Grey and forgotten

By: Anitha MoosathShruti (name changed) remembers the day her world changed forever. “My father assaulted my mother, and she sustained serious head injuries. We rushed her to the hospital, but she did not survive. By the time we returned home, he had died by suicide.”Joseph (name changed) recounts a similar experience. “I woke up in the middle of the night hearing someone scream. My father was trying to strangle my brother. When I stepped in, he said he had already killed my bedridden mother.”Many such incidents have quietly unfolded inside homes across Kerala in recent years, leaving families to grapple with trauma, shame and unanswered questions. These cases mirror global patterns in homicides and homicide-suicides: Perpetrators are often men aged 65 and above, the victims are intimate partners or close family members, and the incidents often occur within domestic spaces.“None of them are habitual criminals. They are individuals caught in acute distress, acting on impulse. Long-standing marital conflict, declining mental health, and caregiver stress among those tending to bedridden or chronically ill spouses are often key triggers. Financial strain compounds the problem,” says Dr Dinesh R S, psychiatrist at the Mental Health Centre, Thiruvananthapuram, who has conducted psychological autopsies in several such cases.He was part of a three-member psychiatric team that recently studied elder homicides and homicide-suicides in the state. Their findings are yet to be published.There is a paucity of data on such cases, but the involvement of the elderly in the ‘impulsive murder’ category is on the rise. This is a disturbing trend in the context of Kerala’s ongoing demographic transition. The state has been ageing faster than the rest of the country, and its population aged 60 and above is projected to increase from 18.7% in 2026 to 22.8% by 2036, according to RBI’s “State Finances: A Study of Budgets of 2025-26.”“Affordable and accessible mental health services remain scarce in India, and free support systems are not easy to find. However, not every mental health issue requires a psychiatrist. Many psychosocial stressors can be addressed by psychologists, counsellors or social workers,” says Dr Shabbir Amanullah, immediate past president of the Canadian Academy of Geriatric Psychiatry.Countries like Canada have designated psychiatry services and community-based programmes for older adults. Such structured care pathways are largely absent in India, he adds.Allocation for mental healthcare remains low, and the doctor–patient ratio is inadequate. Dedicated geriatric mental health services are confined to a few private institutions and are often unaffordable. Given this, it is not surprising that many perpetrators as well as victims had untreated depression. Some individuals were also found to have neurodegenerative conditions and psychotic disorders that weakened their ability to control aggression.In one case, an 84-year-old man killed his wife in a delirious state, believing that someone was trying to strangle her. He was later diagnosed with frontotemporal dementia, a condition that affects impulse control.According to Dr Sen Kallumpuram, consultant psychiatrist with the NHS in London, patterns seen in the UK and the US are likely to unfold in Kerala as well. In these countries, services expanded gradually as ageing populations created sustained demand and drove policy reforms.Survivors are often the ‘secondary victims’, but their needs frequently go unaddressed. Having lost one parent— and sometimes having witnessed the incident—many withdraw into themselves, weighed down by shame.Shruti and Joseph were among the few willing to speak. Six years on, Shruti continues to struggle with suicidal thoughts and social isolation. “My son, who was only five then, has withdrawn from his peers and is still under psychiatric care,” she says.Joseph, too, continues to experience psychological distress. “I still wake up in the middle of the night, shaken. I feel helpless — nobody seems to understand my emotions,” he says.The lived realities of survivors and elderly couples point to a broader concern within Kerala society—the persistent stigma surrounding mental health.“Irrespective of age, anyone who speaks about anxiety or depression is immediately judged. We do not yet have the level of acceptance seen in many Western societies because there is no open discourse around mental health,” says Dr Shabbir.For survivors, the sense of isolation often deepens once the initial support from relatives and neighbours fades. Although a few helplines and counselling centres exist, they are insufficient to meet long-term needs.Given Kerala’s strong local governance system, says Dr Dinesh, there is considerable scope for community-level interventions in risk assessment, awareness generation, and sustained psychosocial support. He also calls for dedicated trauma and grief counselling services, as well as psychological firstaid training for non-professionals.As with suicides, there is no single cause behind homicides or homicide-suicides, and hence no single solution. Only a multi-pronged strategy will work if such silent tragedies unfolding within homes are to be prevented.(The writer is an independent journalist)