Anaesthetists needed in govt-run mental hospitals

19-Jul-2014

VISAKHAPATNAM: With the Bill to conduct electroconvulsive therapy (ECT) under anaesthesia for mentally ill patients all set to become a law, medical experts point to the need for creating posts of qualified anaesthetists at government-run mental hospitals.

In fact, with several ECTs being held per day at government mental hospitals, doctors feel it is important to set up anaesthesia units in each mental hospital.

For instance, at the Government Hospital for Mental Care (GHMC), Vizag, around 20 patients are administered ECT daily and once the Bill becomes a law, it would becoming mandatory to conduct the ECT in the presence of not just a psychiatrist but also a qualified anaesthetist. The anaesthesia dose has to be given for a few minutes, say three to five minutes, but has to be administered by a qualified anaesthetist.

“We have already started conducting ECT under general anaesthesia by making temporary arrangements for anaesthetists since there was a vacancy for two psychiatrists. So, those two vacant posts are held by anaesthetists now. But once regular psychiatrists are posted, we will immediately need sanctioning of posts for anaesthetists,” said GHMC superintendent Dr N N Raju.

“In fact, we have sent proposal to the government to set up a four-member anaesthesia unit that will include a post graduate student too,” added the psychiatrist.

Dr A Satyanarayana, head of the department of anaesthesia at King George Hospital (KGH), also pointed to the need for immediate sanctioning of posts. “At KGH, we are the second largest department after gynaecology comprising around 30 anaesthetists. But overall in the country, there’s a dearth of anaesthetists. They are not distributed proportionately in the area or district hospitals in psychiatry and other wings. With ECT under general anaesthesia to be made mandatory soon, if posts aren’t sanctioned now, anaesthetists from other general hospitals will have to be called in to conduct ECT in psychiatric care centres, which will create confusion and problems,” he said.

http://timesofindia.indiatimes.com/city/visakhapatnam/Anaesthetists-needed-in-govt-run-mental-hospitals/articleshow/38636908.cms

Patients to get right to mode of cure

10-Aug-2013

TEENA THACKER

NEW DELHI : Doing away with pre-Independence direct electro-convulsive therapy (ECT), also known as electroshock, used to treat mentally ill patients, the right of mentally-ill patients to decide their mode of treatment and decriminalising suicide for them are some of the progressive provisions of the new Mental Health Care Bill proposed by the government, which is expected to be introduced in this session of Parliament.

Once passed by Parliament, the bill will repeal the existing Mental Health Act, 1987. The draft bill proposes mental healthcare services affordable, of good quality and available without discrimination.

The Cabinet had in June approved the draft bill that defines mental illness in accordance with international standards. The draft bill describes the right of a mentally ill person for protection from cruelty, legal aid, information, mental healthcare and right to equality and non-discrimination.

The proposed bill is an attempt to bring a legal framework to deal with mentally ill patients. An estimated 10-12 million of the population suffer from severe mental disorders and around 50 million suffer from common mental disorders like depression.

According to the proposed bill, any person that attempts suicide would be presumed to be mentally unwell unless proved otherwise. The bill, therefore, decriminalises suicide for mentally-ill patients. Under the Indian Penal Code, suicide is a criminal act that attracts sentence for at least one-three years.

As per the proposed bill, a person can give advance directive on the treatment that he/she would like to undergo in an event of mental health situation. The draft bill lays down that any treatment or rehabilitation of mental health patients needs consent of that person, taken after full information has been given on his/her condition, the options available and prognosis. However, in cases where the person is unable to do so, the onus will be with the state authority. It also says that long-term care in mental health institute is to be used only in exceptional cases.

Keeping in view that a person may be declared mentally ill by family members due to property or marital disputes, the proposed bill gives states that a person can give an advance directive to the state that he/she should not admitted to a facility without consent.

The proposed legislation bans ECT without anaesthesia and restricts psychosurgery. With an aim to address the needs of the families and homeless mentally-ill people, the new legislation provides setting up Central and state mental health authorities. The proposed bill says that all mental health establishments, personnel and those treating patients with traditional methods of medicines will have to be registered with the Central mental health authority or with the state authority.

http://www.asianage.com/india/patients-get-right-mode-cure-071

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Empowering Mentally Ill to Live with Dignity

Press Information Bureau
Government of India
Special Service and Features

Empowering Mentally Ill to Live with Dignity

16-July-2013 16:50 IST

FEATURE
H&FW

Dr. H. R. Keshavamurthy*

Mental health represents a critical indicator of human development, serves as a key determinant of well-being, quality of life and is the basis for social stability. Social and economic impact of poor mental health is pervasive and far reaching, leading to poverty, high unemployment rates, poor educational and health outcomes, among others. There is a need for a wider recognition of mental and emotional well-being as a core indicator of human development, and it is necessary to integrate a mental health and psychosocial perspective into all development and humanitarian policies, programmes.

Persons with mental and psychosocial disabilities represent a significant proportion of the world’s population. One in four people globally experience a mental health condition in their lifetime. Almost one million people die due to suicide every year and depression is ranked third in the global burden of disease, and is projected to rank first in 2030. In India prevalence of mental disorders is 6-7% for common mental disorders and 1-2% for severe mental disorders. Treatment gap for severe mental disorders is approximately 50% and in case of Common mental Disorders it is over 90%.With such a magnitude of mental disorders it becomes necessary to promote mental health services for the well being of general population, in addition to provide treatment for mental illnesses.

Persons with mental and psychosocial disabilities often face stigma and discrimination due to widely held misconceptions about the causes and nature of mental health conditions. Persons with mental and psychosocial disabilities also experience high levels of physical abuse. They encounter restrictions in their exercise of socio-politico-economic rights in the majority of countries, largely due to the false assumption that they are not able to carry out their responsibilities, manage their own affairs and make decisions about their lives.

Though mental health conditions are one of the leading causes of disability, persons with mental and psychosocial disabilities often lack resources to maintain basic living standards. Furthermore, they are one of the most neglected and discriminated groups in development policies and programmes. Integration of mental health into development efforts is a cost effective pro-poor strategy. There are cost effective treatments available for most mental illnesses, and effective treatment is associated with reductions in overall health-care costs. Child development, education, health, social welfare policies and programmes must integrate mental and psychosocial aspects.

In India, National Mental Health Programme (NMHP) was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all, to encourage mental health knowledge and skills and to promote community participation in mental health service development and to stimulate self-help in the community. Gradually, the approach of mental health care services has shifted from hospital based care (institutional) to community based mental health care, as majority of mental disorders do not require hospitalization and can be managed at community level.

During IX five year plan, District Mental Health Programme was initiated (1996) and at present DMHP is covering 123 districts in 30 States and UTs. In addition to early identification and treatment of mentally ill, District Mental Health Programme has now incorporated promotive and preventive activities for positive mental health which includes; School Mental Health services; College Counselling services; work place stress management and suicide prevention services. Efforts are being made to improve human resource availability in mental health sector so that mentally ill gets required attention and persons having a predilection for mentally illness can get good advice, counselling at the initial stages itself. Components of NHMP are being brought under the overall umbrella of National Rural Health Mission so that the States are able to plan requirements concerning Mental Health services as part of the respective project plans. Rs.623.45 crore has been approved as XI plan outlay (upto 2012) for the National Mental Health Programme.

However, recognizing the difficulties/stigma faced by mentally ill persons the Government is in the process of providing a humane, patient centric legal framework for mentally ill patients. The proposed Mental Health Care bill can be a ‘Game changer’ in the life of millions of mentally ill persons who were often victims of inhuman and degrading treatment, abuse and ridicule, both at the community level and at health care delivery establishments.

The proposed Mental Health Care bill is significant in terms of Rights’ Approach that is being adopted to give pre-eminence to the preferences and opinion of the mentally ill person to a major extent. Provisions like ‘Advance Directive’ empowers every person to make directive on how he wishes to be cared and treated for mental illness or not. Other salient provisions are;

· A mentally ill person admitted to a mental health establishment shall have a right to receive or refuse visitors, phone calls, mail,etc
· A mentally ill person has a right to have treatment in his locality / residence and can prefer only minimum treatment/care at mental health establishments. This is to ensure that the patient is allowed to live in, be part of and not be segregated from society to the extent possible
· Every patient has a right to protection from cruel, inhuman and degrading treatment and the mental health establishment shall be safe, clean with facilities for education, recreation, religious practices.
· No patient shall be forced to undertake work and subject to compulsory shaving of head and wearing of uniforms.
· Mental illness may be made eligible for medical insurance coverage.
· Government is duty-bound to plan, implement mental health programmes and create awareness about mental health and illness to reduce the associated with mental illness
· Every person will have access to mental health care and treatment at affordable cost, of good quality and of requisite quantity, accusable to the report, their families and care givers
· Government should interpret mental health services into general health care services at all levels in all health programmes.
· Government shall arrange good quality care and treatment in hospitals funded by government and in case of non availability in nearby place; refund the costs of treatment to the patient.

To conclude, a mentally well person means a healthy society and developed nation. It is not enough if we have best health care services, protective legislation unless the stigma, discrimination and widely held misconceptions attached to mental illness are weeded out and community becomes more empathetic towards such persons.

(PIB Features.)

******

*Director (M&C), Press Information Bureau, Kolkata.
SS-51/SF-51/16-07-2013

RTS/HSN

http://pib.nic.in/newsite/efeatures.aspx?relid=97244

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‘Need to expand scope of forensic psychiatry’

8-Jul-2013

VISAKHAPATNAM: Soon electro-convulsive therapy (ECT) for psychiatric patients would be performed only under anaesthesia. Also, it would be mandatory for all general hospitals treating a patient for any ailment that subsequently develops into a mental problem, to register with mental health authorities before continuing with the treatment, informed Dr T V Asokan, vice-president of Indian Psychiatric Society on Sunday.

Dr Asokan was speaking on forensic psychiatry at the Conference of Indian Psychiatric Society, South Zone (IPS), being held in the city. He noted that the provision of advance directives would also come into being once the New Mental Health Care Bill 2012, (which has recently been cleared by the Union Cabinet), becomes an Act.

He also stressed on the need for focusing on forensic psychiatry in criminal cases. “Courts can take a lenient view of a person if he commits a crime without understanding its implications. Also, for being a witness or for other legal issues, ‘testamentary capacity’ of a person is checked, that is to see if he or she is of sound mind,” said Dr Asokan.

The provision of advance directives is being introduced under the new Mental Health Care Bill, under which a person can draw up a will or a give a directive on the future course of action on his or her personal or financial front, as a means to check any dubious accusations by others on the person’s mental state of mind. A district cell would be formed and records would be with the district mental health authorities. This would help sort out legal complications and false allegations, informed Dr Asokan.

However, the new bill has already triggered controversy among mental health experts. For instance conducting ECT under anaesthesia will escalate the cost of treatment. “Another problem is dearth of anaesthetists in the country. There are not enough anesthetists even in tertiary care hospitals to take care of trauma cases or conduct other operations. Now, having an anaesthetist for every clinic or small centre conducting the essential ECT on certain patients, would become problematic and affect the patient as the procedure may not be conducted till an anesthetist is present. ECT is very important to prevent suicides and other complications in certain mental patients,” averred Dr N N Raju, organising chairman of the conference and medical superintendent of Government Hospital for Mental Care, Visakhapatnam.

Further, all general hospitals need to be registered with mental health authorities if they are to treat any patient who subsequently develops any mental problem. “For instance, if a cancer or kidney patient becomes depressive or develops any other mental problem, they can be treated in the hospital only if it’s registered or has the required permission to treat such patients. This will increase the stigma associated with mental ailments and hamper treatment,” said Dr Raju.

http://articles.timesofindia.indiatimes.com/2013-07-08/visakhapatnam/40442661_1_advance-directives-union-cabinet-indian-psychiatric-society

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