Volume 11 Issues 2 February, 2021
By virtue of being a resident at one of India’s premier mental health institutes, NIMHANS, I had good exposure to psychiatry, diagnoses and management of psychiatric illnesses. Case discussions, seminars and solving complicated cases was a challenging journey. At the end of residency, I was very eager to start my practice and test my knowledge in the field. That’s when… the roller coaster ride started. Outside NIMHANS the general perception of a psychiatrist is equivalent to that of a counsellor. The knowledge about psychiatry and mental health is extremely poor among the general public. Our own medical fraternity would ask me if I could mind read them. I was called to counsel patients who would cry. Terms like CBT, REBT, Psychotherapy were Greek and Latin to my fellow professionals. Counselling was the general term. Any person who needs psychiatry help would be asked to consult me not for treatment but for
counselling!!!! If only psychiatric illnesses could be cured by 10 minutes of talking.
As a part of DMHP (District Mental Health Program), I was supposed to teach, rather create awareness among all cadres of health staff including health assistants, staff nurse, pharmacists and doctors. However, during the initial days almost everyone resisted training. They even told us that they were overburdened and wouldn’t be treating mentally ill patients. The whole team was ridiculed and mortified. I once heard someone calling me “mental madam”. Ever since that, I usually start the training sessions by educating them to respect each and every person they meet and especially people with mental illness, to not ridicule or humiliate them. There is now a gradual change in the thought process however it’s a work in progress.
In the rural areas where the presumption about paranormal activities and superstition is very high, the concept of treating them with medication is a trying task. We have been successful in few situations. For instance, there was this patient in the village of Sakaleshpur. It is a remote village in western ghats with no access to psychiatric hospital. She was diagnosed to have Paranoid Schizophrenia 15 years back. However, due to poor treatment adherence she continued to be symptomatic. After an awareness programme, one of the ASHA workers informed us about this patient. With help of this worker, we were able to visit the family and motivate them to stick to treatment. The medical officer in charge was also eager to learn and help. After training, the Medical officer was confident of the usage of parental antipsychotics.
The patient started showing improvement after 3-4 months of regular treatment. Every fifteen days a health staff from PHC would visit the house and finally after 4 months the patient agreed to visit PHC for regular medication. Currently, the patient still has cognitive deficits however her self-care and social functioning has drastically improved.
Improvement in the health and behavior of this patient motivated several others in that locality to seek treatment. With constant effort of the team in the last 3-4 years the number of people visiting psychiatry OPD at Taluk Hospitals have increased exponentially. We are trying to train each and every person in health department to recognize mental health issues and to motivate the family to seek help. Every ASHA worker has been educated on the signs and symptoms of mental illness. They refer to me as MANASIKA DOCTOR and discuss about cases they see in the periphery. They call us for home visits when some families do not listen to them. Our team is just a phone call away from each and every health worker in our district. There still is a long way to go, to when a person with mental illness can walk into the OPD without any hesitation. The stigma around mental health has definitely reduced but it is a work in progress.
