New Delhi:  In July 2024, 14 mentally or intellectually challenged inmates died at Asha Kiran, a government-run shelter home in Delhi. The dead included eight women, five men, and a minor. 

A report submitted by the government of then chief minister Arvind Kejriwal on 7 August 2024 to the Delhi High Court cited various causes of death, including pulmonary tuberculosis, gastroenteritis, breathing difficulties, neurological disorders and severe malnutrition. 

The report said there was only one psychiatrist responsible for 938 intellectually challenged inmates. Despite three sanctioned posts, there was no clinical psychologist available, no paediatrician for 210 children, and the home housed 938 individuals, exceeding its capacity of 570.

The report was prompted by a public interest litigation filed by the NGO Samadhan Abhiyan in August 2024, seeking a court-monitored probe into the deaths at Asha Kiran and an audit of all the shelter homes run by the Delhi government. 

Over the last 12 years, a high court order, and four audits and reports revealed problems with its management, without redressal. 

Issues such as nutrient-deficient food, unfiltered water, and cramped living spaces had continued to plague inmates at the Asha Kiran shelter home.

After the deaths came to light several officials, including the Delhi lieutenant governor, and then Delhi revenue minister, now chief minister, Atishi Marlena Singh, called for an enquiry. 

A fact-finding team from the National Commission for Women (NCW) visited the shelter home while the National Human Rights Commission (NHRC) took suo-moto cognizance of the incident.

Asha Kiran has faced scrutiny on multiple occasions in the past, due to unusual numbers of deaths in a short span of time, including in 2009 and 2017. 

A History of Neglect

The Asha Kiran shelter home, run by the Delhi government's department of social welfare, was established in 1989. It was then the only government-run residential facility for the mentally challenged in northern India. 

Delhi’s department of social welfare now runs six homes for the mentally challenged in Delhi. Four of them, one each for children and adult males, and two for adult females, are situated in the Asha Kiran complex. In addition, they run two associate homes: the Asha Deep Home for Mentally Challenged Persons for Male Adults; and Asha Jyoti Home for Mentally Challenged Persons for Female Adults.

Magistrates or judicial officers authorise admission of adults in these home and child welfare committees authorise admission of children.

In 2009, 12 mentally challenged inmates of Asha Kiran died in December, allegedly due to a lack of basic facilities, such as warm clothes. A ministerial committee formed by Delhi’s then social welfare minister Mangat Ram Singhal  decided that Asha Kiran inmates would be moved to different homes.

In 2011, a PIL alleged that these deaths were caused by “inadequate medical treatment, medical services and access to doctors, skewed ratio of staff to look after the inmates, overcrowding, poor distribution and consumption of dietary, clothing, bedding and other items”. 

The PIL also alleged “abuses of various kinds to the mentally challenged persons” in Asha Kiran, “in particular the female residents.” 

In response, the state proposed setting up a governing council to suggest improvements to the Asha Kiran home, appointing 94 “house aunties”, the official term for caregivers, and running training workshops for staff. 

The High Court accepted the government’s plan and closed the matter.

In 2015, a report from the Comptroller and Auditor General (CAG) of India, the government’s auditor, found that the complex housed 970 inmates, though it was designed for 350. 

The CAG report said only 215 of 260 posts for caring staff were filled. Delhi’s department of social welfare had sanctioned the 260 posts based on the home’s original capacity. The current population required 502 staff. 

The CAG also noted that there was no dietician to monitor the quantity and quality of food provided to the residents of the complex. Despite an October 2012 joint report by the National Commission for Protection of Child Rights (NCPCR) and the Delhi Commission for Protection of Child Rights (DCPCR), which cited malnourishment and skin disease, and recommended nutritious diets for the residents, the situation remained the same.

A 2015 report, accessed by Article14, conducted by the Tata Institute of Social Sciences (TISS), confirmed the CAG’s findings of overcrowding. It noted that staff were not trained in handling disabled residents, there was no medical unit, and a doctor was available only for a few hours once a week.

The then DCW chairperson Swati Maliwal accused the home of “gross human rights violations” after a visit in February 2017, prompted by the deaths of  11 inmates in two months. Maliwal said that in some cases four women were sharing a bed, there were not enough blankets for the residents, and women and children were forced to crawl on the floor as wheelchairs were not in use. 

The DCW said that there was only one psychiatrist, and women inmates were not provided sanitary provisions. “The Commission saw the CCTV footage of mentally-challenged women roaming around naked,” Maliwal said.

In 2019, the Delhi government engaged Koshish, a TISS field project, to conduct another social audit of shelter homes in Delhi. The TISS report said that Asha Kiran residents reported beatings, inmates locked up and food deprivation as punishment for disobedience. The audit also found that residents received no psychiatric or counselling support.

In the year leading up to the 14 deaths in July 2024, according to documents filed in the Delhi High Court, Jyoti Singh, the chief medical officer (CMO) of Asha Kiran issued warnings at least eight times.

Singh said injuries among female inmates were “reported frequently” and that male residents had “not been taken care of properly”. 

Pointing out that many inmates had a low body mass index, “which indicates lack of proper food and nutrients”, she suggested the need for proper monitoring of food distribution and supervision while serving meals to residents, “to prevent further escalation”. 

Nothing ever changed.

Achal Bhagat, a senior consultant psychiatrist and psychotherapist who was appointed chairperson of Asha Kiran’s general council in 2017, said the “greatest crunch” was of “trained human resource”, and that 400 people needed to be hired. 

“The process is slow and sometimes like pushing a wall. Once people are hired, they should be trained and supervised,” said Bhagat. “When you put 900 people together in a situation of resource crunch, the likelihood of morbidity increases despite the valiant efforts of the staff.”

A National Problem

The fatalities at the Asha Kiran shelter point to an absence of accountability and transparency in the management of mental health facilities across the country. 

In July 2024, an illegal shelter home for people with disabilities in Tamil Nadu's Nilgiris district was sealed, and a case filed, after the police found 20 bodies buried on its premises. The home, run under the name of the Loveshore Charitable Trust, had been operating without permissions for 25 years, and there was no record of the inmates' background information.

That same month, two children died and 12 fell ill at a shelter home in Madhya Pradesh's Indore in just two days. The shelter home, called Bal Ashram and run by an organisation called Shri Yugpurush Dham, housed more than 200 children, including orphans and those suffering from mental ailments.

In January 2022, four intellectually disabled women at a Noida-based government shelter home died in two weeks.

In August 2018, two inmates died in mysterious circumstances in a shelter home run by an NGO called Anumaya, in Patna, Bihar, leading to the arrest of the manager and secretary.

Despite The Law

The Mental HealthCare Act, 2017, requires every state to establish a State Mental Health Authority (SMHA) to supervise mental health establishments in the state and handle any complaints. The law says this authority must audit all registered mental health establishments to ensure they meet standards set by the government. 

It wasn't until the Delhi High Court issued a directive to the Delhi government that permission was given, in September 2023, to establish an SMHA. As of August 2024, there was still no permanent SMHA in Delhi. 

A 1989 Supreme Court ruling said that the government has a “duty”, under the doctrine of parens patriae (or parents of the nation), to act as a guardian for those who cannot  care for themselves, such as children, elderly people, and people with disabilities. The State assumes this authority to act in the best interests of these groups. 

In the case of the Asha Kiran, it is evident that the State failed its duty to care for and protect the mentally challenged, destitute and orphaned people living there. 

The Mental Healthcare Act stipulates that everyone with a mental illness has the right to live with dignity, and the state is obligated to ensure their protection from any cruel, inhuman, or degrading treatment within any mental health establishment, including those run by the state.

(Krishna Sharma is a practising advocate based in Delhi and legal consultant for International Bridges to Justice (IBJ) India while Kavita Sharma is an assistant professor at Symbiosis Law School, Nagpur.)

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