Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

The rationale and guiding principles to design a psychiatry curriculum for primary care doctors of India

BACKGROUND Integrating psychiatric care into the general practice of primary care doctors (PCDs) is necessary to overcome the shortage of human resources to cater to the burgeoning public mental health needs of India. The traditional psychiatry curriculum is often top–down and specialist-based that contributes little in terms of skill quotient. We designed an innovative, digitally driven, distance education-based, part-time, modular-based Primary Care Psychiatry Programme (PCPP, skill-based). It is being implemented across many states of India to equip PCDs with skills to provide first-line psychiatry treatment. We discuss the rationale and guiding principles behind designing the curriculum of PCPP. DISCUSSION There are nine guiding principles behind designing and implementing PCPP to provide pragmatic, acceptable, feasible modules of higher translational quotient (TQ) that are essential to upskill PCDs. There is a shift in training the location of PCDs in their live brief general consultations utilizing innovative telemedicine-based ‘on-consultation training’ (OCT) augmented with collaborative video consultations. A monolithic treatment protocol-driven, trans-diagnostic approach is used to design a concise, all-inone, point-of-care manual containing a culturally sensitive, rapid, validated screener and taxonomy, called ‘Clinical Schedules for Primary Care Psychiatry’. This incorporates the PCDs’ style of clinical practice that helps in picking up the most commonly prevalent adult psychiatric disorders presenting to primary care. CONCLUSION This PCPP curriculum contains pragmatic modules with higher TQ. This curriculum is dynamic as the learning is bi-directional. This can be used by policy-makers, innovators and academia for integration with national health programmes such as those for non-communicable diseases and reproductive and child health.

Video consultations from an Indian academic hospital: First 3 years of experience from telepsychiatric after-care clinic

BACKGROUND Continuity of care for psychiatric disorders by conventional in-person consultation by psychiatrists is associated with several challenges. There is a need to develop alternative models of specialist care. We studied our 3 years’ experience of live video consultations (VCs) from the tele after-care clinic to patients with psychiatric disorders at an Indian academic hospital. METHODS We did a file review of 669 VCs provided to 213 patients in the first 3 years (2017–2019) from the telemedicine centre of a tertiary care academic hospital. We analysed details of sociodemography, clinical profile, tele after-care consultations and outcome. RESULTS Two hundred and thirteen patients (55% men) were enrolled for the tele after-care clinic. The mean (SD) age of the patients was 42.2 (17.29) years and a majority were educated till high school and beyond. Patients with severe and common mental disorders constituted 60.1% and 40%, respectively. Among the total 669 appointments, 542 (81%) VCs were successfully provided; of the remaining, 125 were cancelled and 2 were aborted due to a medical emergency. Medication prescriptions were unchanged in 499 and modified/totally changed in 47 VCs. CONCLUSION Our large study shows that telepsychiatric after-care is a useful alternative method which can supplement in-person follow-up. Barriers such as distance, cost and medical illness can be overcome using tele after-care clinics for regular follow-ups in stabilized psychiatric patients. There is a need for prospective studies, preferably, randomized controlled trials comparing effectiveness of tele after-care with in-person consultations to assess treatment outcomes.

Ethics education: a priority for general practitioners in occupational medicine.

Cross-system practice is widely prevalent in Indian settings. The recent policy decisions of the Government of India and the legalisation of cross-system practice in various states have brought this issue into the limelight once again. We aim to critically evaluate this issue from the philosophical, academic, and public health perspectives, as well as with reference to training. On the one hand, students of traditional Indian medicine are being introduced to allopathy without philosophical backing, practice based on the aetiological model and training in modern pharmacology. In addition, pharmaceutical industries are wooing AYUSH practitioners and their prescription patterns have already been “allopathised”. As for the allopathic system, it is witnessing enormous scientific advances and growing increasingly complicated. The medicines are risky and also associated with many life-threatening side-effects. Meanwhile, the government is grappling with the humungous problem of ensuring health services for all. The government’s intention is to expand the reach of health services by allowing cross-system practice, but the issue has much wider ramifications. The authors believe that before cross-system practice is allowed, there is a need for a comprehensive and deeper understanding of all the benefits and pitfalls of such as system. A few of these are discussed in this article. Specifically, we delve into the philosophical issues, syllabus and training, advances in medical technology, and larger public health perspectives. We end by suggesting a few steps that may help to improve public health in the country.

Atitudes dos estudantes de enfermagem para os computadores nos cuidados de saúde: uma análise comparativa / Nursing students? attitudes towards computers in health care: a comparative analysis / Actitudes de los estudiantes de enfermería hacia los equipos de atención de la salud: un análisiscomparativo

The present study aimed to determine the effectiveness of basic computer course related to Nursing Students? attitudes towards usage of computers in health care. Cross sectional descriptive design was adopted among purposively selected undergraduates (n=161) to complete self reported questionnaires. Students that completed computer course were found to have positive attitudes as they agreed that ?computers are great solving tools? (÷2 = 9.663, p < .047), and ?computers are natural to use in health care? (÷2 = 11.623, p < .020) than the participants who have not undergone formal instruction in computer course. Contrary to these findings the participants who did not undergo computer training were felt that ?Computers are frustrating to use? (÷2 =9.930, p < .042) and they become restless when they think of using computer? (÷2 = 15.149, p < .004). The findings suggest that integration of informatics throughout curriculum with increasing levels of difficulty is needed...

O presente estudo teve como objetivo determinar a eficácia do curso de informática básica realcionado com as atitudes dos alunos de enfermagem no uso de computadores na área da saúde. Trata-se de um estudo descritivo transversal onde foram selecionados propositadamente graduandos (n = 161) para completar o questionário. Os resultados mostram que alunos que completaram o curso de informática tiveram atitudes positivas e concordaram que ?os computadores são grandes ferramentas de resolução ? ( ÷2 = 9,663 , p < .047 ), e ? os computadores são naturais para uso em cuidados de saúde? ( ÷2 = 11,623 , p < 0,020 ) comparados aos alunos que não tiveram instrução formal em curso de informática. Contrariamente a estes resultados os participantes que não realizaram treinamento em informática afirmaram que os computadores são frustrantes de usar (÷2 = 9,930 , p < 0,042 ) e que tornam-se inquietos ao ter que usar o computador ( ÷2 = 15,149 , p < .004). Pode se concluir que é necessário haver a integração da informática em todo currículo com níveis crescentes de dificuldade...

El presente estudio tuvo como objetivo determinar la efectividad del curso realcionado equipo básico con las actitudes de los estudiantes de enfermería en el uso de computadoras en la asistencia sanitaria. Se trata de un estudio descriptivo de corte transversal que se seleccionaron deliberadamente estudiantes ( n = 161 ) para completar el cuestionario. Los resultados muestran que los estudiantes que completaron el curso de informática tenían actitudes positivas y acordaron que ? las computadoras son una gran herramienta para la resolución ? ( ÷2 = 9,663 , p < 0,047 ), y ? las computadoras son para uso en el cuidado natural de la salud ? ( ÷2 = 11,623 , p < 0,020 ) en comparación con los estudiantes que no han recibido instrucción formal en curso de informática . Contrariamente a estos resultados, los participantes que no se sometieron a la formación informática dijo que las computadoras son frustrantes para usarse ( ÷2 = 9,930 , p < 0,042) ; volverse inquietos al tener que utilizar el ordenador ?( ÷2 = 15,149 , p < 0,004 ) . Por consiguiente, se puede concluir que es necesario que haya integración de las tecnologías de la información a través del currículo con el aumento de los niveles de dificultad...

Psychiatric epidemiology in India.

Epidemiological studies report prevalence rates for psychiatric disorders from 9.5 to 370/1000 populations in India. This review critically evaluates the prevalence rate of mental disorders as reported in Indian epidemiological studies. Extensive search of PubMed, NeuroMed and MEDLARS using search terms "psychiatry" and "epidemiology" was done. Manual search of literature was also done. Retrieved articles were systematically selected using inclusion and exclusion criteria. Only sixteen prevalence studies fulfilled the study criteria. Most of the epidemiological studies done in India neglected anxiety disorders, substance dependence disorders, co-morbidity and dual diagnosis. The use of poor sensitive screening instruments, single informant and systematic underreporting has added to the discrepancy in the prevalence rate. The prevalence of mental disorders reported in epidemiological surveys can be considered lower estimates rather than accurate reflections of the true prevalence in the population. Researchers have focused on broad non-specific, non-modifiable risk factors, such as age, gender and social class. Future research focused on the general population, longitudinal (prospective), multi-centre, co-morbid studies, assessment of disability, functioning, family burden and quality of life studies involving a clinical service providing approach, is required.