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Ranade K, Kapoor A, Fernandes TN. Mental health law, policy & program in India – A fragmented narrative of change, contradictions and possibilities. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Aluh DO, Onu JU, Caldas-de-Almeida JM. Nigeria's mental health and substance abuse bill 2019: Analysis of its compliance with the United Nations convention on the rights of persons with disabilities. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 83:101817. [PMID: 35772283 DOI: 10.1016/j.ijlp.2022.101817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Countries are struggling with reconciling their national mental health legislation with the CRPD approach, which stresses equality as the focal point of legislation, policies, and practices that affect people with disabilities. Several failed attempts have been made over the last two decades to update Nigeria's obsolete mental health legislation. The most recent attempt is the Mental Health and Substance abuse Bill 2019, which aims to protect the rights of people with mental health needs. It addresses many areas neglected by previous bills, such as non-discrimination of people with mental and substance use problems in the exercise of their civil, political, economic, social, full employment, religious, educational, and cultural rights. It categorically prohibits the use of seclusion in the treatment of people with mental health problems, makes provision for service users to be members of the Mental health review tribunal and allows for the protection of privacy and confidentiality of information about people with mental health problems. While keeping to most of WHO's recommendations for mental health legislation, the bill diverges from the CRPD's recommendations by allowing forced admission and treatment based on mental capacity, substitute decision-making by legal representatives or closest relatives, and non-prohibition of coercive practices. The bill does not make provisions for advance directives and is silent on informed consent to participate in research. Despite the bill's deficiencies, it would be a significant step forward for the country, whose current mental health legislation is the Lunacy Act of 1958. Although the CRPD has left it unclear how countries, especially low resource countries, should go about creating a workable legal framework, it is clear that all countries are expected to join the current global effort to eliminate, or at least reduce to the barest minimum, the use of coercion in mental health care. We expect that future revisions of this bill will examine its limitations in light of Nigeria's socio-cultural context.
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Affiliation(s)
- Deborah Oyine Aluh
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nnewi Campus, Anambra State, Nigeria
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
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Ponnudurai R. A journey through psychiatry - A personal perspective. Indian J Psychiatry 2021; 63:215-221. [PMID: 34211212 PMCID: PMC8221215 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_448_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 05/31/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- R Ponnudurai
- Department of Psychiatry, A.C.S. Medical College, Chennai, Tamil Nadu, India.,Department of Psychiatry, Madras Medical College, Chennai, Tamil Nadu, India
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Math SB, Gowda GS, Basavaraju V, Manjunatha N, Kumar CN, Enara A, Gowda M, Thirthalli J. Cost estimation for the implementation of the Mental Healthcare Act 2017. Indian J Psychiatry 2019; 61:S650-S659. [PMID: 31040453 PMCID: PMC6482705 DOI: 10.4103/psychiatry.indianjpsychiatry_188_19] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Mental Healthcare Act, 2017 (MHCA) was a step that was essential, once the Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities in 2007. The MHCA looks to protect, promote, and fulfill the rights of persons with mental illness (PMI) as stated in the preamble of the Act. Further, there is an onus on the state to provide affordable mental health care to its citizens. In India, mental health has always been a lesser priority for lawmakers and citizens alike. The rights-based MHCA looks to overhaul the existing system by giving prominence to autonomy, protecting the rights of the mentally ill individuals, and making the State responsible for the care. The decision to make all this happen is commendable. The annual health expenditure of India is 1.15% of the gross domestic product, and the mental health budget is <1% of India's total health budget. This article systematically analyses and describes the cost estimation of the implementation of MHCA 2017, and it is not an estimation of mental health economics. The conservative annual estimated cost on the government to implement MHCA, 2017 would be 94,073 crore rupees. The present study estimation depicts that investing in the implementation of MHCA, 2017 by the government will yield 6.5 times the return on investment analysis benefit. If the State is not proactive in taking measures to implement the MHCA, the rights promised under this legislation will remain aspirational.
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arun Enara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mahesh Gowda
- Department of Psychiatry, Spandana Health Care, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Abstract
The Mental Healthcare Act (MHCA) 2017, after parliamentary approval in 2017, came into effect from May 29, 2018. It is rights-based and empowers the patients to make their own choices unless they become incapacitous due to mental illness. There is much emphasis on the protection of human rights of persons with mental illness. The act provides a framework and regulation on how a person with mental illness should be treated. The experts, on multiple occasions, have debated on whether the act is a boon or a bane for the practitioners in India. The MHCA 2017 brings about more impetus on documentation, unlike the previous acts. With the act in place, clear documentation with reasons for decisions made and care given are important for good practice. Although this may potentially raise the cost of care, this will ensure a safer practice of psychiatry and will prove beneficial for the patients and the psychiatrists. To comply with the provisions of the act, one will have to modify the manner in which one carries out the day-to-day practice. Regular training through workshops is required to understand the practical implications of different provisions of the act. Furthermore, regular peer group meetings may give a sense of support and an opportunity to learn from one another and help find solutions to difficult aspects. Overall, following this and adapting to the new act may bring uniformity in practice. This article aims to explore ways to leverage the MHCA 2017 from the practitioner's perspective.
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Affiliation(s)
- Vijaykumar Harbishettar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arun Enara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mahesh Gowda
- Spandana Health Care, Bengaluru, Karnataka, India
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Sivakumar PT, Mukku SSR, Antony S, Harbishettar V, Kumar CN, Math SB. Implications of Mental Healthcare Act 2017 for geriatric mental health care delivery: A critical appraisal. Indian J Psychiatry 2019; 61:S763-S767. [PMID: 31040470 PMCID: PMC6482673 DOI: 10.4103/psychiatry.indianjpsychiatry_100_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The prevalence of mental health problems in older adults is increasing globally as well as in India due to population ageing. Mental Healthcare Act (MHCA) 2017 has a rights-based approach and came into force in India in May 2018. Its provisions have significant implications for promoting mental health care and protecting the rights of persons with mental illness (PMI). Older adults with mental health problems such as dementia have a high risk for loss of mental capacity, abuse, violation of their rights, and institutionalization. This act advocates the development of specialized clinical services for the older adults in mental health care institutions. It also recognizes the rights of PMI to access a range of services required, including rehabilitation services. Several provisions of the act, such as those related to mental capacity, advance directive, nominated representative, and responsibilities of other agencies, have specific challenges related to older adults with mental illness. In this article, we present a critical appraisal of the implications of MHCA 2017 in the context of the care of the older adults with mental illness.
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Affiliation(s)
- Palanimuthu Thangaraju Sivakumar
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shiva Shanker Reddy Mukku
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sojan Antony
- Department of Psychiatric Social Work, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vijaykumar Harbishettar
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Forensic Psychiatry Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Forensic Psychiatry Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Gowda MR, Das K, Gowda GS, Karthik KN, Srinivasa P, Muthalayapapa C. Founding and managing a mental health establishment under the Mental Healthcare Act 2017. Indian J Psychiatry 2019; 61:S735-S743. [PMID: 31040466 PMCID: PMC6482708 DOI: 10.4103/psychiatry.indianjpsychiatry_147_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The World Health Organization Atlas reveals lower bed and mental health professionals ratio per population in India. This may be due to a poor allocation of funding in the mental health sector by the Government. This resulted in a lack of complete and comprehensive care ranging from acute treatment to long-term rehabilitation throughout the country. The spiral of specialist care needs such as deaddiction, child psychiatric needs, and rehabilitation facility are available only to a handful of the population in metropolitan cities in India. The launching or establishment of new Mental Health Establishments (MHEs) and upgrading mental health service may provide strategies to bridge this gap from the private mental health sector. Following the inception of "Mental Healthcare Act 2017" (MHCA 2017), the process of setting up MHEs and their operations comes with new legal and healthcare aspects that remain debatable and unsettled. We put forth the basic measures that can be considered and undertaken to establish an exemplary MHE under the MHCA 2017.
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Affiliation(s)
- Mahesh R. Gowda
- Department of Psychiatry, Spandana Nursing Home, Bengaluru, Karnataka, India
| | - Keya Das
- Department of Psychiatry, PESIMSR, Kuppam, Andhra Pradesh, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - K. N. Karthik
- Department of Psychiatry, BGS Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Preethi Srinivasa
- Department of Psychiatry, Spandana Nursing Home, Bengaluru, Karnataka, India
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Abstract
India enacted the Mental Healthcare Act, 2017 (MHCA 2017) on April 7, 2017 to align and harmonize with United Nations Convention on Persons with Disabilities and the principles of prioritizing human rights protection. While MHCA 2017 is oriented toward the rights of the patients, the rights of the family members and professionals delivering treatment, care, and support to persons with severe mental disorder (SMD) often suffer. MHCA 2017 mandates discharge planning in consultation with the patients for admitted patients and makes the service providers responsible for ensuring continuity of care in the community. The concerns surrounding the chances of relapse and recurrence when a person with a SMD stops medications continue to remain largely unaddressed. The rights-based MHCA 2017 makes it difficult for the prevailing practices of surreptitious treatment by the family/caregiver and proxy consultations on behalf of the patients. This will, in turn, lead to increased chances of relapse, risk of violence, homelessness, stigma, and suicide in persons with SMDs in the community, largely due to noncompliance to treatment. This will also result in increased caregiver burden and burnouts and may also cause disruptions in the family and the community. To strike a balance over the current MHCA 2017, there is a need to amend or bring-forth a new law rooted in the principles of community treatment order.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arun Enara
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Mahesh Gowda
- Department of Psychiatry, Spandana Health Care, Bengaluru, Karnataka, India
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Math SB, Basavaraju V, Harihara SN, Gowda GS, Manjunatha N, Kumar CN, Gowda M. Mental Healthcare Act 2017 - Aspiration to action. Indian J Psychiatry 2019; 61:S660-S666. [PMID: 31040454 PMCID: PMC6482691 DOI: 10.4103/psychiatry.indianjpsychiatry_91_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is no health without mental health. Recently conducted National Mental Health Survey quoted a prevalence of 13.7% lifetime and 10.6% current mental morbidity. To address this mammoth problem, an aspirational law was enacted titled "Mental Healthcare Act, 2017" (MHCA 2017). The act is progressive and rights based in nature. The whole dedicated Chapter 5 on "Rights of the person with mental illness" is the heart and soul of this legislation. However, the act mainly focuses on the rights of the persons with mental illness (PMI), only during treatment in hospital but is not equally emphatic about continuity of treatment in the community. The act fails to acknowledge and foster the role and contribution of family members in providing care to PMI. Although there are many positive aspects to the MHCA 2017, it may impact adversely on the mental health care in India. This article focuses on the shortcomings and challenges of the act and also makes attempts to offer alternatives considering the available resources and ground reality. Concepts such as "Advance directives" and "Nominated representatives" appear to be very attractive, idealistic, and aspirational, but not evidenced based in the Indian context considering the resources. The act fails to make an impact even after 22 months to attain the goal, and will require pervasive efforts to fulfil a purpose that directs its development. This law needs to be amended as per the local resources and requirements of the society.
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mahesh Gowda
- Department of Psychiatry, Spandana Health Care, Bengaluru, Karnataka, India
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10
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Gowda GS, Lepping P, Ray S, Noorthoorn E, Nanjegowda RB, Kumar CN, Math SB. Clinician attitude and perspective on the use of coercive measures in clinical practice from tertiary care mental health establishment - A cross-sectional study. Indian J Psychiatry 2019; 61:151-155. [PMID: 30992609 PMCID: PMC6425791 DOI: 10.4103/psychiatry.indianjpsychiatry_336_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Use of coercive measures in mental health care is an important issue for research. There are scarce data available on perception and attitudes toward coercion among Indian psychiatrists. AIMS This study aims to study psychiatrists' attitude and perspectives on the use of coercive measure in clinical practice against the background of family and patients' opinion. MATERIALS AND METHODS The study was conducted at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India. Psychiatrist in charge of the inpatients was asked about their general opinion on coercion and was administered Staff Attitude to Coercion Scale questionnaire. Findings were compared to previously published studies on patients' opinion and family opinion in the same sample. Data were analyzed using descriptive statistics. RESULTS Coercion proved to be a common measure applied in nearly 70% of the patients studied. The 189 psychiatrists participating in the study almost all perceived coercion as care, protection and safety, and as protection from dangerous situations. About 66% of psychiatrists perceived physical and chemical restraint (sedation) as necessary and acceptable in acute emergency care. One-third of the psychiatrists felt their patients lost autonomy, dignity, and the possibility of interpersonal contact. The same amount agreed that some patients could have been treated with less restriction and fewer coercive measures. CONCLUSION Psychiatrists felt that physical and chemical restraints are necessary and acceptable in acute emergencies. Most psychiatrists considered coercion as a caring protective and safety attitude but also acknowledged its potential negative impact on patient dignity and therapeutic relationships.
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Affiliation(s)
- Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Peter Lepping
- Bangor University, Centre for Mental Health and Society, Wales, United Kingdom
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysore, Karnataka, India
- Wrexham Maelor Hospital, Liaison Psychiatry, BCUHB, Wrexham, Wales, United Kingdom
| | - Sujoy Ray
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Eric Noorthoorn
- GGNet Community Mental Health Centre, Warnsveld, Netherlands
| | | | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Duffy RM, Kelly BD. India's Mental Healthcare Act, 2017: Content, context, controversy. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:169-178. [PMID: 30122262 DOI: 10.1016/j.ijlp.2018.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 05/13/2023]
Abstract
India's new mental health legislation, the Mental Healthcare Act, 2017, was commenced on 29 May 2018 and seeks explicitly to comply with the United Nations Convention on the Rights of Persons with Disabilities. It grants a legally binding right to mental healthcare to over 1.3 billion people, one sixth of the planet's population. Key measures include (a) new definitions of 'mental illness' and 'mental health establishment'; (b) revised consideration of 'capacity' in relation to mental healthcare (c) 'advance directives' to permit persons with mental illness to direct future care; (d) 'nominated representatives', who need not be family members; (e) the right to mental healthcare and broad social rights for the mentally ill; (f) establishment of governmental authorities to oversee services; (g) Mental Health Review Boards to review admissions and other matters; (h) revised procedures for 'independent admission' (voluntary admission), 'supported admission' (admission and treatment without patient consent), and 'admission of minor'; (i) revised rules governing treatment, restraint and research; and (j) de facto decriminalization of suicide. Key challenges relate to resourcing both mental health services and the new structures proposed in the legislation, the appropriateness of apparently increasingly legalized approaches to care (especially the implications of potentially lengthy judicial proceedings), and possible paradoxical effects resulting in barriers to care (e.g. revised licensing requirements for general hospital psychiatry units). There is ongoing controversy about specific measures (e.g. the ban on electro-convulsive therapy without muscle relaxants and anaesthesia), reflecting a need for continued engagement with stakeholders including patients, families, the Indian Psychiatric Society and non-governmental organisations. Despite these challenges, the new legislation offers substantial potential benefits not only to India but, by example, to other countries that seek to align their laws with the United Nations' Convention on the Rights of Persons with Disabilities and improve the position of the mentally ill.
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Affiliation(s)
- Richard M Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
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Saya A, Brugnoli C, Piazzi G, Liberato D, Di Ciaccia G, Niolu C, Siracusano A. Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review. Front Psychiatry 2019; 10:271. [PMID: 31110481 PMCID: PMC6501697 DOI: 10.3389/fpsyt.2019.00271] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Saya
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Chiara Brugnoli
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gioia Piazzi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Daniela Liberato
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gregorio Di Ciaccia
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
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13
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Tekkalaki B, Patil VY, Patil S, Chate SS, Dhabale R, Patil NM. How do Our Patients Respond to the Concept of Psychiatric Advance Directives? An Exploratory Study From India. Indian J Psychol Med 2018; 40:305-309. [PMID: 30093739 PMCID: PMC6065124 DOI: 10.4103/ijpsym.ijpsym_10_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Psychiatric advance directives have been incorporated in the Mental Health Care Act 2017 despite strong concerns about their feasibility and utility in the Indian patient population. Data on its utility in India is very scarce. AIMS To determine the possible treatment options our clients make as a part of psychiatric advance directives. MATERIALS AND METHODS Fifty consecutive individuals with severe mental illness were interviewed using a self-designed semi-structured tool to find out the possible choices they make as part of advance directives and the factors affecting their choices. RESULTS About 10% of the participants failed to understand the concept of advance directives. Of those who understood, 89% were willing to make advance directives, 15% refused future hospitalizations, 47% refused future electroconvulsive therapies (ECTs), and 62% refused physical restraints in future. CONCLUSION The majority of the participants agreed to make advance directives. The majority of those who agreed to make advance directives refused to undergo ECTs and physical restraints in future episodes of illness. Approximately 10% of the patients could not understand the concept of advance directives.
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Affiliation(s)
- Bheemsain Tekkalaki
- Department of Psychiatry, K.L.E. Academy of Higher Education, J.N. Medical College, Belagavi, Karnataka, India
| | - Veerappa Y Patil
- Consultant Psychiatrist, District Mental Health Program, Bagalkot, Karnataka, India
| | - Sandeep Patil
- Department of Psychiatry, K.L.E. Academy of Higher Education, J.N. Medical College, Belagavi, Karnataka, India
| | - Sameeran S Chate
- Department of Psychiatry, K.L.E. Academy of Higher Education, J.N. Medical College, Belagavi, Karnataka, India
| | | | - Nanasaheb M Patil
- Department of Psychiatry, K.L.E. Academy of Higher Education, J.N. Medical College, Belagavi, Karnataka, India
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14
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Duffy RM, Narayan CL, Goyal N, Kelly BD. New legislation, new frontiers: Indian psychiatrists' perspective of the mental healthcare act 2017 prior to implementation. Indian J Psychiatry 2018; 60:351-354. [PMID: 30405264 PMCID: PMC6201661 DOI: 10.4103/psychiatry.indianjpsychiatry_45_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
CONTEXT The mental healthcare act 2017 represents a complete overhaul of Indian mental health legislation. AIMS The aim of this study was to establish the opinions of Indian psychiatrists regarding the new act. SETTINGS Mental health professionals in Bihar and Jharkhand were interviewed. DESIGN A focus group design was utilized. MATERIALS AND METHODS Key questions explored the positive and negative aspects of the act and the management of the transitional phase. All focus groups were recorded and transcribed. ANALYSIS Data were coded and analyzed using an inductive approach. RESULTS Many positive aspects of the new legislation were identified especially relating to rights, autonomy, and the decriminalization of suicide. However, psychiatrists have significant concerns that the new legislation may negatively impact patients and increase stigma. Psychiatrists held varying views on the proposed licensing and inspection of general hospital psychiatric units. CONCLUSIONS Careful evaluation of the new legislation is needed as the concerns raised warrant ongoing monitoring.
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Affiliation(s)
- Richard M. Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Tallaght, Dublin D24 NR0A, Ireland
| | | | - Nishant Goyal
- Academic Section, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Brendan D. Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Tallaght, Dublin D24 NR0A, Ireland
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15
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Abstract
A large proportion of patients with substance use disorders have clinical comorbidities, either medical or psychiatric. An initial assessment is necessary initially for prompt identification and management of any psychiatric or medical emergency, and thereafter a more detailed assessment for the comprehensive understanding of the individual. This should be done keeping in mind the goals of both immediate and long term assessment so that a comprehensive but individualized, context and culture sensitive, reality based, recovery-oriented management plan can be formulated. Assessment should consist of not only history-taking, physical and mental status examination but also laboratory and instrument based assessment as needed. During assessment, collateral reports and past medical records are valuable additions along with self-report. Since substance use disorders influence various aspects of daily life, hence medical, social, occupational, religious, spiritual, financial and legal aspects should be evaluated. Overall, the assessment needs to be diagnosis and management focused, covering the various bio-psycho-social domains relevant to the individual.
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Affiliation(s)
- Debasish Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Abhishek Ghosh
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rawat S, Joshi PC, Khan MA, Saraswathy KN. Trends and determinants of suicide in Warangal District Telangana, India: six years retrospective study based on secondary data. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0041-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Böge K, Zieger A, Mungee A, Tandon A, Fuchs LM, Schomerus G, Tam Ta TM, Dettling M, Bajbouj M, Angermeyer M, Hahn E. Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India. Indian J Psychiatry 2018; 60:24-31. [PMID: 29736059 PMCID: PMC5914258 DOI: 10.4103/psychiatry.indianjpsychiatry_406_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors. MATERIALS AND METHODS Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis. RESULTS Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P < 0.01), with female participants showing higher levels of perceived stigma compared to male counterparts. CONCLUSION Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Abhinav Tandon
- AKT Neuropsychiatric Centre, Allahabad, Uttar Pradesh, India
| | - Lukas Marian Fuchs
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Matthias Angermeyer
- Center for Public Mental Health, Untere 12 Zeile 13, A-3482 Gö-sing am Wagram, Austria
| | - Eric Hahn
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
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18
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Gowda GS, Kondapuram N, Kumar CN, Math SB. Involuntary admission and treatment experiences of persons with schizophrenia: Implication for the Mental Health Care Bill 2016. Asian J Psychiatr 2017; 29:3-7. [PMID: 29061422 DOI: 10.1016/j.ajp.2017.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Involuntary admission and treatment experiences may affect the attitude of patients toward subsequent treatment and further outcomes. This issue has received relatively less research attention in persons with schizophrenia from developing countries. METHODOLOGY In this hospital based prospective observational study, involuntary admission, treatment and coercion experiences among 76 persons with schizophrenia, admitted under special circumstances of Mental Health Act -1987 were studied. Demographic, clinical and assessments related to coercion experiences were completed within 3days of admission. In 67 subjects, a reassessment was done just before discharge. RESULTS Mean (SD) age was 33.1 (±11.5) years, 47.8% (n=32) were males and 32.8% (n=22) were married. 92.5% (n=62) had absent insight at admission. Mean CGI Severity score at admission was 6.27 (±0.53). Mean (SD) score on MacArthur Perceived Coercion Scale at admission was 4.04 (±1.61). This reduced to 2.43(±1.91) [p<0.001]. This reduction correlated significantly with improvements in global functioning (r=-0.40, p <0.001), insight level(r=0.26, p<0.001) and as well as symptom severity(r=0.36, p<0.001). At discharge, 70% (n=47) patients reported that their involuntary admission was justified. CONCLUSION Perceived coercion in schizophrenia though common clinical phenomena, it is a dynamic state which reduces over course of treatment. At Discharge, majority reported that their admission was justified, even though they were admitted involuntarily. The study underlines the need for a standardized rule of conduct based coercive practice in psychiatry.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India.
| | - Nithin Kondapuram
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India
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19
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Zieger A, Mungee A, Schomerus G, Ta TMT, Weyers A, Böge K, Dettling M, Bajbouj M, von Lersner U, Angermeyer MC, Tandon A, Hahn E. Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India. Indian J Psychiatry 2017; 59:341-346. [PMID: 29085094 PMCID: PMC5659085 DOI: 10.4103/psychiatry.indianjpsychiatry_190_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes. MATERIALS AND METHODS Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference. RESULTS Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion. CONCLUSION In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.
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Affiliation(s)
- Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aino Weyers
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Ulrike von Lersner
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | | | - Abhinav Tandon
- AKT Neuropsychiatric Centre, Allahabad, Uttar Pradesh, India
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
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20
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Antony JT. Mental Health Care Bill-2016: An illusory boon; on close reading it is mostly bane. Indian J Psychiatry 2016; 58:363-365. [PMID: 28196990 PMCID: PMC5270258 DOI: 10.4103/0019-5545.196721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- James T Antony
- Department of Psychiatry, Jubilee Mission Medical College and Research Centre, Trissur, Kerala, India
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