Psychiatry in UG curriculum of medicine: Need of the hour

Abstract

Byline: M. Thirunavukarasu Planning for health is a relatively new activity in most developing countries. Planning for mental health is an even more recent activity. In 1975, WHO released its first report on mental-health service planning in developing countries. If you really follow it up, little action has been taken; and if any action has been taken, it has been very patchy. Certain heads of state believe that mental illness is not at all present in their country and it is a problem of the West. Not all politicians and health administrators subscribe to these views, but until recently many of them had rather narrow and negative views about mental-health care. In most people's minds mental illnesses are equated with madness, and the popular belief is that such patients should be locked up in hospitals. Few realize and acknowledge most common mental-health problems are dependence on tobacco and alcohol, depression, anxiety, childhood problems, sexual dysfunction, sleeping and eating disorders rather than psychoses, which are the most conspicuous illnesses. Take the rate of suicide and attempted suicide and its prevalence; this clearly indicates high prevalence of underlying depression and its inadequate treatment. Lakhs of people, mostly young, have died because of suicide. Furthermore, a large number of persons have been displaced and exposed to political, religious and other conflict situations over the past few decades. Take the disaster like tsunami, which necessitated hunting for mental-health workers or service personnel. Psychiatric epidemiology in India - Moving beyond numbers is the topic of a chapter in the recently released book Mental health - An Indian perspective. India with its population of more that one billion faces myriad health problems. The increase in per capita income, along with changing health-care availability, with control of nutritional and infectious disorders, has resulted in greater life expectancy of people. The scenario has also brought to the fore the new challenge of behavior-linked manmade lifestyle-related problems. In this evolving health-care scenario, noncommunicable diseases pose major problems due to lack of skilled health-care manpower, inadequate information and inability of the system to meet this challenge all over the world, including India. The aggressive, market-oriented liberalizing economy in combination with an invasive media has helped in rapid expansion of hazardous life styles. The social, biological and psychological strengths of the past have been slowly replaced by a fragile life pattern of people, making them more vulnerable to social, mental and psychological problems at all ages. Mental-health problems have long been recognized in every society. Communities had their own mechanisms of handling these problems, many of which are gradually being replaced by modern science. A greater understanding of mind and behavior in all dimensions has revolutionized our efforts of managing problems in today's society. The interaction of man's mind and behavior is at an exciting phase today, with advances in genetic, molecular, biochemical and environmental domains based on agent-host environment approach. The organization of service for those with mental-health problems has moved from crude primitive methods to more sophisticated technological approaches with a combination of pharmacological and nonpharmacological methods. The Indian medical education system is one of the largest in the world and consists of 262 medical schools, each associated with a university producing 28,000 doctors each year. One-third of these doctors leave India every year for residency and/or practice abroad, with around 1,500 medical graduates immigrating to the USA each year to enter residency training. The quality of Indian medical education and the physicians it produces therefore has implications for the USA and the entire world. A number of high-profile issues confront undergraduate education in India, a country with a long history of medicine. …