A narrow alleyway lined with motorcycles next to the Civil Secretariat on Lower Mall leads to the blue gate which serves as the entrance to Fountain House – one of Lahore’s oldest mental health institutes.

The building, which used to be a shelter for Hindu widows in pre-Partition times, was handed over to the Lahore Mental Health Association (LMHA) in 1971 in order to establish a rehabilitation centre for the mentally ill. It was named Fountain House.

For over four decades, the institute has opened its doors to hundreds of people alienated, and at times, even shunned by society because of their mental disabilities. Yet it is not only their philosophy of treating patients – the Clubhouse model – that makes this institute unique[S1] , rather it is their belief that any person abandoned by their families will not be turned away.

Mental health experts share that it is a common misconception that people with mental health problems can never settle down and lead fulfilling lives.

Mental health patients abandoned by families find home at Fountain House

Muhammad Aslam, a clinical psychologist at Fountain House and a cognitive behavioural therapy expert, says, “Once we are fully assured that members (the institute refers to its patients as members) have gained enough stability, we ask their families to take them back. But social stigmas attached with mental health and negligence on the part of family in taking care of patient’s diet and medications, cause frequent relapses and hinder recovery.”

Shahid Waqas, who has been working as an accountant at Fountain House for the last four years, shares how the fear of not being able to hold a job after being diagnosed with a mental illness led him down a spiral which was hard to recover from.

His family had moved from Qatar in 1975 while he was still in his teens. Waqas shares that his father had wanted his children to get a good education here so he enrolled him at the Forman Christian College. “But I was miserable,” he recalls. Moving to Pakistan had meant a sharp decline in material comforts and Waqas soon realised that he was a ‘misfit’ here.

“I still managed to graduate as a mechanical engineer from UET,” he says. “But I could not get a job.”

It was the period of joblessness after graduation that left Waqas fearful of never being financially independent, he recalls. “It consumed me...and it only got worse after my family faced financial crisis and my sister got a divorce.”

Waqas was first diagnosed with Affective Mood Disorder in 1994. Despite several years of treatment, he found himself unable to cleave himself from the roller coaster that his manic depressive phases had turned into, he says.

He was brought to Fountain House in 2012 and declared somewhat stable after a year. That is when he got the job as an accountant.

He says, “After developing bipolar disorder, I was not able to hold any job and was repeatedly fired from whichever company I joined. Nobody ever realised that it was not my incompetence or laziness but a strain of mental illnesses that I was carrying with me which had limited my functional capabilities.”

Occupation has a deep impact on the rehabilitation of a mentally-ill person, experts explain. At Fountain House, the administrative staff includes 25 to 30 members (patients) who are either currently under treatment or have fully recovered. Some of them provide voluntary services whereas others are paid.

“Considering all the jobs I lost during my mental illness, I used to think that if the mind became unstable once, it would never become stable again... Once I had fallen into the pit of darkness and negative thinking, I could never do anything productive... but I have a job and I’m making a living through it,” Waqas says.

Usman Rasheed Chaudhry, the honorary director of rehabilitation at the Fountain House, feels it is unfortunate that people with a history of psychological illnesses are less likely to be hired for conventional jobs, even if they have completely recovered. He argues that it is the government’s responsibility to implement special quotas for the mentally-ill. The Fountain House has led by example in showing that people with mental ailments can perform any task they have a penchant for.

“Medication alone is not enough for a complete recovery. Task management, time management, and emotional management training are also very significant in rehabilitating a person,” says Aslam, a clinical psychologist. “The responsibilities we allocate to the members do not end when they get better, instead, we start paying them for their services which motivates them further to work more efficiently. And when these members return to society, they perform so well that no one can even perceive them ever having a history of mental illnesses.”

A regular day at the Fountain House begins with morning prayers. The members have breakfast before gathering for daily assembly. They then return to their respective blocks where they undergo various therapies including group therapy, religious therapy, music therapy, art therapy and various other activities.

Irshad Anis, the unit assistant at the institute’s Dr NN Wig Unit, explains that every therapy has its own positive effects on the mental health of the members. Group therapy helps members develop a sense of belonging, whereas religious and music therapies help them gain peace of mind, hope, and optimism. The ultimate aim of these therapies is to engage members in productive activities leaving them less time to focus on the mental baggage they carry from being alienated from their families and looked down upon by society, he says.

Anis, too, was once a member at the institute. He shares that he was 18 when his parents had started developing differences and that had left him very disturbed.

As a child, Anis says, he had always wanted to follow in his father’s footsteps and become an engineer. His mental health started deteriorating when the dispute between his parents reached a point where they got separated. He shares that this had badly affected his studies and his dream to become an engineer never materialised.

He was diagnosed with Bipolar Affective Disorder in co-morbidity with other psychological disorders. Despite the mental health issues, Anis continued his studies and completed his masters in technical education from the Punjab University.

He was brought to Fountain House some 13 years ago and according to his doctors, there has been no noticeable relapse for eight years. As for Ahmad, he says, “People abroad call us God-gifted, but here in Pakistan, we are bullied, hurt and marginalised by society. Our social values have deteriorated to a lamentable level where parents end up destroying their children’s lives because of their personal conflicts; unnecessary limitations or either through strict monitoring or setting them completely free...on the other hand, children cause their parents mental torture as there is little mutual understanding between them. Our society needs to learn compassion.”

Mental health problems tend to produce similar ruptures in routine life as physical illnesses and they can be treated, doctors at the institute explain. But imagine being fired from a job, having to drop out of school and being singled out because of a mental illness. “The role of the family is fundamentally important in this scenario, as it should work in coordination with the psychologist to help the person regain confidence and return to society,” Chaudhry says.

The occupational therapy unit at the institute was built with the intention of providing members a chance to develop occupational skills. The unit is fitted with various materials for arts and crafts and other products and unit assistants remain at hand to guide the members according to their interests. The articles produced at the unit are put on exhibition and sold to raise funds for the institute.

Computer lab assistant Umaid Muslim says, “I have been working here for many years, sometimes members are illiterate but I have seen them learn computer skills very quickly despite mental ailments and limited educational background...no one can say that providing digital facilities to the mentally ill is futile. It is a demonstration of the fact that these people can recover their learning abilities very quickly if treated with care under the right conditions.”

Zahid Ali Khan has been working as a mess in charge at Fountain House for several years. He was brought here as a schizophrenic 19 years ago after he had lost half of his family in a tragic incident which he had been unable to cope with. After suffering from hallucinations and delusions he was eventually diagnosed with schizophrenia.

There are a handful of public mental health institutes for Punjab’s cities and a large segment of the population lacks access to these facilities. “There is an overall deterioration of the standards of treatment for physical ailments at public sector institutes, how can one expect the government to prioritise mental health, an issue that comes with stinging stigma. Furthermore, policies made for mental health are yet to be brought into practice,” Aslam states.

One of the ways institutes like Fountain House continue to function are through raising funds and donations.

Dr Shahid A Zia, chairman of Corporate Communications at Fountain House, says, “The purpose of life is not to be happy. It is to be useful, to be honourable, compassionate, and to make a difference and knowing that you have lived and lived well. This place connects patients to educational employment and transitional employment placements. The community functions with the input and talents of its own members and staff, but we do need help from every person who feels for this special community.”

*The names of former mental health patients have been changed to protect identity.

Published in Dawn, September 13th, 2017