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Vajawat B, Dinakaran D, Nandimath OV, C AH, Kumar CN, Basavarajappa C, Math SB. COMMENTARY: The Consumer Protection Act, 2019: A critical analysis from a medical practitioner's perspective. Indian J Med Ethics 2024; IX:65-69. [PMID: 38375645 DOI: 10.20529/ijme.2023.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The landmark judgment in the case of Indian Medical Association v VP Shantha in 1995 brought the medical profession under the ambit of the Consumer Protection Act, 1986. The Consumer Protection Act, 1986, was later repealed and replaced by the Consumer Protection Act, 2019. This article delves into the implications of the 2019 Act, highlighting significant changes in its scope, including the expansion of the definition of "consumer" and the incorporation of telemarketing and e-commerce within its ambit. Moreover, the amendments affect pecuniary jurisdiction, grounds for litigation, and introduce mediation cells, and the Central Consumer Protection Authority (CCPA). This article underscores concerns related to an increase in frivolous cases against medical practitioners and in defensive practice, ultimately impacting the overall quality of patient care. Recommendations for timely redressal and safeguards against unwarranted litigation are proposed to mitigate the adverse implications of the amended Act and ensure the well-being of both healthcare providers and patients.
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Affiliation(s)
- Bhavika Vajawat
- Senior Resident, Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, INDIA
| | - Damodharan Dinakaran
- Assistant Professor of Psychiatry, Telemedicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, INDIA
| | - Omprakash V Nandimath
- Professor of Law, National Law School of India University, Bengaluru, Karnataka, INDIA
| | - Arpitha H C
- Assistant Professor, School of Law, RV University, Bengaluru, Karnataka, INDIA
| | - Channaveerachari Naveen Kumar
- Professor and Head of Community Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, INDIA
| | - Chethan Basavarajappa
- Assistant Professor, Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, INDIA
| | - Suresh Bada Math
- Professor and Head of Forensic Psychiatry Unit and Head of Telemedicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, INDIA
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Vranda MN, Ranjith PJ, Aadi S, Gunasekaran DM, Thirthalli J, Naveen Kumar C, Thirumoorthy A, Vasanthra CR, Amaresha AC. Predictors of long-stay in a tertiary care psychiatry hospital in India. Int J Soc Psychiatry 2023; 69:1979-1985. [PMID: 37403413 DOI: 10.1177/00207640231183916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Many psychiatric patients continue to stay for longer duration in psychiatric institutions. Community reintegration and rehabilitation of such patients needs to be explored to ensure appropriate bed occupancy rates and access to in-patient care for newer patients in need of the same. OBJECTIVES The aim is to identify the risk and protective factors leading to long-term admission of mentally ill patients in tertiary care hospital. METHODOLOGY A cross-sectional study was conducted with all patients in the long-stay ward between May 2018 and February 2023. A retrospective chart review followed by cross sectional assessment of risks and disability was carried out with all the patients living in a long-stay psychiatric ward (N = 101) at a tertiary hospital in Bangalore, India, between May 2018 and February 2023. RESULTS The hospital's average length of stay (LOS) was 5.70 ± 8.30 years. The risk and protective factors for LOS in psychiatric hospitals were analyzed using the Poisson Regression model. The results revealed that the male gender, diagnosis of schizophrenia or psychosis, clinicians' knowledge of family information, good clinical improvement, and higher participation in ward activities are the protective factors for a shorter hospital stay. While higher age, family history of mental illness, being married and employed, absence of children, and/or having family members rarely visiting the patient at the hospital were some factors that increased the risk of LOS. CONCLUSION This study highlighted the importance of possible LOS predictors in the tertiary care psychiatric hospital. The multi-disciplinary team may utilize risk and protective factors for delayed LOS to introduce comprehensive psychosocial interventions and policies that reduce the risk of delays or length of stay in mental health hospitals.
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Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabhu James Ranjith
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shivaleela Aadi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Ammapattian Thirumoorthy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Cicil Radhakrishnan Vasanthra
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Hegde PR, Nirisha LP, Basavarajappa C, Suhas S, Kumar CN, Benegal V, Rao GN, Varghese M, Gururaj G. Schizophrenia spectrum disorders in India: A population-based study. Indian J Psychiatry 2023; 65:1223-1229. [PMID: 38298877 PMCID: PMC10826875 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_836_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Schizophrenia spectrum disorders represent a significant global health concern, contributing significantly to the global burden of disease. The National Mental Health Survey (NMHS) of India, conducted between 2015 and 2016, investigated the prevalence and epidemiological correlates of schizophrenia spectrum disorders in India. Materials and Methods The NMHS conducted a population-based cross-sectional study in 12 Indian states from 2015 to 2016, encompassing 34,802 adults. The overall study design of the NMHS was a multistage, stratified, random cluster sampling technique, incorporating random selection based on probability proportion to size at each stage. The Mini-International Neuropsychiatric Interview 6.0 was used for psychiatric diagnoses, disability was assessed using Sheehan's disability scale, and the illness-related socioeconomic impact was assessed using a questionnaire based on the World Health Organization Disability Assessment Schedule 2.0. Firth penalized logistic regression was employed to understand the correlates of current schizophrenia spectrum disorder. Results The study found a lifetime prevalence of schizophrenia spectrum disorders at 1.41%, with a current prevalence of 0.42%. A substantial treatment gap of 72% existed for current cases, rising to 83.3% in urban non-metro areas. The penalized logistic regression revealed that the age group category of 30-49 years, unemployed status, and lower education level had higher odds of association with schizophrenia spectrum disorders. Conclusion The primary finding of this study is a lifetime prevalence of 1.41%, a current prevalence of 0.42%, and a substantial treatment gap of 72%. Addressing this treatment gap and holistic intervention is crucial for reducing the socioeconomic impact of this disorder. Strengthening the National Mental Health Program and implementing community-based rehabilitation are essential first steps in this direction.
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Affiliation(s)
| | - Lakshmi P. Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Girish N. Rao
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gopalkrishna Gururaj
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Vajawat B, Suhas S, Moirangthem S, Kumar CN, Varghese M, Gururaj G, Benegal V, Rao GN. Bipolar affective disorder in India: A multi-site population-based cross-sectional study. Indian J Psychiatry 2023; 65:1230-1237. [PMID: 38298870 PMCID: PMC10826869 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_838_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 09/18/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Bipolar Affective Disorder (BPAD) merits careful consideration within the medical and healthcare communities, researchers, and policymakers. This is due to its substantial disability burden, elevated prevalence of co-morbidities, heightened lifetime risk of suicidality, and a significant treatment gap. This article focuses on the lifetime and current prevalence, correlates, co-morbidities, associated disabilities, socio-economic impact, and treatment gap for BPAD in the adult population of the National Mental Health Survey (NMHS) 2016. Materials and Methods The NMHS 2016 was a nationally representative study conducted across 12 Indian states between 2014 and 2016. A multi-stage, stratified, random cluster sampling technique based on probability proportionate to size at each stage was used. The diagnosis of BPAD was based on Mini-International Neuropsychiatric Interview 6.0.0. Sheehan's Disability Scale was used to assess the disability. Results A total of 34,802 adults were interviewed. The overall weighted prevalence of BPAD was 0.3% [95% confidence interval (CI): 0.29-0.31] for current and 0.5% (95% CI: 0.49-0.51) for lifetime diagnosis. Male gender [odds ratio (OR) 1.56] and residence in urban metropolitans (OR 2.43) had a significantly higher risk of a lifetime diagnosis of BPAD. Substantial cross-sectional co-morbidities were noted as per MINI 6.0.0 with the diagnosis of current BPAD such as tobacco use disorder (33.3%), other substance use disorders (14.6%), and anxiety disorders (10.4%). Two-thirds of persons with current BPAD reported disability of varying severity at work (63%), social (59.3%), and family life (63%). The treatment gap for current BPAD was 70.4%. Conclusion Most individuals with current BPAD reported moderate-severe disability. There were substantial co-morbidities and a large treatment gap. These warrant concentrated efforts from policymakers in devising effective strategies.
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Affiliation(s)
- Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Manjunatha N, Dinakaran D, Sarkhel S, Kumar CN. The National Mental Health (?Psychiatric) Survey (2015-2016): A superb acceleration in public mental health scenario of India. Indian J Psychiatry 2023; 65:1205-1207. [PMID: 38298872 PMCID: PMC10826873 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_835_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Damodharan Dinakaran
- Department of Psychosocial Support in Disaster Management, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sujit Sarkhel
- Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India
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Suhas S, Manjunatha N, Kumar CN, Benegal V, Rao GN, Varghese M, Gururaj G. Firth's penalized logistic regression: A superior approach for analysis of data from India's National Mental Health Survey, 2016. Indian J Psychiatry 2023; 65:1208-1213. [PMID: 38298875 PMCID: PMC10826871 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_827_23] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
The National Mental Health Survey of India (NMHS) was a ground-breaking nationwide study that harnessed a uniform, standardized methodology blending quantitative and qualitative approaches. Covering data from 12 states across diverse regions, its mission was to gauge the prevalence of psychiatric disorders, bridge treatment gaps, explore service utilization, and gauge the socioeconomic repercussions of these conditions. This initiative provided pivotal insights into the intricate landscape of mental health in India. One of the analyses planned for NMHS data was to undertake a logistic regression analysis with an aim to unravel how various sociodemographic factors influence the presence or absence of specific psychiatric disorders. Within this pursuit, two substantial challenges loomed. The first pertained to data separation, a complication that could perturb parameter estimation. The second challenge stemmed from the existence of disorders with lower prevalence rates, which resulted in datasets of limited density, potentially undermining the statistical reliability of our analysis. In response to these data-driven hurdles, NMHS recognized the critical necessity for an alternative to conventional logistic regression, one that could adeptly navigate these complexities, ensuring robust and dependable insights from the collected data. Traditional logistic regression, a widely prevalent method for modeling binary outcomes, has its limitations, especially when faced with limited datasets and rare outcomes. Here, the problem of "complete separation" can lead to convergence failure in traditional logistic regression estimations, a conundrum frequently encountered when handling binary variables. Firth's penalized logistic regression emerges as a potent solution to these challenges, effectively mitigating analytical biases rooted in small sample sizes, rare events, and complete separation. This article endeavors to illuminate the superior efficacy of Firth's method in managing small datasets within scientific research and advocates for its more widespread application. We provide a succinct introduction to Firth's method, emphasizing its distinct advantages over alternative analytical approaches and underscoring its application to data from the NMHS 2015-2016, particularly for disorders with lower prevalence.
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Nanjundaswamy MH, Kumar CN, Chandra PS, Badamath S. Need for perinatal services and support during and after disasters - A viewpoint. Asian J Psychiatr 2023; 88:103731. [PMID: 37619418 DOI: 10.1016/j.ajp.2023.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Madhuri H Nanjundaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, India.
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, India
| | - Suresh Badamath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, India
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Ohri U, Paul J, Vijayalakshmi P, Govindan R, Manjunatha N, Kumar CN, Math SB. The rationale and guiding principles to design a psychiatric curriculum for primary care nurses of India. J Family Med Prim Care 2023; 12:2114-2119. [PMID: 38024873 PMCID: PMC10657090 DOI: 10.4103/jfmpc.jfmpc_775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 12/01/2023] Open
Abstract
Background The National Mental Health Survey reports a huge treatment gap for all mental disorders. There is an acute shortage of mental health professionals in India. Hence, there is a dire need to support task-shift interventions by nurses in providing non-pharmacological interventions for persons suffering from mental health issues. The traditional psychiatric nursing curriculum emphasizes nurses' knowledge and skills rather than their competency in providing mental health care. We designed an innovative, digitally driven, modular-based primary care psychiatry program for nurses (PCPP-N) to incorporate mental health with physical health and emphasize redesigning nursing practice. In this paper, we discuss the rationale and guiding principles behind designing the curriculum of PCPP-N. Discussion The PCPP-N program is based on nine guiding principles to provide skill-based, pragmatic, and feasible modules of a higher collaborative care quotient (CCQ) and translational quotient (TQ) that are essential for upskilling primary care nurses. In this program, nurses are trained through telemedicine-based 'on-consultation training' augmented with collaborative video consultations. A tele-psychiatrist/tele-psychiatric nurse will demonstrate how to screen, identify, and plan treatment for patients with psychiatric disorders from patients coming for general medical care using the manual Clinical Schedules of Primary care psychiatry Nursing (CSP-N). The CSP-N manual includes a screener, simplified diagnosing guidelines relevant for nurses and primary care settings, nursing management, pharmacological management, and related side effects, counseling, and follow-up guidelines. This program helps the nurses in identifying the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPN curriculum contains pragmatic modules with higher CCQ and TQ. This curriculum is dynamic as the learning is interactive. Upskilling primary care nurses in integrating mental health with physical health may reduce the mental health burden. Further, the policymakers and administrators plan to integrate mental health along with physical health in national health programs.
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Affiliation(s)
- Uma Ohri
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - James Paul
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Poreddi Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
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Vajawat B, Kumar CN, Hegde P, Moirangthem S, Basavaraju V, Prathyusha V, Bhaskarapillai B, Math SB, Murthy P. Clinical Profile, Course and Outcomes of Male Inpatients with Mental Illness Charged with Homicide: A Chart Review from an Indian Tertiary Care Hospital. Indian J Psychol Med 2023; 45:405-410. [PMID: 37483583 PMCID: PMC10357911 DOI: 10.1177/02537176221127141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background The relationship between imprisonment and mental illness is bidirectional. The clinical outcomes of prisoners with mental illness have not been widely studied, especially in developing countries. This study was conducted to assess the same among male inpatients under judicial custody with charges of homicide. Methods A retrospective chart review of male forensic ward inpatients admitted between January 1, 2003, and December 31, 2016, was conducted. Diagnosis in the files was based on the International Classification of Diseases (ICD)-10 criteria. The Clinical and Global Improvement-Severity (CGI-S) scale was used to measure the severity of illness. Mean CGI-S assessment was carried out at baseline, end of 1 year, 5 years, and 15 years. The data were analyzed using descriptive statistics, Friedman's test, and Dunn's post hoc test. Results Schizophrenia spectrum disorders and other psychotic disorders, mood disorders, and alcohol use disorders were diagnosed in 62(49.6%), 22(17.6%), and 44(35.2%) subjects, respectively. Forty-one (32.8%) subjects had at least one readmission. The average CGI-S score for the total subjects was 5 (markedly ill) at baseline and 2 (borderline ill) at the end of their latest contact with the tertiary care hospital. For the 34 subjects (27.2%) who had follow-up information of 15 years, the average CGI-S score was 1 (normal, not at all ill) at the end of 15 years (P < 0.001). Conclusion Clinical outcomes of prisoners with mental illness seem promising, subject to the seamless availability of services. Studies from other parts of the country are required for a more systematic understanding of the requirements of care.
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Affiliation(s)
- Bhavika Vajawat
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Prakyath Hegde
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vasuki Prathyusha
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Ravindran S, Jadhav P, Philip S, Basavarajappa C, Kumar CN, Thirthalli J, Sivakumar T. Cutoff for Benchmark Disability Using World Health Organization Disability Assessment Schedule 2.0: A Community-Based Cross-Sectional Study from Rural South India. Indian J Psychol Med 2023; 45:397-404. [PMID: 37483576 PMCID: PMC10357917 DOI: 10.1177/02537176221124177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background India uses the Indian Disability Evaluation and Assessment Scale (IDEAS) for quantifying disability due to mental illness. The cutoff score for benchmark disability is 7. India has adopted International Classification of Functioning and Health (ICF) and thereby is a signatory to use World Health Organization Disability Assessment Schedule (WHODAS). Cutoff for benchmark disability in WHODAS in a community-based sample is lacking. Methods The study was conducted in Jagaluru Taluk, Davanagere District, Karnataka. It is a part of an ongoing research funded by Indian Council of Medical Research. Frequency, percentages, mean, standard deviations, mode, median, Receiver Operating Characteristic Curve were used in analyzing the data. Results The study included 184 persons with severe mental illness with mean age of 47 and average duration of illness (DOI) of 11 years. They had mild disability (5.99) in IDEAS. The corresponding cutoff score in WHODAS, as compared to IDEAS, when the influence of DOI is removed was 24. Conclusions A shift from IDEAS to WHODAS is feasible. With the undue influence of DOI removed, both hospital and community-based samples show the score of 24 as cutoff.
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Affiliation(s)
- Swati Ravindran
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- *Swati Ravindran and Prabhu Jadhav are joint first authors
| | - Prabhu Jadhav
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- *Swati Ravindran and Prabhu Jadhav are joint first authors
| | - Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Chethan Basavarajappa
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Jagadisha Thirthalli
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Thanapal Sivakumar
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Gangadhar B, Kumar CN, Sadh K, Manjunatha N, Math SB, Kalaivanan RC, Rao GN, Parthasarathy R, Chand PK, Chandra PS, Thirthalli J, Murthy P, Varghese M, Mathur A, Bairy BK, Kishore C, Gowda GS, Basvaraju V, Harihara SN, Isaac MK, Chaturvedi S. Mental Health Programme in India: Has the tide really turned? Indian J Med Res 2023; 157:387-394. [PMID: 37955215 PMCID: PMC10443714 DOI: 10.4103/ijmr.ijmr_2217_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/14/2023] Open
Abstract
Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.
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Affiliation(s)
- B.N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Kamaldeep Sadh
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rakesh Chander Kalaivanan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health & Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India
| | - Prabhat K. Chand
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mathur
- General of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Bhavya K. Bairy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Chethana Kishore
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basvaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Mohan K. Isaac
- Department of Psychiatry, University of Western Australia, Perth, Australia
| | - S.K. Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
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Paul J, Govindan R, Manjunatha N, Kumar CN, Math SB. Development and Validation of Clinical Schedule for Primary Care Psychiatric Nursing (CSP-N) for Primary Care Nurses. Indian J Community Med 2023; 48:443-452. [PMID: 37469911 PMCID: PMC10353680 DOI: 10.4103/ijcm.ijcm_721_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/06/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction As per the World Health Organization's mental health report for 2022, nearly a billion people have mental health issues, and 82% of them are in low and middle-income countries where mental health services are largely absent. For the successful integration of mental health into primary health care, proper training and education of primary care professionals are mandatory. Primary care nurses are in an excellent position to screen, identify, dual collaboration for treatment planning/referral, and follow-up of persons with mental illness (PMI), but they often lack the confidence and competence to tackle mental health problems. The study aimed to develop and validate the clinical schedule for primary care psychiatric nursing (CSP-N). Materials and Methods It is conducted in two phases: the development and validation phases. An extensive literature search has been conducted, and the ten themes derived from the two-focused group discussions and three-direct one-to-one interviews and input from mental health experts were used to design the CSP-N. The CSP-N was checked for content validity by a panel of 17 experts using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). Results The draft version 1 of the CSP-N showed high content validity for individual items (I-CVI range: 0.82 to 1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The CSP-N was developed in four modules. The single-measure two-way mixed absolute agreement ICC value was calculated (for 32 subjects) for the reliability test, and the ICC value was 0.97 with a 95% CI (0.94, 0.99). Conclusions Using an iterative approach, the development and validation of the CSP-N demonstrated high I-CVI and S-CVI for screening and identification, dual collaboration for the treatment plan, referral, and follow-up of a person with mental illness by the nurses in the community.
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Affiliation(s)
- James Paul
- Department of Nursing, NIMHANS, Bengaluru, Karnataka, India
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Ramu PS, Gowda GS, Moirangthem S, Kumar CN, Yadav R, Srinivas D, Bhaskarapillai B, Math SB. Fitness to re-join job: Neuropsychiatric perspective. J Neurosci Rural Pract 2023; 14:320-326. [PMID: 37181179 PMCID: PMC10174145 DOI: 10.25259/jnrp_78_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives Evaluating "Fitness to Re-join Job" and certification in persons with Neuro-Psychiatric Disorders is an indispensable professional responsibility. However, there is little documented guidance on clinically approaching this particular issue. This study aimed to study the sociodemographic, clinical, and employment profile of patients who sought fitness to re-join their job from the tertiary neuropsychiatric center. Materials and Methods This study was carried out at the National Institute of Mental Health and Neurosciences in Bengaluru, India. A retrospective chart review was adapted for the purpose. One hundred and two case files referred to medical board for fitness to rejoin the duty were reviewed from January 2013 to December 2015. Apart from the descriptive statistics, the Chi-square test or Fisher exact test was used to test the association between categorical variables. Results Patients' mean (standard deviation) age was 40.1 (10.1) years; 85.3% were married, and 91.2% were male. Common reasons for seeking "fitness certification" were work absenteeism (46.1%), illness affecting the work (27.4%), and varied reasons (28.4%). The presence of neurological disorders, sensory-motor deficits, cognitive decline, brain damage/insult, poor drug compliance, irregular follow-ups, and poor or partial treatment response were associated with an unfitness to rejoin the job. Conclusion This study shows that work absenteeism and the impact of illness on work are common reasons for referral. Irreversible neurobehavioural problems and deficits impacting work are common reasons for unfitness to rejoin the job. There is a need for a systematic schedule to assess the fitness for the job in patients with neuropsychiatric disorders.
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Affiliation(s)
- Praveen Shivalli Ramu
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neuro Surgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Hegde PR, Gowda GS, Vajawat B, Basavaraju V, Moirangthem S, Naveen Kumar C, Bada Math S. Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study. Int J Soc Psychiatry 2023; 69:28-37. [PMID: 34961385 DOI: 10.1177/00207640211065675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India. AIMS This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal. METHOD This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices. RESULTS A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading (n = 105, 35.0%), lying (n = 10, 3.3%), and threatening (n = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37-16.46), absent insight (OR 10.0; CI 2.01-47.56), and poor adherence to medication (OR 4.75; CI 1.31-16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care (Z = -4.37, p < .01), interpersonal (Z = -7.61, p < .01), work (Z = -5.9, p < .01), family functioning (Z = -7.82, p < .01) difficult behavior (Z = -8.27, p < .01), and dependency (Z = -6.34, p < .01) in persons with SMI with use of CoAdM. CONCLUSIONS CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.
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Affiliation(s)
- Prakyath R Hegde
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Gajera GV, Pandey P, Malathesh BC, Nirisha PL, Suchandra KHH, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Suresha BM, Jain S. Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India. J Neurosci Rural Pract 2023; 14:91-97. [PMID: 36891122 PMCID: PMC9945417 DOI: 10.25259/jnrp-2022-4-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh. Materials and Methods We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub. Statistical Analysis The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design). Results Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001). Conclusion The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.
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Affiliation(s)
- Gopi V. Gajera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Barikar C. Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P. Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K. Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ferose Azeez Ibrahim
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Bada Math Suresha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sumi Jain
- Department of Non-Communicable Diseases, National Health Mission, Chhattisgarh, India
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Ganjekar S, Moirangthem S, Kumar CN, Desai G, Bada Math S. Reproductive rights of women with intellectual disability in India. Indian J Med Ethics 2023; VIII:53-60. [PMID: 36519358 DOI: 10.20529/ijme.2022.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The reproductive rights of women with intellectual disability (WID) are a matter of concern for all stakeholders, including the woman herself, caregivers, guardians and her treating physicians. The judicial system often calls upon psychiatrists to opine regarding the "capacity to consent" of a WID to procedures such as medical termination of pregnancy and permanent sterilisation. Apart from physical and obstetric examinations, assessment of mental status and intelligence quotient (IQ) are also carried out to facilitate an understanding of the above issue. The Rights of Persons with Disabilities Act, 2016, (RPwD) and the Mental Healthcare Act, 2017, elucidate what constitutes free and informed consent as well as how to assess capacity. The assessment process of "capacity to consent" to reproductive system procedures among WID is important and can guide clinicians. Before assessing capacity, the treating physicians should educate a WID with appropriate information on the proposed procedure, its risks and benefits through various means of communication and then evaluate the "capacity to consent" to the procedure. This article summarises the provisions of the existing legislations on the reproductive rights of WID and puts forward guidance for clinicians on how to approach the issue.
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Affiliation(s)
- Sundarnag Ganjekar
- Additional Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Sydney Moirangthem
- Additional Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Channaveerachari Naveen Kumar
- Professor of Psychiatry, Head, Community Psychiatry Services, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Geetha Desai
- Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
| | - Suresh Bada Math
- Professor of Psychiatry, Head, Forensic Psychiatry Services and Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru 560 029 INDIA
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Nirisha PL, Malathesh BC, Kulal N, Harshithaa NR, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Parthasarathy R, Manjappa AA, Thirthalli J, Chand PK, Arora S, Math SB. Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training. Community Ment Health J 2023; 59:175-184. [PMID: 35779139 PMCID: PMC10290774 DOI: 10.1007/s10597-022-00996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.
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Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Barikar C Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | - Nithesh Kulal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nisha R Harshithaa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - N Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Adarsha Alur Manjappa
- DMHP Psychiatrist, Department of Health and Family Welfare, Government of Karnataka Office of the District Health Officer, Ramanagara District, Ramanagara, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Vranda MN, Janardhana N, Kumar CN. Development of preparedness to respond to intimate partner violence scale among mental health professionals. J Neurosci Rural Pract 2023; 14:98-102. [PMID: 36891117 PMCID: PMC9945028 DOI: 10.25259/jnrp-2022-4-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Violence against women has been associated with serious health and mental health consequences. Health-care professionals play an important role in screening and providing care and support to victims of intimate partner violence (IPV) in the hospital setting. There is no culturally relevant tool to assess the mental health professional (MHP) preparedness to screen for partner violence in the clinical setting. This research aimed towards developing and standardizing scale to measure MHP preparedness and perceived skills in responding to IPV in the clinical setting. Materials and Methods The scale was field tested with 200 subjects using consecutive sampling at a tertiary care hospital. Results The exploratory factor analysis resulted in five factors constituting 59.2% of the total variance. The internal consistency Cronbach alpha 0.72 for the final 32-item scale was highly reliable and adequate. Conclusion The final version of the Preparedness to Respond to IPV (PR-IPV) scale measures MHP PR-IPV in the clinical setting. Further, the scale can be used to evaluate the outcome of IPV interventions in different settings.
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Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Navaneetham Janardhana
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Moorkath F, Vranda MN, Naveen Kumar C. Eventful past, stagnant present, and hopeful future: A time order analysis of experiences of homeless women with chronic mental illness residing in shelter care homes. Int J Soc Psychiatry 2022; 68:1790-1794. [PMID: 34865542 DOI: 10.1177/00207640211060148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In developing countries like India, many women with mental illness are residing in shelter care homes (SCHs) without their wish. SCHs are residential facilities provided to the socially and economically backward women for free of cost. These facilities are funded by government or voluntary organizations. AIM To understand the living experiences of homeless women with chronic mental illness (HWCMI) admitted in SCHs. METHOD This article highlights learning from a qualitative study, 17 HWCMI participated in the research. Along with their past experiences, present life, and expectations in the future, other socio-demographic details also recorded. Qualitative data were analyzed using thematic analysis approach with the Atlas ti-8 software. Findings: Three main themes were emerged from the analysis such as 'Eventful past', 'Stagnant present', and 'Hopeful future'. The theme 'Eventful past' shows clear pathways to homelessness. 'Stagnant present' reflects upon trapped present life and their concerns and care-related aspects. The final theme, 'hopeful future', depicts strong hope in future and readiness for changing their living situations. The findings are discussed in the background of current trends in psychiatric rehabilitation and what is lacking in the Indian context. CONCLUSION This study attempts to unveil the gender-specific and person-centric explanations of experiences associated with the combination of homelessness and mental illness.
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Affiliation(s)
- Febna Moorkath
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Shadakshari D, Vajawat B, Malathesh BC, Damodharan D, Gowda GS, Seshagiri D V, Kumar CN, Math SB. The Interface of Clinical, Legal, and Rehabilitative Aspects of Patients With a Neuropsychiatric Disorder in Forensic Psychiatry Setting in India: A Systematic Approach. Indian J Psychol Med 2022; 44:607-611. [PMID: 36339692 PMCID: PMC9615444 DOI: 10.1177/02537176211008564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Darshan Shadakshari
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bhavika Vajawat
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Barikar C Malathesh
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dinakaran Damodharan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guru S Gowda
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seshagiri D V
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022; 7:212. [PMID: 37953926 PMCID: PMC10636350 DOI: 10.12688/wellcomeopenres.18028.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/14/2023] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24 th May 2021.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Vanteemar S. Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Chandramouli Roy
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Uppinkudru Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kiran Basawaraj Bagali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Sudhir Venkataramaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Gopala Krishna Kadarapura Nanjundaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
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Sinha P, Shreekantiah U, Goyal N, Sreeraj VS, Arumugham SS, Samantaray S, Jammigumpula A, Nanjundaiah GKK, Venkataramaiah S, Thennarasu K, Roy C, Purohith AN, Shenoy S, Kumar CN, Shivakumar V, Udupa K, Muralidharan K, Venkatasubramanian G, Thirthalli J, Praharaj SK, Mehta UM. Study protocol for evaluating the clinical efficacy and neurobiological correlates of sequential treatment with tDCS primed iTBS and ECT in treatment-resistant depression. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18192.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Treatment-resistant depression is a burdensome condition. Intermittent theta burst stimulation (iTBS) of the left dorsolateral prefrontal cortex is considered a treatment option in early course of resistance with a proportion of such patients responding to it. Preliminary evidence suggests a role of priming iTBS stimulation with preconditioning using cathodal transcranial direct current stimulation (tDCS). This protocol describes a double-blind randomized sham-controlled study to evaluate the clinical efficacy and tolerability of tDCS-primed iTBS in the treatment of resistant depression. Non-responders to this trial will be offered open-label electroconvulsive therapy. All participants will undergo neurobiological investigations that will enable the identification of potential response predictors and mechanisms. Methods: Three hundred and fifty consenting patients with treatment resistant depression will be randomly assigned to receive 20–30 daily sessions of true-tDCS or sham-tDCS primed iTBS over left dorsolateral prefrontal cortex at three study centers. After this blinded sham-controlled trial, non-responders to the intervention will be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging, electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphisms) will be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial will evaluate the improvement in depressive symptoms (Hamilton depression rating scale) between the two groups as the primary outcome measure.
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23
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Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24th May 2021.
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Ibrahim FA, Malathesh BC, Gajera G, Pandey P, Nirisha P L, Jyrwa S, Kumar CN, Manjunatha N, Jain S, Bairy BK, Bada Math S. Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached. Int J Soc Psychiatry 2022; 68:954-957. [PMID: 33860714 DOI: 10.1177/00207640211011191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings (n = 2150). The objective of this article is to give a brief overview of the initiative. METHODS CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. RESULTS AND CONCLUSION From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.
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Affiliation(s)
- Ferose Azeez Ibrahim
- Dorothy Pattison Hospital, Black Country Healthcare NHS Foundation Trust, CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Barikar C Malathesh
- Telemedicine Centre, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Gopi Gajera
- CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Praveen Pandey
- CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Lakshmi Nirisha P
- Telemedicine Centre, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Sonakshi Jyrwa
- Department of Psychiatry, AIIMS Nagpur and Ex-Senior Resident, CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | | | - Sumi Jain
- NCDs and Mental Health, Government of Chhattisgarh, Raipur, Chhattisgarh, India
| | - Bhavya K Bairy
- NIMHANS Digital Academy, NIMHANS, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Community Psychiatry Services, NIMHANS, Bengaluru, Karnataka, India
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Sivakumar T, Jadhav P, Allam A, Ramachandraiah S, Vanishree BNG, Meera J, Santhosha S, Doddur D, Janardhana AL, Basavarajappa C, Kumar CN, Thirthalli J. Continuity of Care for Persons With Serious Mental Illness in a Rural Rehabilitation Program During the COVID-19 Pandemic in India. Psychiatr Serv 2022; 73:830-833. [PMID: 34991340 DOI: 10.1176/appi.ps.202100462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has posed challenges to community-based rehabilitation (CBR) for persons with mental illness, especially in resource-constrained settings. This column discusses the pandemic-related challenges faced by a rural CBR program in Jagaluru taluk (a subdistrict) in Karnataka, India. Thanks to stakeholder collaboration, task shifting with lay health workers, and implementation of telepsychiatry, the authors' clinical team could ensure uninterrupted medical care for persons with serious mental illness. Other CBR components were reduced because of pandemic-imposed resource and logistic constraints.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Prabhu Jadhav
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Abhishek Allam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Sujai Ramachandraiah
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Byalya Nanje Gowda Vanishree
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jyothi Meera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Shivamurthy Santhosha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Dundappa Doddur
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Akkalapura Lokappa Janardhana
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
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Philip S, Varshney P, Chander R, Patley R, Dosajh AC, Basavaraju V, Manjunatha N, Kumar CN, Math SB. Telementoring Counseling Skills for Deaddiction Counselors in Punjab During the COVID-19 Pandemic. Indian J Psychol Med 2022; 44:419-421. [PMID: 35949626 PMCID: PMC9301738 DOI: 10.1177/02537176221081777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prateek Varshney
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rakesh Chander
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rahul Patley
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anu Chopra Dosajh
- Dept. of Health and Family Welfare, Mental Health and Deaddiction, Government of Punjab, Chandigarh, Punjab, India
| | - Vinay Basavaraju
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Vranda MN, Kumar CN, Janardhana N. Development and training of mental health professionals in providing psychological intervention and support for women survivors of intimate partner violence - A pre-post evaluation study. Ind Psychiatry J 2022; 31:325-330. [PMID: 36419680 PMCID: PMC9678173 DOI: 10.4103/ipj.ipj_164_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Health care providers play a significant role as they are the first contact for seeking help for intimate partner violence (IPV) survivors. AIMS This research aimed toward developing a comprehensive culturally appropriate intervention package for the mental health professionals (MHPs) to provide psychological intervention and support for women survivors of IPV and test the training impact on the level of attitude, knowledge, and preparedness to respond to IPV disclosure among MHPs. SETTINGS AND DESIGN A single group, pre-post intervention study, was conducted at Tertiary Mental Health Hospital in the Southern part of India, Bengaluru. MATERIALS AND METHODS A total of 30 MHPs were recruited for the study using purposive sampling. MHP Attitude, Knowledge, Preparedness to Manage IPV (MAP-IPV) questionnaire was used to collect the data. STATISTICAL ANALYSIS USED Descriptive statistics were used to assess the sociodemographic characteristics of the participants. The pre-post evaluation was analyzed using the independent "t" test by comparing the means scores of the MAP-IPV questionnaire. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) - 20 version of the software. RESULTS The results revealed a lack of attitude, knowledge preparedness, and available resources materials among MHPs in addressing IPV cases. Pre-post evaluation showed statistically significant improvement in attitude, knowledge, and preparedness to identify and respond to IPV disclosure among MHPs after the intervention program. CONCLUSION The comprehensive IPV intervention package effectively brings gain in attitude, knowledge, and preparedness among MHPs in addressing survivors of IPV. Practice guidelines and clear referral pathways following IPV disclosure need to be implemented to support the gains made through the training.
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Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), (Institute of National Importance), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), (Institute of National Importance), Bengaluru, Karnataka, India
| | - Navaneetham Janardhana
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), (Institute of National Importance), Bengaluru, Karnataka, India
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Philip S, Suhas S, Nirisha PL, Pandey P, Manjunatha N, Kumar CN, Math SB. Ethical and legal issues concerning COVID 19 vaccinations in persons with mental illness in India. Ind Psychiatry J 2022; 31:183-190. [PMID: 36419684 PMCID: PMC9678180 DOI: 10.4103/ipj.ipj_228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/22/2022] [Accepted: 05/11/2022] [Indexed: 11/04/2022] Open
Abstract
Mental healthcare in India faces severe challenges amid the ongoing pandemic. India runs the largest vaccination drive globally, including booster doses to rapidly vaccinate its population of over a billion. As persons with mental illness are at greater risk of adverse outcomes from COVID 19, they need prioritized access and administration of these vaccines. This manuscript examines the current legislation and identifies how the legal and ethical frameworks can prioritize COVID 19 vaccinations for persons with mental illness in India through a review of the various legislations of India concerning persons with mental illness and judicial judgments concerning the pandemic and vaccination. Subsequently, we discuss ethical and legal challenges associated with vaccination in this vulnerable population and possible solutions. Based on the current review, the authors recommend the guidelines for capacity assessment for vaccination decisions and discuss existing legal frameworks relevant to the vaccination of persons with mental illness.
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Affiliation(s)
- Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Praveen Pandey
- 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
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
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29
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Kadiveti S, Vajawat B, Kumar CN, Hegde PR, Moirangthem S, Math SB. Free legal aid in hospitals for persons with mental illness: Is it helpful? An Indian prospective study. Indian J Psychiatry 2022; 64:322-325. [PMID: 35859558 PMCID: PMC9290419 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_510_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Legislative backing exists to set up free legal aid clinics in psychiatric hospitals to provide legal assistance to their patients. AIMS This study aimed to assess the utility of a free legal aid clinic running inside a mental health establishment. METHODS In this prospective study, 71 subjects (chosen via convenience sampling) were recruited. Assessments were carried out at baseline and two months after intake. Legal needs and the legal outcomes were assessed. RESULTS Most of the legal issues were either family-related (50.7%) or civil issues (28.2%). A majority of patients (64.4%) had implemented the advice given at the clinic. Those who had implemented the advice had a better legal outcome, defined as either resolution of the legal issue or that the legal issue was in an active proceeding compared to those who had not implemented the advice (P = 0.007). CONCLUSION The provision of free legal aid services in mental health establishments would benefit patients.
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Affiliation(s)
- Sriharsha Kadiveti
- Department of Psychiatry, Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Victoria, Australia
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Prakyath R Hegde
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, Mehra A, Saha G, Sahoo S, Singh OP, Tripathi A, Gangadhar BN, Math SB. Current telepsychiatry practice in India - An online survey of psychiatrists. Indian J Psychiatry 2022; 64:307-311. [PMID: 35859562 PMCID: PMC9290427 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_331_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 03/14/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines released in 2020 have provided legal backing for telepsychiatry practice. AIMS To understand the current telepsychiatry practices in India. SETTINGS AND DESIGN An online survey was conducted after ethics approval by the IPS Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose email address was available with the society, were sent the survey link by email. METHODS AND MATERIAL Information about existing telepsychiatry consultation practices in India was collected between June and July 2020. STATISTICAL ANALYSIS USED Frequency, percentages, mean, and standard deviation were calculated. RESULTS 340 responses were analyzed. Nearly three-fourths of the responders used smartphones (n = 260, 76.47%) for audio consultations (n = 196, 57.65%). Among those who were using a dedicated software (n = 36), one-third used the Zoom software (n = 12, 33.33%). Nearly three-fourths (n = 218, 73.4%) provided prescriptions with their registration number on a letterhead in the form of an email or text message. Two-thirds of the responders (n = 228, 67.06%) felt that in-person consultation is better. Many preferred a combination of voice, video, and text including emails (n = 134, 42.01%). CONCLUSIONS This online survey showed that the use of technology has caught up with the practicing psychiatrists. Many are practicing telepsychiatry either formally or informally in India and are comfortable and satisfied with the telepractice.
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Affiliation(s)
- Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajit Avasthi
- Department of Psychiatry, Fortis Hospital, Mohali, Punjab, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Barasat, West Bengal, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Singh
- Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Vranda MN, Kumar CN, Janardhana N. Developing a Screening Tool for Mental Health Professionals for Measuring Intimate Partner Violence among Women with Mental Illness at Tertiary Care Setting. J Neurosci Rural Pract 2022; 13:393-397. [PMID: 35946023 PMCID: PMC9357474 DOI: 10.1055/s-0042-1744227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background
Intimate partner violence (IPV) is the major public health issue seen in all cultures. Mental health professionals play a significant role in screening IPV and providing needed care and support to the survivors. There is a dearth of scale to measure comprehensively different dimensions of violence. The study aimed to develop a screening tool for measuring IPV among women with mental illness (WwMI) in India.
Methods
The newly developed IPV scale was administered to 200 WwMI at a tertiary care hospital.
Results
The factor analysis revealed four factors constituted 67.15% of the variance. The internal consistency Cronbach's α (0.92) and split-half reliability coefficient value (0.80) for the final 31-item IPV scale were found to be highly adequate and reliable.
Conclusion
Psychometric properties of scale found to be an effective tool for screening IPV among WwMI by mental health professionals and planning effective intervention strategies to prevent the IPV.
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Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health Neurosciences, Bengaluru, Karnataka, India
| | | | - Navaneetham Janardhana
- Department of Psychiatric Social Work, National Institute of Mental Health Neurosciences, Bengaluru, Karnataka, India
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Basavaraju V, Murugesan M, Kumar CN, Gowda GS, Tamaraiselvan SK, Thirthalli J, Nagabhushana SH, Manjunatha N, Bada Math S, Parthasarathy R, Arunachalam V, Kumar Ks C, Am A, H C. Care at door-steps for persons with severe mental disorders: A pilot experience from Karnataka district mental health program. Int J Soc Psychiatry 2022; 68:273-280. [PMID: 33356744 DOI: 10.1177/0020764020983856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public funded outreach services for persons with severe mental disorders (SMDs), a norm in developed nations, is non-existent in India. We share our pilot experience with an indigenous model named 'Care at Doorsteps' (CADs) for persons with SMDs who dropped out from clinical care of District Mental Health Program (DMHP) at three sites of Karnataka, a south Indian state. AIM The objectives of this study were to identify the reasons for drop outs from routine care and to assess the burden of illness and disability after the intervention. METHODOLOGY Six-month prospective observational study on patients aged 18-60 years, diagnosed as Schizophrenia or bipolar disorder was conducted. Three home visits were made by the team and provided medications, also offered brief psychoeducation and counselling. Care-givers were interviewed to identify the reasons for drop outs and their expectations from the treating team. Patients were also assessed using the Clinical Global Impression Scale (CGI), Indian Disability Evaluation and Assessment Scale (IDEAS) and Burden Assessment Schedule (BAS) during each visit. RESULTS Ninety-six patients (50 males and 46 females) were followed up, of which 85 had a diagnosis of schizophrenia and 11 with bipolar illness. Common reasons for drop out were: single caregiver (breadwinner) unable to accompany the patient, loss of faith in medical treatment and financial constraints. Symptomatic improvement and restoration of productive work were the priority expectations. Over the course, the mean CGI-S showed significant reduction (4.81 ± 1.57, 4.46 ± 1.32 and 4.11 ± 1.39 respectively; p = 0.001). Mean score on BAS showed a significant reduction (85.76 ± 12.15, 83.46 ± 11.30, 84.27 ± 11.82; p = 0.04). Mean total IDEAS scores did not show significant change (13.27 ± 4.78, 12.82 ± 4.24, 13.17 ± 4.40; p = 0.16). CONCLUSION Meaningful assertive outreach care is feasible in India and is found to be useful for persons with SMDs by utilising the already existing public sector resources.
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Affiliation(s)
- Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Manisha Murugesan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Vikram Arunachalam
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Chetan Kumar Ks
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Adarsha Am
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Chandrashekar H
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, Mehra A, Saha G, Sahoo S, Singh OP, Tripathi A, Gangadhar BN, Math SB. The prescriptions of psychotropic medications in telepsychiatry: An online survey of psychiatrists in India. Indian J Psychiatry 2022; 64:159-163. [PMID: 35494322 PMCID: PMC9045339 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1438_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Over the years, telepsychiatry services have expanded in many institutes. The Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines (TPOG) released in 2020 have been received by the fraternity with a mixture of apprehension, relief, and dissatisfaction on the list of drugs provided in Lists O, A, B, and C. Many psychiatrists have raised the issues of having a consensus in the formulation of List A. AIMS To draw consensus on the medications that can be listed in Lists O, A, B, and C in TPOG-2020. SETTINGS AND DESIGN This was an online survey with ethics approval by the Indian Psychiatric Society Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose E-mail address was available with the society, were sent the survey link by E-mail. METHODOLOGY Opinions and suggestions on Lists O, A, B, and C of TPOG-2020 and reasons for the suggestions were collected. STATISTICAL ANALYSIS USED Frequency, percentages, mean, and standard deviation were calculated. T-test and Chi-square tests were used to see the influence of demographics on the concurrence of the lists. RESULTS Responses from 340 responders were analyzed. Majority of the responders agreed that List O (277, 85.5%), List B (263, 82.4%), and List C (223, 69%) are apt except for List A (162, 50.3%). CONCLUSIONS This online survey showed that majority of the responders agreed to the lists except for List A. The approach taken to include the medications in List A, which was to include the essential drugs, has various benefits. However, the lists are not final, and the results of this survey may become an impetus to modify the list in the next edition of TPOG.
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Affiliation(s)
- Chethan Basavarajappa
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Channaveerachari Naveen Kumar
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Barasat, Kolkata, West Bengal, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Singh
- Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bangalore N Gangadhar
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Dinakaran D, Manjunatha N, Kumar CN, Math SB, Thirthalli J. The rationale and guiding principles to design a psychiatry curriculum for primary care doctors of India. Natl Med J India 2022; 35:32-37. [PMID: 36039625 DOI: 10.25259/nmji_289_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Integrating psychiatric care into the general practice of primary care doctors (PCDs) is necessary to overcome the shortage of human resources to cater to the burgeoning public mental health needs of India. The traditional psychiatry curriculum is often top-down and specialist-based that contributes little in terms of skill quotient. We designed an innovative, digitally driven, distance education-based, part-time, modular-based Primary Care Psychiatry Programme (PCPP, skill-based). It is being implemented across many states of India to equip PCDs with skills to provide first-line psychiatry treatment. We discuss the rationale and guiding principles behind designing the curriculum of PCPP. Discussion There are nine guiding principles behind designing and implementing PCPP to provide pragmatic, acceptable, feasible modules of higher translational quotient (TQ) that are essential to upskill PCDs. There is a shift in training the location of PCDs in their live brief general consultations utilizing innovative telemedicine-based 'on-consultation training' (OCT) augmented with collaborative video consultations. A monolithic treatment protocol-driven, trans-diagnostic approach is used to design a concise, all-inone, point-of-care manual containing a culturally sensitive, rapid, validated screener and taxonomy, called 'Clinical Schedules for Primary Care Psychiatry'. This incorporates the PCDs' style of clinical practice that helps in picking up the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPP curriculum contains pragmatic modules with higher TQ. This curriculum is dynamic as the learning is bi-directional. This can be used by policy-makers, innovators and academia for integration with national health programmes such as those for non-communicable diseases and reproductive and child health.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Sivakumar T, Kumar CN, Thirthalli J. Role of accredited social health activists in treatment of persons with severe mental illness in the community. Indian J Psychiatry 2022; 64:102-105. [PMID: 35400750 PMCID: PMC8992760 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_702_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, Sahoo S, Saha G, Mehra A, Singh OP, Tripathi A, Gangadhar BN, Math SB. Perceived advantages and disadvantages of telepsychiatry - An online survey of psychiatrists in India. Indian J Psychiatry 2022; 64:93-97. [PMID: 35400742 PMCID: PMC8992744 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_332_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/11/2021] [Accepted: 12/23/2021] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Telepsychiatry is being practiced in India for many years but was formalized only in 2020. It has many advantages and disadvantages. AIMS This study aimed to understand the perceived advantages and disadvantages of telepsychiatry practices in India. SETTINGS AND DESIGN An online survey with ethics approval by the Indian Psychiatric Society (IPS) Ethics Review Board. All psychiatrists who are members of the IPS and whose email address was available with the society were sent the survey link by email. METHODOLOGY Information about existing telepsychiatry consultation practices in India and perception of advantages and disadvantages by the practitioners were collected between June and July 2020. STATISTICAL ANALYSIS Frequency, percentages, mean, and standard deviation were calculated. RESULTS Responses by 340 responders were analyzed. Majority of the responders felt that telepsychiatry would provide easy accessibility to mental health services (n = 283, 83.24%) and would lead to less exposure to infections (n = 222, 65.29%). Half of the responders (n = 177, 52.06%) felt that there would be an increased doctor shopping resulting in poor care and nearly three-fourth (n = 245, 72.06%) felt that mental health professionals would fall into a problem while dealing with a suicidal or a homicidal patient. Some expressed that the inability to do physical and central nervous system examinations could lead to missing out comorbidities. About one-third (n = 117, 36.56%) felt that the patient recording the consultation would be a legal issue. CONCLUSIONS This online survey showed that psychiatrists perceive many advantages and some disadvantages in practicing telepsychiatry.
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Affiliation(s)
- Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Barasat, Kolkata, West Bengal, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Singh
- Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Malathesh BC, Bairy BK, Kumar CN, Nirisha PL, Gajera GV, Pandey P, Manjunatha N, Ganesh A, Mehrotra K, Bhaskarapillai B, Gunasekaran DM, Arora S, Sinha NK, Math SB. Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India. Psychiatr Q 2021; 92:1855-1866. [PMID: 34510379 DOI: 10.1007/s11126-021-09945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10 months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0-20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0-10). Total 20,909 patients were cared for in the 12 months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t = - 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.
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Affiliation(s)
| | - Bhavya K Bairy
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - P Lakshmi Nirisha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopi V Gajera
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aurobind Ganesh
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kanika Mehrotra
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjeev Arora
- Distinguished Professor of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Chander R, Murugesan M, Ritish D, Damodharan D, Arunachalam V, Parthasarathy R, Raj A, Sharma MK, Manjunatha N, Bada Math S, Kumar CN. Addressing the mental health concerns of migrant workers during the COVID-19 pandemic: An experiential account. Int J Soc Psychiatry 2021; 67:826-829. [PMID: 32594816 DOI: 10.1177/0020764020937736] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID pandemic has affected the world in a drastic manner taking a toll of not only human lives but also the economy and lifestyle. Of all the population suffering, the underprivileged and vulnerable groups have faced the maximum economic burden. Within India, an ample quota of people migrates annually for elementary occupations in service, sales, building and domestic industries. Generally, they are exposed to discrimination, work-rights exploitation and job insecurity. The onset of COVID 19 has accentuated these issues in unprecedented ways. The Apex Court of the country took note of this plight and gave directions to the governments to take care of the immediate needs of the migrant workers. This article attempts to reflect the mental health concerns of the migrant workers who were temporarily sheltered at relief camps across Bengaluru city in the state of Karnataka, during the ongoing COVID pandemic. The article ends with giving recommendations.
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Affiliation(s)
- Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manisha Murugesan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Daniel Ritish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dinakaran Damodharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vikram Arunachalam
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Aravind Raj
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manoj Kumar Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Narasimha Vranda M, Naveen Kumar C, Muralidhar D, Janardhana N, Thangaraju Sivakumar P. Intimate Partner Violence, Lifetime Victimization, and Sociodemographic and Clinical Profile of Women with Psychiatric Illness at a Tertiary Care Psychiatric Hospital in India. Indian J Psychol Med 2021; 43:525-530. [PMID: 35210681 PMCID: PMC8826200 DOI: 10.1177/0253717620938870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is one of the major public health problems. Little is known about the extent of violence experienced, its severity, or history of childhood abuse or exposure to intergenerational family violence in women with mental illness. METHODS One hundred women seeking in-patients (IP) or out-patients (OP) services at a tertiary care psychiatric setting were recruited using consecutive sampling. IPV Questionnaire and Danger Assessment Questionnaire were administered. RESULTS The data revealed a moderate level of IPV experienced by the women. In their childhood, more than one-third had undergone physical abuse by their fathers and witnessed violence by fathers toward mothers. CONCLUSION Screening for intimate violence is essential in women attending mental health settings.
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Affiliation(s)
- Mysore Narasimha Vranda
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Dalibonia Muralidhar
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Navaneetham Janardhana
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Manjunatha N, Kumar CN, Math SB. Virtual physical examination in video consultations: A valid inspection component of physical examination? Natl Med J India 2021; 34:122. [PMID: 34599133 DOI: 10.4103/0970-258x.326756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Agarwal V, Thirthalli J, Kumar CN, Christopher R, U Arunachal G, Reddy KS, Rawat VS, Gangadhar BN, Wood J, Nimgaonkar V. Parental consanguinity among patients with schizophrenia in a rural community of South India: A clinical and genetic investigation. Asian J Psychiatr 2021; 64:102814. [PMID: 34425412 DOI: 10.1016/j.ajp.2021.102814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Studies from certain regions of the world indicate that consanguineous marriages are a risk factor for the development of schizophrenia in offspring. However the evidence is inconsistent partly due to methodological limitation of which hospital based recruitment contributing to significant bias. The studies from the Indian subcontinent, is scarce, where rates of consanguinity is high. METHODS The schizophrenia patients living in a geographically defined rural south Indian community and randomly selected controls dwelling in the same community sharing sociocultural, economic and lifestyle factors were recruited. They were assessed for parental consanguinity using the clinical interviews as well as DNA-based estimates. The latter was conducted by calculating the coefficient of inbreeding 'f'. A participant was considered to have consanguineous parentage if his/her parents shared a common ancestor no more remote than a great-great-grandparent, corresponding to DNA-based estimates of 'f' ≥ 0.0156. RESULTS The rates of parental consanguinity assessed by clinical interview were comparable in both groups (Cases: 10.71 %, Controls: 7.25 %; χ2 = 0.493, p = 0.4825). However, DNA-based rates of parental consanguinity showed that 'f' was significantly higher among cases than controls (Mann-Whitney U = 11315.5; p = 0.022). Seventy-five cases (62.5 %) and 108 control participants (48.6 %) had 'f' ≥ 0.0156 (χ2 = 6.008; p = 0.014). The results were consistent across different quality control measures. CONCLUSION Schizophrenia is associated with higher parental consanguinity, suggesting a role for multiple recessive risk alleles in its etiology. Replication in future studies in diverse settings would add further strength to this.
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Affiliation(s)
- Vikas Agarwal
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India.
| | | | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Gautham U Arunachal
- Department of Human Genetics, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - K Shanivaram Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Mediacal Sciences, Rishikesh, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Hospital, Pittsburgh, USA
| | - Vishwajit Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Hospital, Pittsburgh, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
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Rangarajan SK, Sivakumar PT, Manjunatha N, Kumar CN, Math SB. Public Health Perspectives of Geriatric Mental Health Care. Indian J Psychol Med 2021; 43:S1-S7. [PMID: 34732947 PMCID: PMC8543608 DOI: 10.1177/02537176211047963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In older adults (aged 60 years and above), mental health problems are gaining public health importance because of the increasing prevalence, disease burden, disability, morbidity, and mortality. Epidemiological studies on major mental health disorders such as depression and dementia in older adults have contributed to a better understanding of the distribution and determinants of these conditions. Identifying potential risk factors has stimulated interventional research on preventing these conditions under the public health framework towards their management. The increasing burden of geriatric mental health conditions like dementia in developing countries like India can contribute to significant challenges if there is no adequate strengthening of the public health response. This includes scaling up the measures of prevention, public awareness, early diagnosis, and quality health and social care equitably available to all sections of the population. The Decade of Healthy Ageing (2021-2030) provides the opportunity for concerted and coordinated initiatives to improve intrinsic capacity (physical and mental) and offer an age-friendly environment to enhance the functional ability of all older adults. METHODS This article reviews the critical public health issues related to geriatric mental health in India.
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Affiliation(s)
- Subhashini K. Rangarajan
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Dept. of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Vajawat B, Hegde PR, Malathesh BC, Kumar CN, Sivakumar PT, Math SB. Palliative Care and Legal Issues in Geriatric Psychiatry. Indian J Psychol Med 2021; 43:S31-S36. [PMID: 34732952 PMCID: PMC8543619 DOI: 10.1177/02537176211031077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is an increased risk of debilitating illnesses that often have no curative treatment with aging. The mainstay of treatment in many such conditions is palliative care: a holistic approach focused on preventing and relieving physical, psychosocial, legal, ethical, and spiritual problems. It involves the facilitation of end-of-life care decisions aimed at relieving distress and improving quality of life. In this article, the authors discuss the role of mental health professionals in legal issues related to palliative care in the elderly around decision-making, right to autonomy, euthanasia, and advanced directive. The cognitive decline associated with aging and mental health issues in the palliative care setting of an individual such as dementia, depression, and hopelessness, and impact on the family members like burnout may influence the overall capacity of that individual to make decisions about their treatment. While an individual has a right to self-determination and autonomy, withholding or withdrawing treatment has many legal and ethical implications, more so in those with incapacity, especially in India due to the absence of uniform legislation. The decision to withhold or withdraw treatment might be a restrictive choice due to limited options in a setting with a lack of palliative care options, poor psychosocial support, nonaddress of mental health issues, and lack of awareness. As the right to health is a constitutional right, and the right to mental health is legally binding under Section 18 of the Mental Health Care Act 2017, systematic efforts should be made to scale up services and reach out to those in need.
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Math SB, Nagendrappa S, Mukku SSR, Harshitha NR, Venu MA, Manjunatha N, Kumar CN, Sivakumar PT, Thirthalli J. Video consultations from an Indian academic hospital: First 3 years of experience from telepsychiatric after-care clinic. Natl Med J India 2021; 34:261-265. [PMID: 35593247 DOI: 10.25259/nmji_189_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Continuity of care for psychiatric disorders by conventional in-person consultation by psychiatrists is associated with several challenges. There is a need to develop alternative models of specialist care. We studied our 3 years' experience of live video consultations (VCs) from the tele after-care clinic to patients with psychiatric disorders at an Indian academic hospital. Methods We did a file review of 669 VCs provided to 213 patients in the first 3 years (2017-2019) from the telemedicine centre of a tertiary care academic hospital. We analysed details of sociodemography, clinical profile, tele after-care consultations and outcome. Results Two hundred and thirteen patients (55% men) were enrolled for the tele after-care clinic. The mean (SD) age of the patients was 42.2 (17.29) years and a majority were educated till high school and beyond. Patients with severe and common mental disorders constituted 60.1% and 40%, respectively. Among the total 669 appointments, 542 (81%) VCs were successfully provided; of the remaining, 125 were cancelled and 2 were aborted due to a medical emergency. Medication prescriptions were unchanged in 499 and modified/totally changed in 47 VCs. Conclusion Our large study shows that telepsychiatric after-care is a useful alternative method which can supplement in-person follow-up. Barriers such as distance, cost and medical illness can be overcome using tele after-care clinics for regular follow-ups in stabilized psychiatric patients. There is a need for prospective studies, preferably, randomized controlled trials comparing effectiveness of tele after-care with in-person consultations to assess treatment outcomes.
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Affiliation(s)
- Suresh Bada Math
- Tele-Medicine Centre, Forensic Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Sachin Nagendrappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Shiva Shanker Reddy Mukku
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Nisha R Harshitha
- Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Mekala A Venu
- Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Narayana Manjunatha
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Forensic Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
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Abstract
BACKGROUND The sociocultural changes associated with globalization and development have weakened the traditional values and family support systems for senior citizens (age 60 years and above). There is an increase in the prevalence of elder abuse and difficulties in getting appropriate care and support. This has mandated legal measures to protect the rights of the senior citizens and provide them care and support by the family and other stakeholders. Consequent to being the signatory for the "Madrid International Plan of Action on Ageing, 2002," several countries, including India, have introduced legislation for the social protection of senior citizens. "The Maintenance and Welfare of Parents and Senior Citizens(MWP) Act, 2007" is an important legislation in India to safeguard the elderly from exploitation and abuse. METHODS This article critically evaluates the implementation of the MWP Act, 2007, and the related challenges in protecting senior citizens from abuse. The article will also highlight the proposed amendments in the Act to strengthen the effective implementation of legal protection for senior citizens and ensure their well-being and dignity. CONCLUSIONS The MWP act is an important legal measure to ensure mainatinence and welfare of senior citizens and protect them from abuse and neglect. There is an immediate need to incorporate the necessary amendments so that the act gets more pragmatic value and becomes and important tool for elderly care and protection and reduce vulnerabilities and ensure holistic care with support in various bio-psycho-social domains.
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Affiliation(s)
- Thomas Gregor Issac
- Geriatric Psychiatry Unit, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Abhishek Ramesh
- Geriatric Psychiatry Unit, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shiv Shanker Reddy
- Dept. of Psychiatry, Vishwabharati Medical College and Hospital, Kurnool, Andhra Pradesh, India
| | - Palanimuthu T Sivakumar
- Geriatric Psychiatry Unit, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Forensic Psychiatry Unit, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Philip S, Gajera G, Nirisha PL, Sivakumar PT, Barikar MC, Panday P, Patley R, Chander R, Sinha P, Basavarajappa C, Manjunatha N, Kumar CN, Math SB. Future-Proofing Geriatric Mental Health Care Services in India: Training and Policy Directions. Indian J Psychol Med 2021; 43:S134-S141. [PMID: 34732966 PMCID: PMC8543623 DOI: 10.1177/02537176211032342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A burgeoning rise in the elderly subpopulation is being noted in India. This rise has already earned the designation as a shining nation by the United Nations/World Health Organization. This growth will take the elderly subpopulation to 324 million persons above 60 years by 2050. The mental health needs of this subpopulation are varied and nuanced compared to that of the general population. The risk and prevalence of mental health morbidity are also greater. There is an urgent need to gear up the health care systems. CONSIDERATIONS Various aspects of the ongoing demographic transitions are considered alongside available health information. Legislative mandates and laws are also reviewed to provide context to qualify the action points and recommendations. Recommendations, India must act urgently to strengthen health care delivery systems in a concurrent multipronged approach. These efforts should focus on developing trained Human Resources and adequate infrastructural resources. Review mechanisms to inform on required updates on best practices and evidence-based medicine must also be incorporated and developed to perform periodically.
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Affiliation(s)
- Sharad Philip
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gopi Gajera
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - P Lakshmi Nirisha
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Palanimuthu Thangaraju Sivakumar
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Malathesh C Barikar
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Praveen Panday
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rahul Patley
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rakesh Chander
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Preeti Sinha
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chethan Basavarajappa
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Channaveerachari Naveen Kumar
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Suresh Bada Math
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. 2Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Affiliation(s)
- Prateek Varshney
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Harkishan Mamtani
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Prabha S Chandra
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Vajawat B, Hegde PR, Varshney P, Malathesh BC, Kumar CN, Math SB. Civil responsibility in Geriatric Psychiatry. Indian J Psychol Med 2021; 43:S60-S65. [PMID: 34732956 PMCID: PMC8543617 DOI: 10.1177/02537176211031062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mental health issues impair decision-making capacity, more so in elderly people. Impaired decision-making capacity can make person unfit to enter into various civil deeds and agreements. Such civil deeds can include guardianship, property transaction, holding a bank account, having voting rights, making a will, donating an organ, etc. This article focuses on importance of mental health in entering into above-mentioned civil agreements, how to do assessments to determine if one is fit to enter into civil agreements, and what are the legal ways in which a person can avail help to execute his/her civil rights even when affected by mental health issues.
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Affiliation(s)
| | | | | | - Barikar C. Malathesh
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
- Barikar C. Malathesh, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka 560029, India. E-mail:
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Malathesh BC, Ibrahim FA, Nirisha PL, Kumar CN, Chand PK, Manjunatha N, Math SB, Thirthalli J, Manjappa AA, Parthasarathy R, Reddy S, Arora S. Embracing Technology for Capacity Building in Mental Health: New Path, Newer Challenges. Psychiatr Q 2021; 92:843-850. [PMID: 33215290 PMCID: PMC7676753 DOI: 10.1007/s11126-020-09859-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
Technology driven capacity building initiatives are the way to break the barrier of shortage of mental health human resources in India. This new path, while is a welcome step, comes with its own set of challenges. In one prototypic project that is being implemented in Ramanagara District of Karnataka, a south Indian state, we encountered many such issues. They ranged from issues related to availability of dedicated space to set up the hub-studio, inconsistent internet connectivity (particularly in remote areas) and inadequate digital literacy among the grassroot community health workers who hail from villages. This article summarises these challenges and ends by looking into ways and means of overcoming them.
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Affiliation(s)
- Barikar C Malathesh
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Ferose Aziz Ibrahim
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - P Lakshmi Nirisha
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India.
| | - Prabhat Kumar Chand
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Narayana Manjunatha
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | | | | | - Shanivaram Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Sanjeev Arora
- The ECHO Institute, University of New Mexico, Albuquerque, NM, USA
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Abstract
Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.
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Affiliation(s)
- Rakesh Chander Kalaivanan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Patley Rahul
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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