Challenges in Undergraduate Psychiatric Training in India

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Despite a clear evidence of enormous burden of mental health problems in India, there is a gross deficit in the mental health care services in the country. The existing medical curriculum does not provide sufficient opportunity to bridge this gap. Keeping in view the conclusions of a recent review, the prevalence of serious mental disorders in the country is around 6.5 %; meaning thereby that there are about 70 million people suffering from serious mental disorders. But we have only about one psychiatrist to take care of one lakh people in the country. The deficit in mental health services varies from 50 to 90 % from state to state. The deficit is more prominent in rural areas, which support about 80 % of the population. At the current pace of postgraduate training in psychiatry, it will take more than 50 years to overcome the deficit. However, the deficit can be effectively managed if psychiatric teaching is strengthened at the undergraduate level. With more than 30,000 MBBS students passing out every year from the country, focus on psychiatry at undergraduate level seems to be a viable solution to bridge the gap between the burden of mental health problems and deficit in services. Undergraduate training in psychiatry is still a part of medicine and the number of training hours allotted for psychiatry by Medical Council of India are far from adequate. At present, no separate examination in psychiatry is required to get a MBBS degree. The authors who have been supervising undergraduate training in psychiatry in their college for more than 20 years feel that with such policies, it is possible for a medical student to get through the examination without knowing anything about psychiatry. This underexposure to the subject acts as a road block for the students to understand and appreciate importance of psychiatry, and they may not prefer psychiatry for their career at the postgraduate level. Thus, the undergraduate training in psychiatry needs to undergo drastic changes in the curriculum, which is not easy as MBBS curriculum is already known to be one of the most overburdened ones, due to the ever-expanding demands of each medical specialty. This pressure should, however, in no way hamper training and neglect important disciplines such as psychiatry. The medical curriculum may be modified by integrating the mental health issues with every existing subject in the present curriculum, in addition to increases in theory hours and the training period. A separate examination in psychiatry in the final year is a must as this would ensure that an undergraduate student gets through with sufficient knowledge and skill to deal with mental health issues.