While several medical specialities have made spectacular advances in various areas within their domain, humanism has often got neglected and forgotten. We all recognize that mental health is essential to overall health and the well-being of individuals and societies.
Mental health affects the individual's ability to function, to be productive, to establish and maintain positive relationships, and to experience a state of well-being. Such estimates have drawn attention to the importance of mental disorders for public health. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions.
Because these interactions are protean, there can be no health without mental health. Mental disorders increase the risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis.
Factors related to mental illness can interfere with the treatment of other illnesses and frequently co-occur with CVS, diabetes, cancer, and other non-communicable diseases Eliot and Sacher, Health systems across the world remain significantly fragmented, affecting access, quality, and costs of the care delivered.
Strengthening health systems is a global health challenge for all countries: low, middle, and high income. According to the World Health Organization, the key components of a well-functioning health system, namely, leadership and governance, health information systems, health financing, human resources for health, essential medical products and technologies, and services delivery are sine qua non for health system's functioning and strengthening.
The development of mental health care all over the world is best described as a developing process. This change is based both on respect for the human rights of individuals with mental disorders and on the use of updated interventions and techniques. The care of people with mental and behavioural disorders has always reflected prevailing social values related to the social perception of mental illness.
At the time of Indian Independence, the Bhore Committee, ,[ 5 ] emphasized the need for training in the social aspects of medicine to boost India's meager mental health resources 19 hospitals with 10, beds and a few general hospital psychiatric units.
It also recommended setting up of psychiatry departments in every general hospital to review and enhance the existing curriculum and training in Psychiatry for medical undergraduates. It is now realized that training of Psychiatry to undergraduate medical students is very vital. Knowledge of Psychiatry, Mental health, and Behavioral Sciences equips the students to deal with various difficult and complex situations during medical practice. This will in turn help them to develop proper communication skills and to empathize with their patients and their suffering.
It instils humanistic values in them, further empowering them to establish and maintain fruitful professional relationships with their patients. Since mental health services were grossly inadequate at the time of Indian independence, the initial period of — focussed on doubling of the psychiatric beds,[ 7 , 8 ] along with development of training centers to train psychiatrists, clinical psychologists, psychiatric social workers, and psychiatric nurses.
This was followed by the establishment of general hospital psychiatric units at several centers in the s and s. In nearly one-and-a-half decades after independence, mental hospital beds were doubled to 20, in India. In the s, such units were established in Chandigarh, Delhi, Madurai, and Lucknow. The twin challenges of the s and s were of moving mental health care beyond the isolated mental hospitals and bringing mental health care to the general medical care settings liaison psychiatry.
These in turn led to the development of GHPUs which have contributed immensely to the development of liaison psychiatry[ 11 — 15 ] and to training of psychiatrists and research. General Hospital Psychiatry GHP has been one of the biggest silent revolutions in mental health delivery and psychiatric education in India. Several new medical colleges were started, which also had psychiatric units, which were part of teaching requirements.
Also, during the last one or two decades, psychiatric units in most major hospitals have become a reality. This shifting of the place of care to the general hospital setting has contributed significantly to the process of destigmatization of psychiatric illnesses and psychiatric care. Several epidemiological studies have demonstrated the existence of a wide variety of mental disorders in the community in India. It showed that the prevalence rates of depression were higher than those of psychoses, but the rates treated were far lower, which pointed to the limited awareness about depression in the community.
The WHO Atlas[ 18 ] and a recent state-wise analysis of psychiatrists[ 19 ] highlights the low numbers of mental health professionals in India. The number of psychiatrists is far too inadequate in India. Besides, most of the psychiatrists are concentrated in urban areas.
The number of psychologists, social workers, and psychiatric nurses is also quite inadequate. There is widespread stigma about mental illness and psychiatric services in India.
Films, newspaper reports, and magazines often depict mental illness as chronic, incurable, and as a subject matter of ridicule. Mental hospitals formed the mainstay of treatment until few years ago and this has led to strong negative attitudes among the lay public, increasing the stigma.
National Human Rights Commission in India had undertaken reviews of the functioning of the mental hospitals in and [ 20 , 21 ] and had highlighted several inadequacies. It is well known that we have poor mental health infrastructure in India.
Besides, even the existing facilities are not adequately utilized. Many do not seek modern psychiatric care. Even those who avail these services often come late for treatment. Many patients have to commute long distances to come to the nearest psychiatric facility.
They often need someone to accompany them. Even then, drugs may not be available in the government-run hospital. Lack of rehabilitation centers and difficulties to avail welfare benefits are the other problems. Community involvement in mental health care can be an answer to this problem. Literacy also plays an important role in utilization of psychiatric services as evidenced in states like Kerala.
With a very high literacy level, there is much wider acceptability and utilization of psychiatric services here. A large majority of them avail treatment from primary health centers, especially for financial reasons. If the medical officers in these primary care facilities have adequate knowledge in Psychiatry, it will be a great gain for mental health. Imparting this knowledge to primary health centre doctors is best achieved through adequate training in Psychiatry during their MBBS course.
Primary care facilities are well organized in India. Delivering mental health care through primary care will be cost-effective, possible, and practical. The number of psychiatrists in India is only about for 1. This is grossly inadequate. The number of psychiatrists should be tripled if we have to achieve a minimum ratio of 1 psychiatrist for , people.
Even this is not conceivable now. Only medical graduates, having at least basic training in Psychiatry, can fill up this huge vacuum. There is poor understanding of the psychological distress as requiring medical intervention in the general population. Poor literacy is one factor which leads to lack of awareness regarding mental disorders. Stigma is another important barrier to mental health care. It has been observed that there are large treatment gaps and treatment delays in India.
Studies have shown that about half of the patients of schizophrenia are living in the community without treatment. Community involvement is crucial to mental health. Although it is not advisable to mix up various systems of medicine in India, opening up of a dialogue and exploring collaboration may be very helpful.
In delivering mental health care, community psychiatry is a suitable model not only in rich countries but also in low- and middle-income LAMI countries. Setting up of special institutions for the care of the persons with mental disorders asylums , the humane treatment of the ill persons, deinstitutionalization, and recognition of the rights of the ill persons with mental disorders[ 4 ] are some of the phases through which Community Psychiatry has developed in the world. Community Psychiatry in India is nearly six decades old.
During the first 2 years, there are about 60 h of teaching in various psychosocial areas. In the third year, 30 h are devoted to practical teaching of Psychiatry. In the fourth year, there is a full-time posting of 8 weeks of Psychiatry clerkship compared to 8 weeks each allotted for Obstetrics and Pediatrics and 12 weeks for both Medicine and Surgery. In Denmark, the teaching of mental disorders started in and was well established in During the fifties, it acquired the status of a major clinical subject, rising to third place after Surgery and Medicine and ahead of Pediatrics and Obstetrics and Gynecology.
It is a major clinical discipline with a qualifying examination at the end of the course. In Britain, Psychiatry established its place in medical education in the forties. However, it went through major changes in the seventies following the General Medical Council's recommendations in regarding medical education, which re-emphasized the importance of Behavioral Sciences and Psychiatry in medical teaching and practice.
Currently, 80 h are devoted to the behavioral science course during basic medical science teaching. During the clinical course, students first learn interview skills and psychiatry history taking once a day during the 36 weeks and then attend a full-time Psychiatry clerkship for 3 months.
This is usually followed by a university examination as in other subjects. In South Asia, both Sri Lanka and Nepal give prominence to Psychiatry and medical students need to pass examination in Psychiatry to qualify for medical degree. There are three reasons for this agreement. First, the general approach of Psychiatry which stresses the unity of body and mind is important in the whole of medical practice. Secondly, skills that are learned in Psychiatry are important for all doctors: for example, the ability to form a good relationship with a patient, to assess the mental state, and to convey distressing information.
Thirdly, psychiatric problems are common among patients seen by doctors working in all branches of medicine. Psychiatric disorders are even more frequent among patients attending general practice.
Therefore, all future doctors must know about these psychiatric problems, not only because they are common but also because their management involves much medical time and resources and gives rise to many serious incidents. In many countries, doctors who have chosen a career in primary care general practice receive a further period of training after graduation; and in most of these countries, this training extends their psychiatric skills.
On the other hand, the good news is that awareness is growing, and there are strong pushes to get a better balance with our mental health in our lives, and receive the treatment we need to live a well-rounded life.
So when it comes to mental health treatment, what makes psychiatry so important? The ability to have access to proper mental health care is increasingly critical, and has been highlighted by the growing number of children, adolescents, adults and seniors who are struggling with particular behavioral health issues or mental health conditions in this country.
We are seeing an increasing number of addictions on the rise, such as opiate use, alcohol and other drug abuse. Depression rates have continued increasing as well, and there is a serious issue within our military, as the suicide rate has skyrocketed. Part of the solution is to help fight against stigmas associated with having mental health conditions, and making sure that men and women are able to get the help that they need to treat their conditions.
Psychiatry is beneficial in this way, by:. Psychiatry helps give an individual the power to make major changes in their life, and to help target the exact issues relating to their mental or behavioral health challenges. The guidance and support an individual receives is usually a key aspect of being able to diagnose, address and help put specific plans into motion in order to heal and alleviate symptoms. At other times, it can stem from more psychological issues, or potentially even biological challenges.
Sometimes it is difficult to identify until one is able to be examined in detail by a mental health professional, psychiatrist or doctor. Johnson says. A person with depression is no longer missing days at work and received a promotion. A person with mania returned to college. A person with an addiction stays sober. A person with psychosis gets their own apartment. Johnson shares. Outcomes in psychiatry may not be as black-and-white as in other specialties.
But in psychiatry, success reveals itself in a range of immeasurable results. Metzger states. It is a gift to see them get their joy back. Beyond the satisfaction of helping patients overcome their own personal challenges, psychiatry also offers many specialties for doctors to pursue throughout a career. Like other medical doctors, psychiatrists must attend medical school to obtain their medical degree. They must also complete a four-year psychiatric residency in addition to more training in their area of specialty.
Finally, they must become licensed and board-certified in their state. Johnson adds. Psychiatrists may work in a hospital with inpatients or doing consultations. They may work in psychiatric hospitals, jails or prisons, substance use programs, and outpatient facilities such as a private practice.
They may also find a career in psychiatric research. Metzger explains. They can work with psychologists, nurses, and licensed social workers. Metzger explains you may see partnerships where the psychiatrist provides the medications for the patient and the psychologist does the therapy.
Alarmingly, the US is facing a psychiatrist shortage in the coming years.
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