The chains have gone, but the problem persists

'No one is allowed to be chained’. This is the notice that greets visitors to the famous Baba Saeed Ibrahim Dargah in Erwadi, at the entrance and across the sprawling complex.

For devotees seeking solace, the warning can seem bizarre. In Erwadi, however, it holds specific meaning. On 6 August 2001, the inmates of a mental asylum near the shrine were, as usual, chained to their beds (ostensibly to prevent escape or self-harm). When flames engulfed the thatched building, all 28 died.

The tragedy turned Erwadi into a national symbol of the neglect, exploitation and indignity suffered by people with mental illness. It exposed the existence of unregulated private asylums where desperate families deposited their mentally ill relatives. It also exposed the failure of a formal healthcare system that had not reached rural India.

It was all the more disturbing because the practice of chaining mentally ill people was not unknown. The National Human Rights Commission (NHRC) had asked authorities to intervene, with reminders sent in May and July 2001. Nothing was done.

After the tragedy, the NHRC issued sterner directives to states and Union Territories. Its website notes: ‘The District Collectors … have also been directed to ensure that whenever mentally ill patients were found in chains, they should be unchained and suitable arrangements made for their welfare.’

But the malpractice continues. In October 2025, in response to a PIL referring to inmates found chained in a mental asylum in Budaun, Uttar Pradesh, the Supreme Court directed the NHRC to strongly monitor the implementation of the Mental Healthcare Act 2017, with specific reference to chaining mental patients, in blatant violation of rights under Article 21.

Enforcement is only one part of the response. Changing attitudes the other, more difficult one. And there Erwadi offers instruction.

After the tragedy, the then Ramanathapuram district collector S. Vijayakumar invited C. Ramasubramanian, founder of the Madurai-based M.S. Chellamuthu Trust and Research Foundation, to work with the dargah administration and local community. “We convinced dargah authorities that faith and scientific treatment could coexist. This led to the iconic ‘Dawa-Dua’ programme in Erwadi,” says Ramasubramanian.

He and his colleagues understood that a confrontational approach would not work. Faith was deeply embedded in the way families understood mental illness. If their belief was rubbished, they might simply withdraw altogether. ‘Dawa-Dua’ (medicine and prayer) recognised a simple reality: families who trusted the dargah would continue to arrive. Could a psychiatrist be present on the premises? Gradually, that became possible.

Today, a mental health clinic is fully functional within the dargah complex, allowing visitors to seek professional treatment without leaving the environment in which they feel comfortable. Just outside the shrine, a 50-bed facility provides psychiatric and rehabilitation support through collaboration between the dargah committee, the Tamil Nadu government and the Chellamuthu Trust. A psychiatric ward at the Government District Headquarters Hospital in Ramanathapuram provides in-patient care for those requiring more intensive treatment.

What has proved transformational is the unusual understanding between the shrine and mental health professionals: people do not have to abandon their faith in order to seek psychiatric treatment.

A quarter of a century after the Erwadi incident, the annual Chandanakkoodu festival continues to draw large crowds. The 800-year-old shrine continues to attract people from different parts of India and different religious communities. Murasal Ibrahim Alim Vahidi, a trustee, says around 5,000 people visit the dargah every day. Mental illness remains an important part of that pilgrimage.

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For generations, the dargah offered a place where families could take a distressed relative without being judged or asked questions in a vocabulary they did not understand.

Families brought sons, daughters, husbands, wives and elderly relatives troubled by ‘possession’, ‘black magic’ or other ‘inexplicable forces’. Behind their descriptions lay psychiatric conditions including schizophrenia, depression, psychosis and severe anxiety.

“Several private asylums and religious healing homes emerged in the area, mostly operating without government oversight or medical personnel while exploiting the legacy of the dargah. Chaining patients was a common practice to restrain violent behaviour or prevent escape. Patients were often kept in inhumane, overcrowded conditions, and these institutions, unaffiliated with the dargah, charged families exorbitant amounts for their care,” recalls Ramasubramanian.

Janardhan Babu, programme director of the Chellamuthu Foundation, is careful to distinguish the dargah from the private institutions that operated around it.

“It would be untrue to claim the dargah promoted illegal healing centres that practised abusive systems and kept mentally challenged people in chains. The tragic incident revealed similar practices across Tamil Nadu, particularly at Gunaseelam Temple near Trichy and St. Antony’s Catholic Church in Puliyampatti near Jayamkonden. At that time, many people turned to black magic and witchcraft to treat mental disorders. There was also the disturbing tendency of confining mentally challenged relatives in chained facilities, paying a monthly fee to avoid the responsibility of caring for them,” says Babu.

The significance of Erwadi’s experiment is perhaps best understood through those who use it. K. Ayub Khan, a native of Beemapalli near Thiruvananthapuram, says, “I have been here for the last two months, spending time around the dargah to escape my depression. This is my second visit since January last year. I find solace in both the prayers and the medicines available at the ‘Dawa-Dua’ clinic within the compound.”

Henri Tiphagne, a social worker based in Madurai, sees value in precisely this accommodation.

“Instead of eradicating indigenous healing practices, a more collaborative approach has emerged over time, particularly in areas with insufficient mental health professionals,” he says.

The National Mental Health Survey of 2015-16 documented efforts to train faith healers to recognise mental health problems and refer people for professional treatment. The reasoning was practical. India’s mental health crisis cannot be addressed only through hospitals and psychiatrists, particularly when specialist services remain concentrated in cities.

For a poor rural family, a shrine may be more accessible than a district hospital, and a religious healer may be the first person they approach when a relative begins behaving in an unfamiliar or frightening manner. Erwadi’s contribution lies in trying to turn that first contact into a possible route towards professional care.

Yet, reports of mentally ill people being chained at religious sites elsewhere in India is a disturbing reminder that the circumstances that produced the Erwadi tragedy have not disappeared.

In March, the Maharashtra State Human Rights Commission raised concerns over reports of mentally ill people being brought to the Sailani Baba Dargah in Buldhana in search of a divine cure, with some allegedly chained or abandoned.

In July, the Kerala High Court expressed serious concern about conditions at the government mental health centre in Thiruvananthapuram, pointing to staff shortages, poor infrastructure and patients being kept in locked rooms despite available campus space. Clearly, the real lesson of Erwadi goes beyond the abolition of chains.

There are limits to the ‘Dawa-Dua’ experiment. Faith cannot replace psychiatry. Prayer cannot substitute for medication when clinical treatment becomes necessary. Religious institutions cannot be permitted to confine or treat people with mental illness outside legal and medical safeguards.

But the opposite assumption, that modern healthcare can simply erase deeply rooted cultural ideas about illness, is equally unrealistic. Erwadi offers a middle path.

K.A. Shaji has chronicled rural distress, caste and tribal realities, environmental struggles and development fault lines. More by the author here