Psychiatry in Mumbai: What can be done to Expand Services?

Introduction

It is a great pleasure to serve the Bombay Psychiatric Society again, this time as President. I have been Secretary for three consecutive years under the presidentship of Dr. D. M. Bassa, Dr. (Miss) M.B. Gamat and Dr. L. P. Shah – all stalwarts of our Society. I have learnt from them and would like to carry on the work inspired by them.

Spreading Awareness

Ignorance about mental illness and consequent stigma is prevalent and my efforts will be in the direction of eradicating them as much as we can. I firmly believe in taking up every opportunity to educate common people about psychiatric disorders and their management. Talking to patients, relatives, friends, nurses, social workers, occupational therapists – in fact, any person working for the welfare of mentally ill – should be encouraged. They should also be provided due education to increase mental health awareness.

It is not difficult to spread awareness in people who come for help to us with their problems. Psycho-education of patients and their family members is mandatory and goes a long way in helping patients in their recovery, and also in maintaining their improvement later. In addition, we all have to identify groups such as general medical practitioners, local medical and paramedical associations who conduct seminars, lectures, refresher courses and conferences. We should be a part of these programmes and participate in lectures and seminars arranged by them. Pharmaceutical companies are often keen to arrange lectures and group meetings with local medical practitioners and we should not hesitate to take their support.

Public media such as newspapers and television often invite us to write articles, provide opinions or make presentations, and we should be enthusiastic to contribute. Rotary, Lions and Giants Clubs, even schools and colleges, invite us for guest lectures and our members should take such opportunities to spread mental health awareness.

Scaling up Services

We need more centres for treatment of psychiatric disorders. Government, Municipality, Charitable institutions etc., should be contacted to create facilities for establishing mental health treatment centres for children, adolescents, people with addictions and marital problems.

Primary health centres, community health centres, diagnostic centres and tertiary health centres already exist all over the city and its suburbs. Our efforts should to be to visit such centres in the area where we practice at least once a week and help create facilities for psychiatric consultations. Wherever there is an opportunity to involve psychologists and social workers, we should form a team with them to provide better services. It is also important to start indoor treatment facility, wherever possible.

Liaison with other Mental Health Workers and Medical Branches

We need to work as a team with psychologists, psychiatric social workers and occupational therapists, for they form an indispensable part of the mental health team. Liaison with other branches of medicine and surgery is important so that we work with them in a complementary manner for holistic patient management. Special attention is needed for training of medical students, nurses, occupational therapists, physiotherapists and social workers to develop appropriate skills in the ancillary management of psychiatric patients.

We are aware that our colleagues in other medical and surgical branches are often lacking in the knowledge and training for treatment of psychiatric patients. Patients go to them because of their reputation and often these consultants admit them under their care and try to treat them. Liaison with these consultants is essential to convince them and help patients get the right treatment. We also need to improve our relationship and alliance with paramedical groups such as occupational therapists, physiotherapists and special educators for children with learning disabilities.

Rehabilitation Centres

We need to create rehabilitation centres for patients who cannot go back to normal life easily. There is also a need for developing separate facilities for geriatric mental health problems. Families who look after dementia patients need support, guidance and help. They are apparently struggling to manage such patients with constraints of man-power and resources. As a result, these patients are neglected. There was a time in their lives when these patients were useful citizens, but they become a liability for the family and society due to their sickness. There is an urgent need to create adequate facilities for them.

Programmes aimed at empowering people with mental disabilities or residual abilities after illness can bring them back to normal life. Centres for patients with addictions require facilities for detoxification and deaddiction. Such centres are very few in number, and we need many more.

Concluding Remarks [See also Figure 1: Flowchart of the Paper]

There are many things that we can envisage and observe the lack of, but often feel helpless about. But as a group, we can unite to solve problems and make progress at every level. Psychiatry is a developing medical branch and let us turn that to our advantage. This is the opportune time to upgrade facilities and show the way for the future generations of psychiatrists.

All this is possible when we work in tandem to achieve these goals. I am confident that all of you will support me wholeheartedly. I pray to God that He may help me in this endeavour.

Take Home Message

Together we can work miracles in the field of mental health by harnessing our inner strengths and acting on our motivations. Let us join hands and make it a success.

Questions that this Paper Raises

1. How much of psychiatric services should be considered adequate to provide substantial results in psychiatric care?

2. Is it possible to create downtown or outskirt facilities by cost cutting on infrastructure and transporting patients and staff?

3. How does one appeal to and convince the government and private organisations to pay more attention to the mental health of the population, and to take preventive measures?

About the Author

K. P. Dave MD has been Honorary Professor and Head, Department of Psychiatry, L. M. Medical College, Mumbai. He was Honorary Professor and Head, Department of Psychiatry, K. J. Somaiya Medical College and Hospital, Mumbai. Currently he is Honorary Psychiatrist, Hindu Sabha Hospital, Mumbai and Panel Psychiatrist, Bhabha Atomic Research Centre, Mumbai. He also continues to remain in private practice.