The status of mentally ill patients in Maldives; Story of I

As I read a report on the local newspaper about a 19 year old mentally ill girl being raped by her caretaker, something inside me snapped.

I have worked with people with mental illness in the Maldives from 2000 onwards. During my clinical practice , I came across several such incidences, many of which went unreported because this is how the parents wanted it to be.
However, if the violence was ongoing or if the chance of it being repeated was present, I had to take measures to report these incidents.

On several occasions these women are repeatedly abused by their own families and/or by others in the community.
These girls are often understood to be just bad 'badi' girls as people have little understanding of the nature of their illnesses.
Sometimes they may be below average in intelligence , with mental retardation or may have a learning disability. Or they may be going through a psychotic experience, which propels them to behave differently.
I remember once being called by a parent to advise this particular girl , let me call her lady I.

She was reportedly wandering on the streets of Male' for several weeks, sleeping at public places and parents had to run around searching for her frequently. However, after a while parents stopped even doing this because according to them, ' she knows to get back home , so she is just fine , nothing is wrong with her, she knows exactly what she is doing ....she is just out to tarnish our name...whore!"
I was asked to advise her to 'behave'. I visited her house because after the description of her behaviour, I thought this girl was probably going through a psychotic relapse and it was likely she was suffering from Schizophrenia. I felt the need to educate her parents and challenge their mindset and also facilitate her treatment.

I had to go to her house several times to catch her on the times she apparently returns home. Finally when I did meet her, I was positive about her diagnosis, she had delusions of persecution, and also had several command hallucinations , where one voice in particular was commanding her to remove her dress and expose herself.

I asked the parents whether she had been seen by the psychiatrist and after searching the house someone came up with a prescription slip from a psychiatric consultation which dated back to 2 years. She was not on any medication, she was not receiving any help to alleviate the distress she was going through due to her illness.

But one of the relatives said, she was being treated by this 'fanditha veriya' and even showed me some 'thaweeds' tied to her waist and neck.

I asked her where she had been and she said outside with some boys. She told me that this man was telling her to go and meet boys....etc etc. Her body was smeared with sperm. Later I came to know she was gang raped just before she met me.

I had to tell the parents that she needed immediate medical attention, she needed to be admitted in the hospital, and needed the attention of mental health professionals.
It took me a while to educate the family , explaining to them that tying taweeds was not the solution, calling me to advise her was not the solution. Their beautiful daughter was very ill, psychotic and needed to have appropriate antipsychotic medication as soon as possible. Not only was it their duty to treat her but they also had to protect her from a society which was largely insensitive and ignorant to the needs and issues of people with mental illness.

After all this is that country in South Asia which has no mental health policy, no mental health programme or mental health legislation.

She is lucky that atleast there is one outpatient facility at IGMH which can offer her treatment (and the entire country!!!) if she gets lucky may be she would be transfered to Guraidhu until her symptoms could be controlled.