabilitation Centre.

(v) Additional block for Female Ward.

20

1.20 Mental Health Centre, Thrissur—Wards are being fully utilised. Ward2 and 7 are renovated and other cell wards included for same in the proposal planunder special central assistance.

Further Recommendation1.21 About 1% of the total population in Kerala are having mental

disorders. The average in-patient strength have a decreasing tendency inevery year upto 2005. Government should examine and study the reasonfor the decreasing tendency of the in-patients in the Government Mental Hospitalsand take remedial measures.

Recommendation(Sl. No. 8, Para No. 68)

1.22 The Committee found that many posts in the Mental Health Centresare yet to be filled up and that this had affected the functioning of these centresbadly. The Committee, therefore, urge the department to take immediate action tofill up the existing vacancies.

Action Taken1.23 Many posts are yet to be filled up by regular staff in Mental Health

Centre, Thiruvananthapuram. However, most of the vacant posts are filled up bytemporary hands through employment exchanges, contract and daily wages. Thevacancies are reported to the competent authorities promptly and periodically inMental Health Centre, Kozhikode. Some essential posts have been filled. Someposts are vacant. Staff position in Mental Health Centre, Thrissur is appended (as appendix II).

Further Recommendation1.24 Most of the vacant posts are filled up by temporary hands through

employment exchanges or daily wages in the Mental Health Centres. The Committeerecommends that regular staff should be appointed in the existing vacancies.


1.25 The Committee were surprised at the poor performance of the clinicalpsychologists in the Mental Health Centres whose diagnostic assessment during1989-99 to 1993-94 was less than five per cent of the patients admitted to the centresduring the period. The Committee desire the matter to be examined and urge thedepartment to make sure that the services of the clinical psychologists are extendedto the entire patients admitted effectively.

Action Taken1.26 The professional responsibilities of clinical psychologists include

(a) Psychological assessments and diagnosis, (b) Psychotherapeutic interventions,

21

(c) Rehabilitation, consultation and programme implementation, (d) Academicinvolvements such as research.

1.27 Psycho diagnostic work-up is indicated only in the case of patients,where confusion exists regarding the diagnostic status. Hence psychometricassessment is not necessary for all the patients who are attending the Mental HealthCentre. Various psychotherapeutic interventions as —cognitive re-training socialskill training, cognitive therapy, behavioral medicine interventions are indicated fordifferent psychiatric disorders with fair degree of effectiveness and efficacy. Toimplement these interventions, the centre should be equipped with adequate numberclinical psychologists.

1.28 However within the existing facilities attempts are made to provideassessment services, therapeutic services and community programme at the possiblelevel. On an average 8 patients are benefited from assessment and therapeuticservices. An average of 5 patients are being referred from OP department for clinicalpsychological services. The quality and quantity of the services can be optimisedif 3 more clinical psychologists are posted and also adequate infrastructure isprovided.

1.29 The service of clinical psychologists is available for all the needypatients in Mental Health Centre, Kozhikode.

1.30 In Mental Health Centre, Thrissur the test materials needed for theassessment of the patients, especially for psycho diagnostic and intelligent are notadequately available. But with the available materials assessment is done regularly.

Further Recommendation1.31 The Committee recommends that the test materials needed for the

assessment of the patients especially for psycho-diagnostic and intelligence shouldbe provided immediately in the Mental Health Centre, Thrissur.

Recommendation


1.32 Committee observed that there had been lack of co-ordination andharmony between the doctors and clinical psychologists which adversely affectedthe normal functioning of the Mental Health Centres. The Committee note withserious dissatisfaction that the Director of Health Services who is fully aware ofthe fact has not taken any effective step to prevent the unhealthy tendency. TheCommittee urge the Director of Health Services to take immediate action to resolvethe problem and to make the atmosphere congenial for the staff to work with teamspirit and unity.

22

Action Taken

1.33 Lack of harmony between Doctors and Clinical Psychologist does notexist in Mental Health Centres. The mental health professionals are working togetherwith team spirit.


1.34 The Committee observes that lack of Co-ordination and harmonybetween the Doctors and Clinical Psychologists still exists in certain hospitals andtherefore recommends that all necessary steps should be taken to avoid this problemcompletely.

Recommendation


1.35 The Committee are of the view that it is the responsibility of theGovernment to ensure that the human rights of mentally ill patients admitted inMental Health Centres are safeguarded. The Committee are perturbed to note thatthe patients admitted in Mental Health Centres are man-handled by staff. TheCommittee would like to remind all concerned that the patients require mental peaceand not physical torture. The Committee observe that the reason for the inhumanattitude on the part of the staff is lack of proper training. The Committee, are givento understand that there are neither trained nurses nor nursing assistants in MentalHealth Centre, Thiruvananthapuram. The Committee also found that theappointments to these posts in Mental Health Centres are made from a commonrank list.

Action Taken1.36 All efforts are taken to give maximum peace to mental patients.

Instructions are given to all clinical staff and nobody shall be physically tortured.Every year training is given to all regular employees including nurses and nursingassistants.

1.37 The staff posted to the institution are from general rank list. Theymay not have psychiatric training. Nurses are receiving general psychiatric trainingduring their general nursing training. A good number of staffworking in this institution are on daily wages. They are not having previousexperience in psychiatric hospitals. In-service training is given to all staff. Noman-handling or torture of patients occur in Mental Health Centres.

Further Recommendation1.38 The Committee understand that man-handling and torturing still exist

in Mental Health Centres and urgent action should be taken to stop this. Onlypermanent staff should be posted in Mental Health Centres and given in-servicetraining. Posting on daily wage basis should be avoided as far as possible.

23


1.39 The Committee note that there is shortage of essential psychiatric drugsand even life saving drugs in all the Government Mental Health Centres. Duringthe visit the Committee came to understand that costly medicinessuch as ‘Restid’ and ‘Clozatine’ were not available and that the hospital authoritieshad resorted to local purchase which resulted in heavy loss to the exchequer onaccount of payment at higher rates. The Committee feel that the situation underquestion could have been avoided had the department strictly adhered to the normsand conditions stipulated for the purchase of drugs. Therefore, the Committee urgethe department to adhere strictly to the norms and conditions relating to purchaseof drugs/medicines so as to ensure availability of essential drugs and to avoid lossto the Public Exchequer.

Action Taken1.40 At present there is no shortage of essential psychiatric drugs and life

saving drugs in Mental Health Centre, Thiruvananthapuram. Clozapine is includedin the CPC list and action has already been taken to include Rispad (Risperidone)in the latest CPC list. The norms and conditions relating to purchase of drugs arebeing strictly adhered to.

Further Recommendation1.41 In Thrissur and Kozhikode Mental Health Centres, the costly medicines

like ‘Restid’, ‘Glozatine’, ‘Clozapine’ etc. are not sufficiently available. TheCommittee recommends that these medicines should be made available in Thrissurand Kozhikode Mental Health Centres also.

Recommendation


1.42 The Committee found that many times expired drugs had been kept instock for administering the same to patients. The Committee also understand that as many as 8.74 lakh of one of the time expired drugs viz. Diazepamtablets had been administered to many patients in Mental HealthCentre, Thrissur. The Committee are surprised to learn that no action has beentaken against delinquent officers who were responsible for the lapses. TheCommittee, therefore urge the department to take stringent action against thedelinquent officers. The Committee also desire to be furnished with the detailsregarding the issue of the balance of 2.26 lakh of Diazepam received in Mental HealthCentre, Thrissur in April 1987. The Committee also recommend to provide a separatecolumn in stock register for showing the date of expiry of drugs to have a closewatch on the date of expiry to avoid the administration of time expired drugs infuture.

24

Action Taken

1.43 The file regarding Diazepam tablets has been closed by thedepartment on being dropped by the Accountant General. (Order No. OA2/1/12/MISE/2003-2004/4460 dt. 1-3-2004.) No responsibility had been fixed on any officialas necessary timely report on it being slow moving, had been made bySuperintendent to the Director of Health Services and other institutions. Date ofexpiry of drugs are entered in the stock list.


1.44 The Committee recommends that responsibility should be fixed on theofficers concerned and disciplinary action initiated against them. Action should betaken to recover the loss from the delinquent officers and if any ofthem has retired from service, action should be taken against those who have willfullydelayed the proceedings.

Recommendation


1.45 The diet served to patients in Mental Health Centres was noticed tobe not in accordance with the diet schedule fixed in September 1983. The Committeewere informed that a marginal reduction in the quantity prescribed as per schedulewould be effected to avoid wastage since all the patients may not require the samequantity. The Committee urge to follow the recommendations of the Nutrition Boardin dieting.

Action Taken

1.46 Recommendations received from the Nutrition Bureau is attached asAppendix III.


1.47 The Committee recommends that the recommendations of the NutritionBoard should be implemented in all the Mental Health Centres in the State.

Recommendation

(Sl.No. 20, Para No. 80)

1.48 The Committee note that the arrangements made for occupationaltherapy in all the Mental Health Centres are quite inadequate. TheCommittee are distressed to note the lack of enthusiasm on the part of the departmentin bringing out any improvement and implementing the occupational therapyeffectively. The Committee expect that the Department shall give more importanceto the matter hereafter.

25

Action Taken

1.49 In Mental Health Centre, Thiruvananthapuram occupational therapy iseffectively carried on. An occupational therapist is appointed on contract basis forone year.

1.50 Well functioning occupational therapy unit in Mental Health Centre,Kozhikode. This is sufficient to meet the need of the improved patients. There isan occupational therapist who is in charge of this unit.

1.51 In Mental Health Centre, Thrissur post of occupational therapist isvacant. During short spells someone is employed on daily wages. Soap making,book binding etc. are taught at this society for occupational therapy andrehabilitation runs farming up goat and piggery and stationery shop employed bypatients.


1.52 The Committee suggests that, in Thrissur Mental Health Centre also,the service of an Occupational Therapist should be made available urgently.

Recommendation


1.53 As regards the pension scheme for mentally ill patients as a measureof rehabilitation, the Committee were told that Government had decided to formulatea scheme of rehabilitation by considering them as handicapped. The Committeewould like to have a clear picture about the scheme and the pattern of assistanceproposed. The latest position with regard to the implementation of this Schememay be intimated to the Committee.

Action Taken

1.54 Proposal for introducing pension scheme to the poor mentally ill patientswas prepared and submitted to the Government in the year 2000 is pending approval.


1.55 Government should include mental patients also under the coverage ofthe physically handicapped persons pension scheme.

Recommendation


1.56 The Committee were informed that wandering lunatics could be admittedin the Mental Health Centre only if they were brought by the police

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with a certificate issued by Chief Judicial Magistrate. The Committee recommendto give admission to those who are brought with the recommendation of Gramapanchayath also.

Action Taken

1.57 Admission of mentally ill persons in psychiatric hospitals/psychiatricnursing homes is regulated by the Mental Health Act, 1987 of the CentralGovernment. According to Section 19 of the Mental Health Act, 1987 any mentallyill person who does not, or is unable to express his willingness for admission asvoluntary patient, may be admitted and kept as an inpatient in a psychiatricHospital/Nursing Home on an application made in that behalf by a relative or afriend of the mentally ill persons. Provided that no person so admitted as aninpatient shall be kept in the hospital for a period exceeding 90 days except inaccordance with other provisions of the Act. In the Act there is no provision foradmitting wandering lunatics based on recommendation of the Grama Panchayath.


1.58 The Committee recommends that Government should examine whetherMental Health Act, 1987 can be amended by the State suitably.

Recommendation


1.59 The Committee find that Board of Visitors is not being constituted inregular intervals, after the expiry of existing Board. The Committee are also of theopinion that the Board of Visitors constituted is not properly functioning in any ofthe Mental Health Centres as envisaged in the relevant Act. The Committee urgethe department to ensure regular constitution of the Board of Visitors and also toensure that the objectives of the same are achieved through its proper functioning.The Committee are also of the view that it is desirable to appoint one of the membersas Chairman of the Board.

Action Taken

1.60 Board of Visitors are constituted at Mental Health Centre,Thiruvananthapuram regularly. Board of Visitors not constituted in Mental HealthCentre, Kozhikode and Thrissur.

27


1.61 The Committee express displeasure for the delay in constituting theBoard of Visitors in Mental Health Centres. Board of Visitors should be constitutedin Mental Health Centres, Kozhikode and Thrissur urgently.

Recommendation


1.62 The Committee understood that there has been no improvements in theimplementation of the recommendations of Legislature Committees even after audit.The Committee, during its visit to Mental Health Centre, Thiruvananthapuramnoticed that even those recommendations which were claimed to have beenimplemented were not implemented fully. The Committee express their strongdispleasure towards the apathy of the department and urge the department toimplement all the recommendations of Legislature Committees without further delay.

Action Taken

1.63 Most of the recommendations of Legislature Committee have beenimplemented.


1.64 The Committee recommend that all the remaining recommendations ofthe Legislature Committees should be implemented without further delay.

Recommendation


1.65 The Committee understand that action on only two out of the fifteenobjectives as envisaged in the Memorandum of Association of the Instituteof Mental Health and Neuro Sciences, Kozhikode (IMHANS) have been initiatedtill date. The Committee see that the Department has no clear picture about theimplementation of the Programmes of the Institute. The Committee urge theDepartment to study the relevance of the programmes and to take necessary actionto streamline the functioning of the Institute so as to ensure full attainment of theobjectives of the Institute.

Action Taken

1.66 IMHANS Kozhikode is a society registered under society RegistrationAct of 1860, and started functioning at the old office building of Mental HealthCentre, Kozhikode in the year 1985. Now the control and administration of theSociety is vested with the Governing Body consisting of—

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Minister for Health—Chairman

Government Secretary, Health—Vice Chairman

Government Secretary, Finance Department—Member

Government Secretary, Planning —Member

MLA- Kozhikode-1—Member

MLA- Kozhikode-II—Member

Director of Health Services—Member

Professor, Department of Psychiatry, Medical College, Kozhikode—Member

Director, IMHANS— Convenor

1.67 The Institute has no building of its own. 40 beds of Government MentalHealth Centre is earmarked to the Institute. Grant in Aid received from StateGovernment is the main source of finance. Following services are rendered.

General Psychiatric Clinic

Child Guidance Clinic

Psycho Oncology Clinic

1.68 The inpatient care of the 40 beds is managed by the doctors and staffof the Mental Health Centre including diet, clothing etc. Rehabilitation Centre ismaintained with the following units. 1. Book manufacturing, 2. Paper cover making,3. Cartons making, 4. Lamination, 5. Printing Press. About 50 inmates are there.The Institute have only a skeleton staff. Hence all clinical activities are carried outwith the assistance of Mental Health Centre.

1.69 It was decided to develop the Institute into a Centre of Excellence.Revised proposals has been submitted by the Director. The proposal can beconsidered only after providing funds in the Budget.


1.70 The Institute of Mental Health and Neuro Sciences (IMHANS),Kozhikode should be developed into a Centre of Excellence. The Committeerecommends that necessary funds should be provided for this purpose.

29

CHAPTER II

Recommendations which the Committee does not desire to pursue in the lightof replies furnished by Government.

HEALTH AND FAMILY WELFARE DEPARTMENT

Recommendation


2.1 The Committee were informed that the inordinate delay in starting theconstruction works recommended by the Special Legislature Committee was due tothe delay in obtaining administrative sanction and technical sanction. It isdistressing to note that the department failed in the timely execution of works evenwhile there were sufficient funds allotted for the purpose.

Action Taken

2.2 The constructions are going on speedily in Mental Health Centre,Thiruvananthapuram and Kozhikode. Now Administrative Sanction is given withoutdelay. Due to treasury ban and delay in getting monthly ceiling of funds, theconstruction work in Mental Health Centre, Thrissur could not be carried out. Actionis being taken to release the funds. Maintenance works are carried out utilisingfunds of State Plan.

Recommendation


2.3 The departmental witnesses appearing before the Committee are expectedto study the cases under examination properly to furnish as far as possible,sufficient, correct and forthright answers to questions raised by the Committee tohave a clear cut idea on the subject matter. The Committee are distressed to notethat the department witnesses appear before them without studying the case andcollecting all the relevant details. Referring to the incident of postponement of themeeting held on 6-10-2000 without any discussion as the departmental witnessesappeared before the Committee without preparation, the Committee are constrainedto warn that recurrence of such incidents would be dealt with seriously.

Action Taken

2.4 Committees views are noted and action has been taken to avoid suchinstances in future.

Recommendation


2.5 In the circumstances, the Committee recommend that only trainedpersons should be appointed as nurses and nursing assistants in Mental

30

Health Centres. The Committee also recommend that the staff of the Mental HealthCentres should be given obligatory in-service training periodicallyin the respective branches so as to enable them to update their knowledge in moderntechniques of treatment. The Committee, recommend, to start in-service courses inMental Health Centre, Thiruvananthapuram at first and thereafter at Mental HealthCentres, Kozhikode and Thrissur.

Action Taken

2.6 In-service training is being imparted to the staff of Mental Health Centres.

Recommendation


2.7 The Committee understand that the staff of Mental Health Centres arenot given suitable additional remuneration in recognition of the extraordinary andhazardous nature of their duty. The Committee also find that the functioning of theMental Health Centres in the State are not co-ordinated or managed properly underthe existing Health Services Directorate. The Committee are of the opinion that itis advisable to form a separate Directorate for the management and functioning ofMental Health Centres. Therefore, the Committee recommend the formation of aseparate Directorate exclusively for Mental Health Centres in the State. TheCommittee also recommend to consider allowing separate scales of pay with specialallowances and incentives for the staff of Mental Health Centres.

Action Taken

2.8 Doctors and Para medical staff working at Mental Health Centres aregiven risk allowance now. The amount may be enhanced. The same allowancemay be extended to the Psychiatrists working at Psychiatry Department of MedicalCollege Hospitals. It is learned that there is a proposal for insuring the staff whoare dealing with the mentally ill patients. This is pending approval of theGovernment.

2.9 State Government have constituted the Kerala State Mental HealthAuthority consisting of the following members under Rule 3 State Mental HealthRule 1990.

Secretary (Health) Chairman

Joint Secretary (Health)

Director of Health Services

Medical Superintendent, Mental Health Centre.

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Three Non-official members including one Social Worker, one ClinicalPsychologist and one Medical Psychiatrist.

Secretary—Psychiatrist having Post-graduate Degree in Psychiatry.

2.10 The Kerala State Mental Health Authority is in charge of Regulation,Development and Co-ordination with respect to Mental Health Services under StateGovernment vide Section 4 of Mental Health Act, 1987 and theKerala State Mental Health Authority is executing this effectively. In the Directorateof Health Services one Deputy Director (Superintendent, Mental Health Centre,Thiruvananthapuram) is co-ordinating Mental Health Services of the State. A StateNodal Officer is posted vide Government Order (Rt.) No. 900/04/ H & FWD dated.,25-3-2004 for implementing the National Mental Health Programme in the State. Sincedevelopment of the Mental Health Services in the State is part of implementation ofthe National Mental Health Programme. The State Nodal Officer can be entrustedto supervise the functioning of the Mental Health Centres. Above all Kerala StateMental Health Authority is there to regulate, develop and co-ordinate all MentalHealth Services in the State. So forming a separate directorate exclusively for MentalHealth Centres does not seem to be necessary.

Recommendation


2.11 The Committee observe that the issue registers and stock registers arenot properly maintained in Mental Health Centres. The Committee also find thatphysical verification of stock to be conducted by the competentauthority is not performed properly as required in Kerala Financial Code and existingrules. The Committee were informed that stock verification at thetime of transfer of charges by the Pharmacist/Store Keeper was not done asthe incumbent was not aware of the procedure. The reason adduced by the R.M.O.for not conducting stock verification was lack of time. The Committee view withserious concern the absence of stock verification as per rule in the Mental HealthCentres. The Committee urge the Department to take urgent measures to conducta thorough verification of stock and to ensure that in future periodical verificationof stock is conducted regularly. The Committee during their visit to the MentalHealth Centre, Thiruvananthapuram checked the stock and issue registers and theydesired to be furnished with the details regarding stock verification such as reportrelating to internal audit indicating period covered by such audit verificationconducted by R.M.O etc., within one week. But, the department has not furnishedit till date. The Committee express their serious displeasure over the attitude of thedepartment. The Committee also recommend to keep issue register showing wardand patient-wise details of issuance of drugs.

32

Action Taken

2.12 Issue registers and stock registers are properly maintained. Physicalverification conducted by competent authority periodically.

Recommendation


2.13 The Committee also find insufficiency in number of cups and plates inMental Health Centres. The Committee urge the department to supply withenough number of cups and plates to all Mental Health Centres.

Action Taken

2.14 Cups and plates are damaged by patients frequently, which areperiodically replaced. Adequate number of cups and plates are made available inMental Health Centres. The shortage of utensils is not felt.

Recommendation


2.15 The Committee further noticed shortage of cots and mattresses still inmental hospitals. The Committee were informed that as the cot of iron strips werefound to be harmful to patients, they were replaced by cots with iron sheets.However, they were also not found suitable as the patients feel too hot in summerand too cold in winter. Further, iron sheet also causes more or less the samedamages to the body. Therefore, the Committee find that the change from cots ofiron strip to iron sheet has not achieved the desired result. The Committee, hence,recommend for wooden cots instead of these cots of iron strips and iron sheets.The Committee also urge the department to supply sufficient number of cots andmatresses in Mental Health Centres immediately.

Action Taken2.16 Both iron and wooden cots are being used. Mattress covers of ten

sets destroyed by patients. Bugs once inside the coir can’t be eliminated. Hencewhen such mattresses become unserviceable, shortage is felt. This can be mitigatedto an extent by supplying foam mattresses. Now sufficient quantity of cots andmattresses are available. Providing wooden cots is not practicable since it can bedamaged easily by the patients.


2.17 The Committee view that the object of the Mental Health Act is notonly the custodial care of mentally ill patients but also protection of the

33

society from the possible hazards that would be created by Mental Patients. TheCommittee could notice from the records produced and on a visit toMental Health Centre, Thiruvananthapuram that the number of absconders fromMental Health Centres is increasing year after year and that only very few of themare brought back. The Committee also understand that the absconders include evencriminals. The Committee express their serious anxiety over the increasing trend ofabsconding.The Committee were informed that the reason for the situation wasabsence of proper security and the liberal system of treatment. The Committee aresatisfied with the liberal system of treatmentand are of the opinion that itshould be continued.

The Committee at the same time urge the department to tighten the securitywith the help of existing staff and appointing additional staff, if necessary.

Action Taken2.18 There are several reasons for absconding of patients. In Mental Health

Centre, Thiruvananthapuram steps have been taken to prevent the incidents ofabsconding. The security system has been improved. But more persons are requiredfor security. Number of absconding persons are decreasing.

Details of absconding

Year Numbers

1999 378

2000 256

2001 218

2002 63

2003 84

2004 35

2005 38

2.19 In Mental Health Centre, Kozhikode absconding of persons occursespecially from the open family wards. However, no missing of patients has beenreported. They have taken steps to reduce the incidents. Statistical records showthat the number of absconding cases have been decreasing year by year.

2.20 In Mental Health Centre, Thrissur absconding patients are seen in thewards where relatives stay bystander. This Committee’s recommendation is takenseriously.

34

Recommendation


2.21 National Mental Health Programme is a Programme launched byGovernment of India with the objective of integrating Mental Health Care with generalhealth services starting from Primary Health Centres. The Committee understoodthat the physical achievement in terms of number of Primary Health Centres covered,number of Medical Officers and multi purpose health workers trained etc. was farbelow from the projected target. The department could not give the reasons forthe shortfall. The Committee, hence, desire to be furnished with the reason for thenon-achievement of the target fixed.

Action Taken

2.22 Two days training to 18 nurses of Mental Health Centres wereconducted in January 2001 by the Kerala State Mental Health Authority. UnderNational Mental Health Programme Central Government have sanctioned DistrictMental Health Programme at Thiruvananthapuram and Thrissur.

2.23 In-service training is conducted every year for the staff of the threeMental Health Centres. Training is given to Doctors and other Paramedical Staff inThiruvananthapuram and Thrissur under District Mental Health Programme.

2.24 Besides a series of public awareness programmes, IEC Programmes havealso been conducted. On sanctioning District Mental Health Programme in moredistricts the training to more staff can be conducted. The IMHANS, Kozhikodehas submitted a proposal for training programmes to the Medical Officers and ParaMedical Staff of Malabar districts. The total expenditure was estimated asRs. 6,58,700. The Director of Health Services was requested to provide funds.

Recommendation


2.25 The Committee understand that the Government AyurvedaMental Hospital, Kottakkal was sanctioned as a support institution for thePost Graduate Department proposed to be started in Ayurveda College, Kottakkal.The department started the centre without providing all theessential facilities contemplated in the Indian Lunacy Act. The Committee foundthat the hospital is functioning in an ill-equipped building despite sufficient fundsalloted for the construction of buildings. The Committee are unhappy to note thatthe work of construction of hospital buildings has not yet been completed. TheCommittee are also distressed to note that there was inordinated delay in startingthe Post Graduation Course.

35

Action Taken

2.26 In Ayurveda College Hospital, Post Graduate Course in Manasika Rogawas started from 2000-2001 onwards with an intake capacity of 6 students per year.PG course has been started during 2001-2002.

ARYADAN MUHAMMED,

Thiruvananthapuram, Chairman, December 17th, 2008. Committee on Public Accounts.

36

1 1.6 Health and FamilyWelfare

While considering the action takenstatement on Para No. 61 the Committeecould not find justification for the non-implementation of some of therecommendations of KrishnamoorthyCommission. The Committee, therefore,strongly recommends that theDepartment should implement thefollowing recommendations withoutfurther delay.

Item No. 16

A team of experts should be appointedto examine the methods of treatment inthe Mental Hospitals and the sameshould be implemented urgently.

Item No. 20

If temporary Nursing and ParamedicalStaff are appointed in unavoidablecircumstances they should be givenadequate in service training.

Item No. 26

All Cellular Wards must be givenmodern facilities so that the patientshould not feel a lonely atmosphere.

Item No. 37

The Three Mental Health Centresshould be brought under the control ofa Joint Director.

32/2009.

Sl. No. Para No. DepartmentConcerned


(1) (2) (3) (4)

APPENDIX I

Summary of main Conclusion /Recommendations

37

(1) (2) (3) (4)

Item No. 46

(vi) Half Way-Homes to increasepsychological competence of patients tobe started urgently.

(vii) Day Care Service to beprovided at Kozhikode and Thrissur.

(viii) Self employment projects fortrained patients should be implementedwith grant and loan assistance.

(ix) Self employment projects andplacement for qualified patients insuitable jobs with the help of variousGovernment Departments, Public SectorUndertakings and Nationalised Banksshould also be implemented urgently.

Item No. 47

Government should include mentalpatients also under the coverage of thephysically handicapped persons pensionscheme.

Item No. 48

Should take necessary steps tointroduce a Mental Health andRehabilitation Fund for the Welfare ofthe Mental patients.

Item No. 49

Board of Visitors in the Mental Hospitalsof Kozhikode and Thrissur should alsobe reconstituted immediately withCompetent Qualified and Willing PublicMen & Social Workers of variedexperience.

38

(1) (2) (3) (4)

Item No. 50

The Committee would like to be informedwhether Government had implementedthe State Mental Health Rule 1990 andhow far it is practicable.

Item No. 51

A special cell should be constituted forimplementing the Mental Heath Manual.

Item No. 52

The Mental Health Institutions should bere-organised on a three tier pattern. TheCommittee expressed displeasure in nothaving implemented the recom-mendation.

Item No. 53

The National Mental Health Programmeshould be implemented in the Stateurgently incorporating the followingadditional proposals Sl. No. (1) Thenames of discharged patients may beregistered in Primary Health Centres andRegistration Cards issued to them and(Sl. No. (4) The field staff of NationalMental Health programme may beentrusted with the task of collectingstatistics regarding mental health.Arrangements should also be made atstate level to compile and periodicallypublish such data.


The Committee opines that even in caseswhere no financial commitment isinvolved, no action is seen taken for theimplementation of the recommendationsof the Commissions/Committees, for thewelfare of the mental patients. TheCommittee suggests that all suchrecommendations should beimplemented urgently.

39

(1) (2) (3) (4)

4 1.16 ,, The Committee recommends thatGovernment should take necessaryfollow up steps to get the additionalCentral Government Assistance forenhancing the mental treatment facilitiesto the Mental Health Centres andMedical College Psychiatry Units.

5 1.21 ,, About 1% of the total population inKerala are having mental disorders. Theaverage in-patient strength have adecreasing tendency in every year upto2005. Government should examine andstudy the reason for the decreasingtendency of the in-patients in theGovernment Mental Hospitals and takeremedial measures.

6 1.24 ,, Most of the vacant posts are filled upby temporary hands throughemployment exchanges or daily wages inthe Mental Health Centres. TheCommittee recommends that regular staffshould be appointed in the existingvacancies.

7 1.31 ,, The Committee recommends that thetest materials needed for the assessmentof the patients especially for psycho-diagnostic and intelligence should beprovided immediately in the MentalHealth Centre, Thrissur.


Funds are provided according to therequirements proposed by theDepartment. The funds allotted undereach head should be utilised for thepurpose for which it is allotted and thatfunds cannot be diverted to any otherpurpose. The Committee expressdispleasure on the reply received fromGovernment.

40

(1) (2) (3) (4)8 1.34 Health and Family

Welfare The Committee observes that lack ofCo-ordination and harmony between theDoctors and Clinical Psychologists stillexists in certain hospitals and thereforerecommends that all necessary stepsshould be taken to avoid this problemcompletely.

9 1.38 ,, The Committee understand thatmanhandling and torturing still exist inMental Health Centres and urgent actionshould be taken to stop this. Onlypermanent staff should be posted inMental Health Centres and given in –service training. Posting on daily wagebasis should be avoided as far aspossible.

11 1.44 ,,

10 1.41 ,, In Thrissur and Kozhikode MentalHealth Centres, the costly medicines like‘Restid’, ‘Glozatine’, ‘Clozapine’ etc. arenot sufficiently available. TheCommittee recommends that thesemedicines should be made available inThrissur and Kozhikode Mental HealthCentres also.

The Committee recommends thatresponsibility should be fixed on theofficers concerned and disciplinaryaction initiated against them. Actionshould be taken to recover the loss fromthe delinquent officers and if any ofthem has retired from service, actionshould be taken against those who havewillfully delayed the proceedings.

12 1.47 ,, The Committee recommends that therecommendations of the Nutrition Boardshould be implemented in all the MentalHealth Centres in the State.

41

(1) (2) (3) (4)

17 1.64 ,, The Committee recommends that all theremaining recommendations of theLegislature Committees should beimplemented without further delay.


The Committee suggests that, inThrissur Mental Health Centre also, theservice of an Occupational Therapistshould be made available urgently.

14 1.55 ,, Government should include mentalpatients also under the coverage of thephysically handicapped persons pensionscheme.

15 1.58 ,, The Committee recommends thatGovernment should examine whetherMental Health Act, 1987 can be amendedby the State suitably.

16 1.61 ,, The Committee expresses displeasurefor the delay in constituting the Boardof Visitors in Mental Health Centres.Board of Visitors should be constitutedin Mental Health Centres, Kozhikodeand Thrissur urgently.

18 1.70 ,, The Institute of Mental Health andNeuro Sciences (IMHANS), Kozhikodeshould be developed into a Centre ofExcellence. The Committee recommendsthat necessary funds should be providedfor this purpose.

42

1 Deputy Director (Supdt.) 1 1 Nil

2 Civil Surgeon 4 4 - 3 non psy-chiatrist

3 Asst. Surgeon 4 4* 1 *one psy-chiatrist ondaily wages

4 Nursing Superintendent Gr. I 2 Nil 2

5 Nursing Superintendent Gr. II 1 1 -

6 Clinical Psychologist 1 1 - retiring Apr .2005

7 Psychiatric Social Worker 1 1 -

8 Lay Secretary & Treasurer 1 1

9 Store Superintendent 1 1 -

10 Head Clerk 1 1 -

11 L.D./ U.D . Clerk 5 5 -

12 Peon 2 2 -

13 Typist 1 1 -

14 M.R.L. 1 1 -

15 Driver 1 1 -

16 Head Nurse 8 8 -

17 Staff Nurse 27 27 -

18 Pharmacist Store Keeper 1 1 -(onmedical leave)

APPENDIX II

Government Mental Health Centre, Thrissur

Staff Position as on 22-9-2004

Sl.No. Category of Staff Staff

strengthIn

positionVacant

(1) (2) (3) (4) (5)

43

(1) (2) (3) (4) (5)

19 Pharmacist 6 6 -

20 Dietitian 1 1 -

21 Lab Technician 1 1 -

22 Lab Attender 1 1 -

23 Electrician 1 1 -

24 Occupational Therapist 1 - 1

25 Sergeant 2 2* 2 *on daily wages

26 Security Staff 2 2* 2 *on daily wages

27 Plumber 1 1* 1 *employmenthand

28 Nursing Assistant 38 38 -

29 Hospital Attendant Gr. I 4 3 1 2 under ordersof promotion

transfer

30 Hospital Attendant Gr. II 17 17 -

31 Cook 6 6 -

32 Dhoby 3 3 -

33 Gardener 3 3 -

34 Barber 1 1* 1 *on daily wages

35 Binder 1 Nil 1

44

APPENDIX III

No. 89/04/SNB. State Nutrition Bureau,Director of Health Services,Thiruvananthapuram,Dated 24-9-2004.

NOTE

Sub : PAC (2001-04) 8th Report—Diet for patients of Mental Health Centre reg .

Ref : Letter No. AB5-76547/04/Director of Health Services dated 16-9-2004.

Please see the reference cited. I am forwarding herewith the revised menuproposed for the diet of the patients of Mental Health Centre as per the para 77 ofthe PAC Report, for necessary action.

Y. Rasheeda Bai,Technical Officer,I/C of Chief Scientific Officer.

Enclosures :

Menu, Daily Allowance Table and Remarks.

To

The Director of Health Services,Thiruvananthapuram,(AB5 Section).

45

PROPOSED MENU OF DIET FOR THE PATIENTS OF MENTALHEALTH CENTRES

Remarks

This menu has been prepared taking into account the nutrient content ofthe food and also the prevention of wastage of food.

The quantity of cereals is too much in the present diet. Every day wheat conjeeand bengalgram curry are served for breakfast at present. That will lead to monotonyfor food, and hence wastage of food. So idly, dosai, upuma, wheat conjee etc. havebeen introduced for breakfast in rotation.

At present vegetables have been classified according to their size. Butvegetables have to be classifed according to their nutritive value. Hence it has beendone so. Presently there is no provision to receive more variety of vegetables otherthan the limited vegetables mentioned before, for the preparation. Hence a list ofdifferent groups of vegetables which can be selected is attached. It is seen thatsufficient quantity of spices and condiments are not allotted in the present scale.Eg. Garam masala for mutton curry etc. This will result in preparations becominginsipid and hence in the wastage of food.

24 grams of sugar allotted in the present scale is not sufficient for tea/coffeeto be served three times a day.

Cereals, pulses, vegetables, milk, meat, fish, oil etc. have been recommendedin sufficient quantity.

for I/C OF CHIEF SCIENTIFIC OFFICER..

MENU (DESIRABLE)

Timings Monday Tuesday Wednesday Thursday Friday Saturday Sunday

5.30-6 A. M. Black Coffee Black Coffee Black Coffee Black Coffee Black Coffee Black Coffee Black Coffee

Uppuma, Wheat Conjee, Uppuma,7-7.30 A. M. Dosai, Sambar Banana-1 or Idly, Sambar Bengal gram, Dosa, Sambar Banana-1 or Idly, Sambar

Plantain-2 Curry Plantain-2

9.30-10 A. M. Tea Tea Tea Tea Tea Tea Tea

10.30-11 A. M. Milk, Bread, Milk, Bread Milk, Bread, Milk, Bread Milk, Bread, Milk, Bread Milk, Bread,Egg Egg Egg Egg

12.30-1 P. M. Rice, Aviyal, Rice, Erussery, Rice, Aviyal, Rice, Erusserry, Rice, Aviyal, Rice, Erusserry, Rice, Aviyal,Thoran, Pulisserry, thoran, Pulissery, thoran, Pulissery, Thoran,Butter milk Tapioca, Butter milk Tapioca, Butter milk Tapioca, Butter milk

Fish curry Mutton curry Fish curry

3.30-4 P. M. Black Coffee Black Coffee Black Coffee Black Coffee Black Coffee Black Coffee Black Coffee

5.30-6 P. M. Rice, Rice, Rice, Rice, Rice, Rice, Rice,Green gram, Green gram, Green gram, Green gram, Green gram, Green gram, Green gram,dhal conji dhal conji dhal conji dhal conji dhal conji dhal conji dhal conji

ENERGY : 3500 K. Cal. (Approximate)PROTEIN : 75 gram (Approximate).

46

47

DAILY ALLOWANCE—COMPARISON (MENTAL HEALTH CENTRE)

Sl.No.

Dietary Articles Servingtime

Existing Scale Desirable Scale Remarks

1 Raw rice B. F. - 100 gms. 4 days New item

2 Rawa B. F. - 150 gms. 2 days New item

3 Wheat B. F. 200 gms. (Daily) 150 gms. 1 day -

4 Rice L 250 gms. (Daily) 175 gms. (Daily) -

5 Rice S 200 gms. (Daily) 150 gms. (Daily) -

6 Bread 10. A. M. 100 gms. (Daily) 100 gms. (Daily) -

7 Blackgram Dhal B. F. - 40 gms. 4 days New item

8 Red gram Dhal L 14 gms. (daily) 14 gms. 4 days -

9 Bengal gram B. F. 28 gms. (daily) 28 gms. 1 day -

10 Green Gram S 65 gms. (Daily) 60 gms. Daily -

11 Green Peas L - 25 gms. (For veg.) New item

12 Tapioca L 170 gms. 3 days -

13 Banana B. F. - 1 (app. 150 gms.)10. A. M. 2 days -

For veg. 4 daysinstead of egg

14 Potato L 57 gms. 1 day 30 gms. (forvegetarians)

15 Vegetables (large) - 70 gms. 3 days veg. A+C=70gms.

16 Vegetables (Small) - 70 gms. 3 days Vegetable B=50 gms. -Vegetable C-50gms.Vegetable E-included3 days

17 Vegetables (large) - 170 gms. 4 days Vegetable A+C= -140 gms. 4 days

(1) (2) (3) (4) (5) (6)

48

(1) (2) (3) (4) (5) (6)

18 Vegetables (small) - 170 gms. 4 days Vegetable B 100 gms.4 days -Vegetable D 60 gms.4 days

19 Coconut 42 gms. daily 42 gms. daily -

20 Coconut oil - 12 gms. (daily) 12gms. 5 days -20 gms. 2 days

21 Gingely Oil - - 5 gms. 4 days New item

22 Onion - 14gms. daily 14 grms. 5 days -30 grms. 2 days -

23 Sugar - 24 gms. daily 30 gms. daily -

24 Tea(Coffee)Powder 6 grms. daily 6 gms. daily -

25 Salt 42 grms. daily 42 gms. daily -

26 Egg - 2 each (2 day) 4 Nos. 1 each 4 days -

27 Fish - 70 grm. 2 days 70gms.(2 days) -

28 Mutton - 50grm 1 day 70 gms. 1 day -

29 Asafoetida - 220 mg. daily 220 mg. daily -

30 Garlic 440 mg. daily 400mg. daily -

31 Cumin seed - 194 mg. daily 190 mg .daily -

32 Fenugreek - 65 mg. daily 65 mg. daily -

33 Tamarind - 7 gm. daily 5mg. daily -

34 Curry powder - 10 gms. - -(without pepper)

35 Chilly powder - - 4 gms. New item

36 Coriander powder - - 5 gms. New item

37 Turmeric - - 1 gms. New item

38 Garam Masala - - 1 gms. New item

49

DIFFERENT GROUPS OF VEGETABLES

VEGETABLE—A

Ash GourdBitter GourdBrinjalCucumberDrum stickFrench BeansKnol-KnolLadies fingerMango greenOnion StalkPlantain flowerPumpkinRidge GroundCherkinsSnake GourdTomatoPapaya GreenBeans (Long)Cluster BeansSoya BeansCauliflower

VEGETABLE—BCarrotBeet RootRadish

Double Beans

Sword beans

Jackfruit tender

Bread fruit

50

Platain green

Banana green

VEGETABLE—C (LEAFY VEGETABLES)

Amaranth (differnt variety)

Agathy

Cabbage

Drumstick leaves

Drumstick Flowers

Spinach (Palak)

Lettuce

Cherkumanis

Edible Flowers and other edible leaves

VEGETABLE—D (ROOTS AND TUBERS)

Tapioca

Potato

Sweet Potato

Yam

Colocasia

Khamealu

Koorkha

VEGETABLE—E

Ginger

Green Chilly

Small Onion

Coriander Leaves

Curry Leaves

Mint Leaves

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