Rakesh Chandra Narayan v. State of Bihar and Others

In 1985 the Petitioners wrote a letter to the Court regarding the deteriorating state of the Ranchi Mansik Arogyashala, a mental hospital (the Hospital) in Bihar. The Court treated it as a public interest litigation under Article 32 of the Constitution. The Court directed the Chief Judicial Magistrate to visit the Hospital and submit a report on the conditions prevailing there. The report stated, among other things, that there was a severe shortage of water, electricity, beds, medicines and medical personnel. Sanitation and hygiene was also a recurring problem. The report also provided statistics for the number of deaths of patients between the years 1977 and 1986. The year 1984 saw the highest death toll, which was allegedly due to internal management conflicts. The report sought for a change in the administration for the welfare of the patients. The Respondent Government denied the claims contained in the report.

Subsequently, in 1994, the Union Health Secretary, M.S. Dayal submitted a report (the Dayal Report) on the functioning of the Hospital in furtherance to the directions of the Court issued between 1988 and 1994. The report made recommendations for the improvement of the existing conditions at the hospital regarding treatment and rehabilitation of patients.

The Court issued two main orders, in 1988 and 1994 respectively. In 1988, the Court ordered that the matter remain pending, as the Respondent Government had to issue periodic reports.

Download 1994 Order

On the issue of the conditions prevailing at the Hospital, the Court was appalled at the complete lack of an efficient administrative system. The Court held that the mismanagement of the Hospital had seriously affected the patients, some of whom were languishing in the Hospital despite being cured. The Court relied on the report submitted by the Chief Judicial Magistrate that highlighted the lack of medical personnel, medicines, food, water and electricity, among other problems. The Court held that even though the mentally ill require a soothing environment for their treatment, the Hospital resembled a “medieval torture house.”

As to whether the management of the Hospital was satisfactory, the Court held in the negative. Due to the reports furnished by the Respondent Government, the Court held that it could not place any trust in the prevailing administration of the Hospital. The Court held that the Respondent Government had been lethargic and half-hearted in its duty to improve the conditions at the Hospital. The Court constituted a Committee of Management to oversee the Hospital. The Court also held that they “cannot close the proceedings at this stage” and hence the parties could move the Court from time to time.

After the submission of the Dayal Report in 1994, all the recommendations made therein were accepted by the Court. The Court held that construction and renovation of the Hospital, with respect to functioning toilets, an uninterrupted supply of electricity and “additional construction for occupational and rehabilitation activities,” were to be carried out immediately. The Court also directed the budget for food for the indoor patients to be increased.

As to the administration of the Hospital, the Court held that it was essential that the Hospital remain an autonomous entity to ensure its smooth functioning. The Court accepted the recommendations of the Dayal report, which called for, among other things, a Director with a medical background committed to the treatment and rehabilitation of the mentally ill. The Court also approved the Ranchi Mansik Arogyashala Rules, 1994 (the Rules) appended to the Dayal Report. The objectives of the Rules were:

(a) Diagnostic and therapeutic facilities for mental patients;
(b) Social and occupational rehabilitation of mental patients;
(c) Professional and paraprofessional training in the field of Psychiatry, clinical Psychology, Psychiatric Social Work and Psychiatric Nursing;
(d) Expansion of mental health services at community level by providing training to medical and para medical personnel in the field; and
(e) Research in behavioral sciences.

“In a welfare State - and we take it that the State of Bihar considers itself to be one such - it is the obligation of the State to provide medical attention to every citizen. Running of the mental hospital, therefore, is in the discharge of the State's obligation to the citizens . . .” 1988 SCR Supl. (3) 306, pg. 318.

“The State has to realize its obligation and the Government of the day has got to perform its duties by running the hospital in a perfect standard and serving the patients in an appropriate way.” 1988 SCR Supl. (3) 306, pg. 318.

“The fact that lakhs of rupees had been spent on improvement is indeed of no consequence until the Arogyashala is restored to acceptable hospital standards.” 1988 SCR Supl. (3) 306, pg. 317-18.