Admission and Discharge Procedure The outpatient department (OPD), which is managed by the nursing staff handles the admission procedure of the hospital. While patients are allocated to different units based on their residential addresses, the assessment of the patient at the OPD is conducted by the medical officer who is assigned to that particular area of residence as well. Apart from that, a separate Psychiatry Intensive Care Unit (PICU) will handle the patients who appear to be aggressive and are showing signs of high risk. Despite the requirement of a safe space for a patient to disclose his/her psychiatric problems, it was revealed that the OPD only comprises of 4 examination rooms to assess the patients thereby some of them having to share a space during their initial assessment. It was further observed that the OPD does not possess a doctor specifically assigned to it. Hence, according to the existing process, the medical officers of the wards who are assigned to each residential area manage the patients at the OPD and the patients in the wards at the same time, which in turn significantly extends the waiting period. The outsiders’ unawareness about the complicated admission procedure of the hospital is also noticed to be an issue which often leads to patients’ and their family’s dissatisfaction. Additionally, not having security personnels stationed in front of the OPD 24/7, and PICU not being spacious enough to handle the patients, were also identified to be some of the substantial issues. The discharge of the patients is carried out in the wards, and if a guardian does not visit, the social workers will take him/her home. In the instances where the families refuse to take them back, measures will be taken to bring the patient back to the hospital. A multi-disciplinary team comprised of community psychiatric nurses, psychiatric social workers, and a medical officer will arrange the follow-up of the patients. Out of the concerns raised, it was revealed that with the stigma surrounding the mentally ill, visiting the homes using ambulances makes the family members as well as patients hostile towards the follow-up procedure. Conditions of the Wards While the conditions of most of the wards were satisfactory, some issues were observed with regards to lighting, temperature, ventilation, bedding, storage, seclusion facility, and pest control. The seclusion rooms were not up to standard and consist of many ligature points which the patients could use to harm themselves. While the lighting, temperature, and ventilation was acceptable in some wards, problems were identified in relation to provision of light bulbs, availability of natural light, and functioning of the fans. The Commission also observed that the number of beds for the number of patients in some units was inadequate, thereby necessitating patients to share beds or sleep on the floor. There was no proper storage space to store patients’ personal property in the wards. While most locker systems appeared to be broken, some patients have resorted to storing their belongings inside their pillowcases. Furthermore, it was observed that mosquitoes were a serious issue since mosquito nets cannot be put in place due to suicidal risks of patients. Even though measures such as fogging were carried out in the past, no such actions are being taken 3|Page