A psychiatrist is navigating mental health challenges in Tihar Jail

Every morning at around 10 am, Vivek Rustagi, a 43-year-old psychiatrist from Delhi, arrives at the Tihar Jail for his regular workday. As per the jail's security protocol, he submits his phone at the security checkpoint before entering the premises.

Rustagi's responsibilities within the jail premises are diverse. As a psychiatrist, he takes charge of the medical aspect of the inmates' well-being which involves providing medications for their mental health issues. He sometimes also helps in counselling the inmates, however, that falls under the domain of a psychologist. He also manages administrative duties and ensures the smooth functioning of the prison.

The Tihar Prison Complex, considered South Asia’a largest jail, is spread over 400 acres and includes nine central prisons. Apart from Tihar, Rohini and Mandoli complexes having six Central Jails, two other prison complexes fall under the Delhi Prisons.

According to an RTI response from the office of the Director General of Prisons that Outlook received, Tihar has a capacity for 5,200 inmates, but it currently houses 13,183. Similarly, Mandoli, with a capacity of 1,050, holds 2,037 inmates, while Rohini, designed for 3,776, accommodates 4,355 prisoners.

Dr Vivek Rustagi, the Head of the Department of Psychiatry, is in charge of the mental health units of Tihar and Mandoli complexes. He has handled many high-profile cases such as–the Nirbhaya case (2012) and the Butcher of Delhi case (2007).

The beginning

Rustagi pursued MBBS from Maulana Azad College, Delhi. During his final year, he observed that individuals around him were silently grappling with mental health issues, yet there was a glaring deficiency of adequate resources to address their needs.

“I realised that many people around me were going through mental struggles. However, there was a lack of proper resources in the system. So I decided to do something in this field,” he says.

Rustagi says psychiatry was the “obvious option” after MBBS. He pursued a postgraduate course in psychiatry in 2004, from the Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi. For the last seven years, Rustagi has been posted at the Tihar complex.

Working in a volatile and unpredictable environment such as a prison and dealing with cold-blooded criminals can be challenging. And so it was for Rustagi as well.

He recalls that when he joined, his interactions with the inmates were unsettling. “When I was new I was very much affected by my interaction with the inmates. I would go back home and think of the crimes some of them committed,” he says.

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Rustagi adds that maintaining objectivity in tough situations has been challenging.

To illustrate his point, he provided an example where an inmate shares a personal story or presents a problem that the counsellor can deeply relate to. In such cases, there is a possibility that the counsellor might unintentionally develop a strong sense of empathy toward the inmate.

Additionally, he explains that many convicts present false stories or pretend to suffer from serious mental illnesses so that the court will commute their sentences. Rustagi believes that navigating through such lies and not letting them personally affect one is a difficult feat but not impossible.

“Well, it can be a challenging job. However, since I have been here for the last seven years, things don’t affect me much on a personal level,” he tells SocialStory.

Crime and mental illness

Often the lines between criminality and mental illness get blurred. But Rustagi says that the two subjects come with clear definitions. Elucidating further, he adds that any actions where a law of the country has been broken is considered as a criminal activity.

Rustagi explains that deviant or delinquent behaviour is characterised by acts against social and legal structures with an element of willfulness. Mental illness on the other hand is persistent and pervasive abnormalities of thoughts, moods and behaviours that impair a person's functioning. The behaviours may cut across moral, social or legal fabric but there is no willfulness.

To differentiate between the two, experts consider–"mens rea", a criminal intent (an intent to deliberately harm somebody). The presence of severe mental illness, characterised by symptoms like delusions and hallucinations, can influence an individual's actions, including the potential for harming others. Therefore, it is crucial to consider the individual's intent behind their actions before making any hasty judgments or assumptions.

Rustagi explains that new studies show that while temperament in associated with genetics, people develop their own personality as they get older. Personality is often affected by parenting, peer influence and exposure to the world and media.

Antisocial personality is often associated with criminal behaviour. Rustagi defines antisocial personality as a medical diagnosis for a person who has tendencies to flout norms (social or cultural), disobey authority, violate people and not feel guilty about the same. He explains that certain antisocial people might be sociopaths or psychopaths.

"An antisocial person who tends to have a scheduled life and is a social fit is typically called a psychopath. The one who is socially awkward and doesn't fit well into society is often called a sociopath." he further explains.

He says that these terms were hardly used in non medical settings till a couple of decades back but the use is increasing gradually. "These are mostly archaic terms but commonly used in parlance especially due to the persistent use in media and movies," he adds.

In the same vein, he remembers the horrifying Delhi gang rape case (2012). One of the four convicts, Vinay Sharma had filed a plea in the court for better psychological treatment. The plea claimed that Sharma was not able to recognise his own mother, had head and arm injuries and was suffering from serious mental illness.

However, a report by Rustagi, who was meeting all the convicts every day and Dr Akash Narade, said that the Sharma’s conduct was suggestive of deliberate disruptive behaviour to commute his death sentence.

In another case, a woman who had killed her husband was later found dancing at a wedding. She was apprehended and was found to be suffering from schizophrenia.

Rustagi remembers that when she came to the prison her thoughts and speech were disorganised. She didn’t respond well to the initial treatment but got better after her medication was changed.

She was later acquitted on the grounds of her mental illness.

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Rehabilitation in Indian jails

Rustagi explains that the Indian Judicial System is non-punitive. The focus of the system is to reform, rehabilitate, and reintegrate the inmates.

The process involves helping the person in getting mentally healthy so that they can step on the ladder of reformation. After it, the person is offered educational, vocational training and other such resources which they could use for their survival after their term. Lastly, they are helped in reintegration with society so they are not ostracised.

He further explains that individual therapy is also important for a person suffering from mental illness. “A psychiatrist can identify the problem and provide medication. We do some counselling as there is no psychologist here. However, clinical counselling can be done by a psychologist only,” he says.

Rustagi remembers a case where a 30-year-old man came to jail after committing a heinous crime. The person was suffering from schizophrenia and was “dishevelled and delusional” when he arrived. However, with medications, he became better in two to three months.

Rustagi remembers that when his family saw him doing better, they were very happy as he had been suffering from the illness for the last 12 years.

However, Rustagi says, “Unfortunately after a person leaves the prison there is no mechanism to help them in the outside world.”

Challenges

Rustagi says that the lack of proper staff strength puts immense pressure on the whole system. Tihar and Mandoli complexes have 12 posts of psychiatrists, 13 posts of clinical psychologists, and 17 posts of psychiatric social workers. However, half of the psychiatrists' posts remain empty. He says that the lack of psychologists puts a lot of pressure on the psychiatrist.

Rustagi also shed light on the complex power plays inside the jails. He explains that inside the prison, inmates form groups and dominate others around them. One common problem that arises is that many convicts treat fellow prisoners booked under the POCSO Act with utter contempt.

He believes that mental health awareness is lacking in society in general. And it becomes even rarer inside the prisons.

“People have a relative apathy towards criminals and that prejudice is a big roadblock in the whole process of treating an inmate with mental health issues,” Rustagi says.

Adding to that he says that inside the prison system, the main attention is given to handling the misdemeanours of the inmates. But not much attention is given to their overall mental well-being.

“Recruiting more mental health experts and providing more liberty to the health professionals can be really helpful in mitigating these challenges,” he says.