Undergraduate psychiatry training in India; past, present, and future looking for solutions within constraints!!

Abstract

Byline: M. Kishor, Mohan. Isaac, M. Ashok, Lakshmi. Pandit, T. Sathyanarayana Rao Psychiatric disorders are considered one of the leading causes of morbidity and mortality worldwide.[sup][1] They are closely associated with other medical conditions such as diabetes and hypertension, adversely affecting their outcome.[sup][2],[3] India has more than 1/6[sup]th of the global population, and is a rapidly developing country with enormous changes in all spheres of life. Mental health issues are gaining a great deal of importance, in keeping with other health issues, and are likely to play a key role in the diverse indicators of development. Suicide rates in India are reportedly one of the highest in the world and have already attracted political and socio-cultural trajectories in both causation and solutions for the problem, underplaying mental health causes for the same, as well as understating the inadequacy of mental health services in India.[sup][4] Concerns regarding the mental health scenario in India are directly related to a lack of awareness among the public and a lack of the minimal mandatory training in psychiatry for medical undergraduates, which has consistently produced thousands of doctors who are incompetent to diagnose and manage common conditions such as depression and suicide.[sup][5] Training undergraduates in the field of psychiatry can be considered as one of the most important pathways to improve mental health services in India. That undergraduate training in psychiatry is inadequate has been the contention from the first report of the subcommittee on undergraduate teaching in psychiatry, Indian Psychiatry Society (1965).[sup][6] The emphasis has been on inadequate hours of training in psychiatry as well as a lack of the required trained staff. Painfully, despite the numerous evidences about benefits of undergraduate psychiatry training [sup][7],[8],[9] nothing seems to have changed in this half of the century (1965–2015) as the Medical Council of India is reluctant to make psychiatry a mandatory subject for the MBBS examination,[sup][10] impairing the mental health component of basic health services in India. This great lacuna in Indian medical education is likely to have an adverse effect on mental health services for the next few decades. In addition is the issue that India has a large deficit of psychiatrists with just 0.3 for 100,000 populations, as mentioned in world mental health atlas 2014.[sup][11] To address this challenge, we may have to look for solutions that enable us to attract medical students to the subject of psychiatry, and build psychiatric knowledge and skill in them through diverse ways. The onus for achieving this lies on each faculty and the department as a team, the policies of the Institution and University to which they belong, as well as professional bodies like the Indian Psychiatric Society, each of whom will have a major role to play. The efforts of Indian Psychiatry Society have been well-summarized by Dr. Roy Abraham Kallivayalil in his presidential address at ANCIPS 2012, Kochi. The Medical Council of India had made it mandatory for all medical colleges to have a department of psychiatry as a part of teaching hospitals, providing mental health services in a general hospital setting. Needless to say, most nonteaching hospitals in India, public or private, do not have psychiatric services on a regular basis. Hence, medical colleges are crucial centers for providing Mental Health Services. Currently, there are 412 medical colleges in India with 52,325 MBBS seats.[sup][12] The onus of training these medical graduates in psychiatry for whom the subject is not mandatory, as in, not assessed in the current examination system, lies with the faculty in psychiatry, they have to use their knowledge and passion in delivering psychiatric training for these students. Departments that have recognized postgraduate seats must also put in the same degree of effort in teaching the undergraduates. …