Roadmap to Indian Psychiatry

Byline: E. Mohandas Introduction We are responsible for what we are, and whatever we wish ourselves to be, we have the power to make ourselves. If what we are now has been the result of our own past actions, it certainly follows that whatever we wish to be in future can be produced by our present actions; so we have to know how to act . - Swami Vivekananda With all its alluring contrasts and remarkable features, India has a grand heritage of 34,000 years. Down the traditional lane, it has evolved into a pluralistic, multilingual, and multiethnic society. It is quite striking that while India is the second-most populous country, it has the largest democracy in the world. The second fastest growing economy and the third largest military force are also her golden quills. Seventy-four per cent of the 1.14 billion population of India live in rural areas. India has 28 states, seven union territories, 612 districts, and 6, 38,365 villages. The fact that there are 22 official languages in a single country is ample evidence for the heterogeneous nature of the society it represents. Having a literacy rate of about 64.8%, India has 80 million internet users. With all this, I do not mean to say that India is not without its lacunae. Even while India is the world's twelfth largest economy, we cannot close our eyes to the grim truth that 22% of the population exists below the poverty line.sup 1,2,3 With regard to the academic scene, India is proud to have 289 institutions providing undergraduate medical training (196 MCI recognized, 77 MCI permitted, and 16 in the danger zone). The postgraduate training in psychiatry includes Doctor of Medicine (MD) (83 centers, 159 seats), Diploma in Psychological Medicine (DPM) (46 centers, 107 seats), and Diplomate of National Board (22 centers, 36 seats). Strikingly, 25% of the medical colleges in India do not have a Psychiatry Department.sup 4,5,6 Apparently, there are only around 4000 psychiatrists in India to serve the five crore mentally ill population currently. Mental Health Scenario in India Obviously, in a vast country like India, the threat posed by the psychiatric and behavioral disorders is just inexplicable. A meta-analysis of 13 epidemiological studies consisting of 33,572 persons reported a total morbidity of 58.2 per 1000. Another meta-analysis of 15 epidemiological studies reported a total morbidity of 73 per 1000.The saddest aspect is that the bulk of the affected falls in the 15 to 45 year age group. The existing facilities in the country fall short of the required norms, which makes the situation still worse. The number of psychiatric beds in the country is only about 0.2 per 1, 00,000 population and there are only two psychiatrists per 10 lakh population. The major share of psychiatric facilities lies with the government sector (especially mental hospitals), which is centered on certain areas of particular states. The psychiatric services have not yet been integrated into the primary health care system and this leaves large populations in dire need of such facilities, with no hope of effective treatment. Therefore, they seek help from the private sector and there are no clear policies regarding treatment of the mentally ill in the private sector. A significant population in India cannot afford private hospital care and the insurance system in the country is in its infancy. The rehabilitation of psychiatric patients is also given little importance in the existing mental health framework. The integration of psychiatric services to primary care needs a public-private partnership to enable comprehensive mental health care.sup 7,8,9,10 Indian Psychiatric Society Evolution Our society sprouted from the Indian Association for mental hygiene founded in 1929 by Berkeley Hill. In 1935, the Indian division of the Royal Medico-Psychological Association (RM-PA) was formed, due to the efforts of Dr. …