Stress on preventive steps to help stop suicides

16-Jun-2014

BANGALORE : The spate of suicides in the city, including the 10 reported over Friday and Saturday, is a cause of concern. Medical and psychological experts have underlined the need for educational institutions and workplaces to take preventive measures to stop people from committing suicide.

According to a study conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), as against every reported case of suicide, there are at least 10 attempt to commit suicide cases. And, the number of those contemplating suicide is not known.

NIMHANS has, in its study report, termed suicide as a public health issue. The report underlines the need for recognising those with suicidal tendencies the symptoms of which include loss of interest in work or studies, disturbed sleep, and increased inclination to smoke cigarettes and drink alcohol.

Rani Shetty, counsellor at Parihar that runs the helplines at the Police Commissioner’s office, underlined the need to identify why any person has suicidal tendency. “As there are multiple causes of suicides, chalking out one single measure for prevention of suicides is not the solution,” she said. She also said that there was a need for all educational institutes and workplaces to have a full-time counsellor to address the issue.

According to Ms. Rani Shetty, there is a rise in the number of adolescents showing suicidal tendencies. “Many adolescents call the helpline and express their desire to commit suicide over trivial issues,” she added.

According to the Police, 2,033 unnatural deaths were reported in 2013. The number of suicides among these cases is yet to be tallied. As per statistics provided by the National Crime Records Bureau, 1,989 suicide cases were reported in Bangalore in 2012. Also, Bangalore accounted for 10 per cent of the 19,120 suicides reported in 88 cities during the year. This is a 15.8 per cent increase compared to 2011 when the number of suicides stood at 1,717.

The highest number of suicides in 2012 was reported in Chennai (2,183). The four metro cities — Chennai, Bangalore, New Delhi and Mumbai — contribute to about 35 per cent of the number of suicides reported in 88 cities.

Additional Commissioner (Crime) Pronab Mohanty said that it is difficult to attribute the 10 suicides reported over two days to any one reason.

“The incidence of 10 suicides over Friday and Saturday could be just a coincidence and no pattern can be determined when we look at the profiles of the dead persons,” he said.

http://www.thehindu.com/news/cities/bangalore/stress-on-preventive-steps-to-help-stop-suicides/article6117246.ece

Attacker shows clear sign of mental ailment: JJ dean

14-May-2014

Mateen Hafeez & Sumitra Deb Roy

MUMBAI: The 42-year-old patient, who attacked three others in Bombay Hospital on Monday, was kept sedated in the psychiatry ward of JJ Hospital. Hospital insiders also said he was restrained to the bed, but authorities denied this.

Dean Dr TP Lahane said doctors have found clear symptoms of mental ailment. Whether or not that could have led him to attack cancer patient Lilabihari Thakur (65) is difficult to say, said JJ doctors. Thakur died in the attack.

“In two days, we will carry out a CT Scan and MRI to see if he has brain lesions,” said Lahane. He added that the patient has a history of mental illness. JJ staffers also said he had refused to eat and was being fed through a tube.

Lahane said knowing his condition, it was perhaps erroneous to keep him in a general ward. The patient’s family has told JJ doctors that he was admitted to Masina Hospital’s psychiatry facility 5-6 years ago.

Bombay Hospital doctors, however, said they were completely unaware of any mental ailment history the patient may have had. They had treated the patient twice for brain TB in a span of one year.

Psychiatrist Dr Harish Shetty lashed out at the consultants. “Non-psychiatric doctors are condescending to mental health issues. Patients should always be evaluated for mental health problems,” he said.

Meanwhile, the Azad Maidan police said two ward boys had overpowered the accused but let go of him as he tried to bite them. “Fearing an infection, they left him on the bed,” said the officer.

Krishna Prakash, additional CP, said on Sunday, the accused was seen banging his head against the wall. “A nurse had informed his wife about this,” he said.

“On Monday, he had an argument with his brother-in-law and kicked him 3-4 times. Later, he also kicked a woman sweeper before attacking the patients,” said a police officer.

http://timesofindia.indiatimes.com/city/mumbai/Attacker-shows-clear-sign-of-mental-ailment-JJ-dean/articleshow/35078688.cms?

‘Hosps should not shun psychiatric patients’

14-May-2014

MUMBAI: Even before the HIV-TB patient with a history of mental illness attacked fellow patients in Bombay Hospital, killing one on Monday, it has been a practice in most city hospitals to not admit patients with serious psychiatric illness. Psychiatrists now fear hospitals will be doubly wary of accepting psychiatric patients needing emergency care for ailments such as diabetes, heart care, etc.

“Most hospitals only offer OPD service for psychiatric patients. They never apply for the licence needed to admit serious psychiatric patients,” said psychiatrist Dr Yusuf Matcheswalla, who operates the biggest psychiatry facility in a hospital with 110 beds (the handful of other institutions in Mumbai with this licence operate as nursing homes).

He said psychiatric patients manage to get entry into big hospitals only when there is a flare-up of other ailments not relating to their mental state. “More violent crimes are committed by normal people than psychiatric patients,” said psychiatrist Dr Harish Shetty. Dr Anjali Chabbria said the Bombay Hospital attacker could have suffered an electrolyte imbalance, triggering violence. “People shouldn’t stigmatize those with mental illnesses,” she added.

Could Monday’s attack have been averted? Dr Matcheswalla, acting head of JJ Hospital’s psychiatry department, believes so. “The patient has a history of mental illness, which should have been spotted,” he added.

Jaslok Hospital for instance, has a psychological counsellor visiting patients prone to depression. “If the counsellor feels the patient needs help, s/he is referred to the psychiatrist,” said hospital CEO Dr Taran Gianchandani. tnn

http://timesofindia.indiatimes.com/city/mumbai/Hosps-should-not-shun-psychiatric-patients/articleshow/35078710.cms?

IIT reach-out for peace of mind

21-Apr-2014

KOLKATA: IIT-Kharagpur, the country’s oldest and biggest IIT, is on top of a very dubious list that’s being pursued by the HRD ministry. With 22 suicides in the past six years, the mental health of students on this campus is a cause of concern for the ministry and though it is in a limbo at the moment because of the ensuing elections, the institute has been advised by officials in Delhi to devise ways in which student interaction could be maximized so that aberrations can be easily be identified.

A slew of changes have been rung in by the campus authorities. Students are excited and they say that this is the first time that they are actually being told by the faculty and other senior members of the administration that there is more to life than just grades. On an average, a student spends at least 16 hours in a day studying or completing projects. The rest of the time is divided between social networking sites, sleep and food.

The programme has been christened “Reach Out” and each is designed to bring students out of their hostels for at least an hour every day for informal interaction. Lights are being turned off and LAN connections cut off at the hostels at the appointed hour so that students are forced to come out on the greens and do nothing but laugh, joke and chat. “It was such a relief, we were actually sitting here and there and chatting in real and not virtual terms,” said Atal Ashutosh, a second-year student of mining engineering.

The last two suicides on the campus in March has left it rattled. Both students chose to end their lives despite being good students. Facts like they seemed cut off and depressed started tumbling out after they were gone and beyond help.

“It is sad that someone is so depressed next door that he takes his life while the boys next door are out celebrating Holi downstairs. Obviously he must have showed palpable signs for days together but no one had the time or the urge to notice that. IIT Kgp was never like this and we needed to do something urgently to identify crisis cases,” said P P Chakraborty, the director of the institute.

Night tug-of-war, hopscotch, kabaddi, pittoo, kho-kho and other indigenous matches are being played to involve everyone. Absentees, if any, are being met and encouraged to join.

“We have coined a slogan – ‘We are keeping our flames alive’ and are sending each other these messages. Each one of us is on the look out for a chance loner who might be avoiding such activities. These will immediately be reported,” said Pravin Kaushal, a fifth-year student.

Third-year student Ravish Raja said he has already made a huge gang of friends through the reach-out programme.

Special assignments are also being charted out for faculty members so that they visit hostels, have dinner with the boys and spend hours interacting with them.

Many felt that the rising numbers at the campus has put the faculty under so much pressure that they have become somewhat alienated from students.

http://timesofindia.indiatimes.com/city/kolkata/IIT-reach-out-for-peace-of-mind/articleshow/34016464.cms

In search of a revolutionary road

16-Feb-2013

K. S. JACOB

Psychiatric diagnoses continue to lack the predictive power required of hard science. A new framework is needed to understand mental health, distress and disease

 

The American Psychiatric Association (APA) will release the fifth edition of its Diagnostic and Statistical Manual (DSM-5) in May 2013. DSM-5 has been years in the making. The process included planning sessions, international research conferences, review of literature, a series of monographs, secondary analysis of data and field trials involving hundreds of scientists and clinicians, drawn from many countries and disciplines, and feedback from the public. Many interest groups — neurologists, psychologists, insurance and pharmaceutical industries, legal and forensic fraternity, military veterans and anti-psychiatry groups — have been watching the process and outcome closely as the DSM has a wide impact. The Indian Psychiatric Society also submitted its views to the APA.

International standard

The DSM-5 has pursued the basic framework adopted by its forerunners, DSM-III and its successors DSM III R, IV and IV TR. DSM III, with its atheoretical approach, objective diagnostic criteria and specific exclusions, was revolutionary at the time of its introduction in 1980. Its focus on standardised diagnosis and on improving inter-rater reliability had a major impact on psychiatric practice and research. It soon became the international standard.

The absence of laboratory tests to diagnose mental disorders forced psychiatry to focus on clinical presentations for this purpose. The lack of pathognomonic symptoms required the discipline to rely on identifying collections of symptoms to define clinical syndromes. Psychiatric classifications include medical conditions (e.g. delirium, dementia and psychiatric manifestations of medical diseases), severe mental disorders (schizophrenia, bipolar disorders, psychotic depression, and stupor) and stress-related conditions (e.g. depression, anxiety and adjustment disorders).

The DSM laid out objective criteria for diagnosis. It offered differential diagnosis in order to distinguish similar conditions. It allowed psychiatrists working around the globe to read from the same page. It facilitated collaboration and comparison. It improved communication, standardised research, increased, and improved the evidence base. A unified language also helped mental health activism.

Despite major advances and significant progress, the DSM has many critics. Most detractors are free with their criticism, without providing comprehensive solutions to the complex issues facing people with mental illness. Defining mental illness is no simple task. A single definition to partition health, illness and disease has proved to be extraordinarily difficult. The diversity of and heterogeneity within these conditions are major challenges. Typically, patients emphasise distress and suffering, while psychiatrists diagnose and treat “diseases.” Mental disorders include both disease and illness. Nevertheless, diagnostic criteria for psychiatric disorders did not bridge the classical disease-illness divide between physicians’ perspectives and patients’ subjective experience of sickness. In fact, the DSM resulted in language, concepts and frameworks, which contrasted starkly with those held by patients, impeding understanding of the illness experience and diminishing the role of patient narratives. In addition, DSM could not overcome the fact that different etiology and pathology can result in similar clinical presentations, and that a particular cause can produce diverse clinical manifestations. Research and specialist interests also increased manifold the number of diagnostic categories.

Little regard for context

The difficulty in separating disease from distress is a major challenge. The DSM system emphasised symptom counts to identify psychiatric categories, with little regard for the context (e.g. psychosocial stress, personality, and coping). This strategy improves reliability of diagnosis for non-psychotic conditions associated with psychosocial adversity, but also includes people with normal responses to such difficulties. Psychiatry tends to reify diagnosis, making abstract concepts concrete. Psychiatric practice transmutes clinical syndromes (collection of symptoms) into diseases.

The DSM III also suppressed etiological debates about mental disorders and placed them on the back burner. The biomedical model, which undergirds the approach, became dominant, annihilating psychological, behavioural and social conceptualisations. However, the APA argued that reliable diagnoses would result in the recognition of underlying neurobiological substrates and facilitate etiological research; it would lead to the development of new and more effective treatments.

However, the frequent revisions of the DSM, with minor changes often based on limited evidence, also prompted debates on the motivation of the APA. The numerous minor and major disagreements with World Health Organisation’s International Classification of Diseases (ICD) -10 diagnostic categories supported the argument that most changes were arbitrary as there was no agreement among international experts. The DSM had to contend with many charges including medicalising normal reactions, lowering diagnostic thresholds to create spurious “epidemics,” creating new categories without evidence, using medication responses to define categories and playing into the hands of the pharmaceutical industry.

Challenges to diagnosis

Defenders of the DSM argue that its primary purpose is to enable psychiatrists to reliably identify individuals who seek clinical attention, and to facilitate communication among clinicians and researchers. The field of psychiatry has to grapple with the current state of knowledge with its inherent limitations. The lack of laboratory diagnosis, poor understanding of genetic basis and psychological vulnerability, and the need to provide categorical diagnosis for phenomena which lie along a spectrum (e.g. depression, anxiety, cognitive impairment and substance misuse) are difficult challenges.

The most ardent supporters of the DSM acknowledge its imperfections but argue that it reflects our current understanding and state of the science. They contend that DSM-5 is not an attempt to define normal and that being normal is not the same as not having a DSM-5 diagnosis. They argue that having a psychiatric diagnosis is not the same as being insane or crazy, stigmatising labels, which do not apply to the vast majority of people with a DSM diagnosis. They suggest that prescribing medication for any condition in preference to time and labour-intensive psychological interventions is dependent on many factors, including the economic realities of medical practice, and does not necessarily imply medicalising normality.

Pressure from user groups

The use of a single set of criteria, useful to psychiatrists working in specialist settings, in other locations (e.g. definitions for legal use and for reimbursement, in primary care and across cultures) is not without problems. There was also pressure from patient and user groups, as any changes to the DSM-IV categories in the new revision would have affected their claims for disability support and health insurance. Consequently, there were demands to enlarge and to reduce the diagnostic net from different quarters.

A close examination of the DSM-5 suggests the maintenance of status quo. Psychiatric diagnoses and theories, with their technical language, operational criteria, elaborate classificatory systems and empirical data continue to lack the predictive power required of hard science. Its diagnostic systems and models do not explain many aspects of mental health and illness. Human cognition, emotion and behaviour are complex, interconnected and under a variety of influences (e.g. genetics and biology, psychological, social and cultural forces), whose effects cannot be teased out under controlled experimental conditions.

Nevertheless, psychiatric treatments help millions of people lead productive lives. The DSM process and consultation was elaborate and transparent, seeking opinions and evidence from people with diverse backgrounds. Despite its shortcomings, it does reflect the current state of the science. Psychiatry, at this moment in time, has been compared to biology before Darwin and astronomy before Copernicus.

Thomas Kuhn in his book The Structure of Scientific Revolutions described three stages: (i) normal science (routine scientific work) within existing paradigms and a dedication to solving puzzles, (ii) serious anomalies produced by research, which leads to a crisis, and finally (iii) resolution of the crisis by the creation of a new paradigm. Psychiatry today, with its attempt at solving the clinical puzzles and its many anomalies, is awaiting a paradigm shift, which will not only clarify these complex issues but will also provide for a new framework, insight and understanding. Psychiatric research, despite its current attempts at testable conjectures and refutations, is still within a paradigm that seems inadequate for the complexity of the task. Psychiatry awaits its new dawn.

 

(Professor K.S. Jacob is on the faculty of the Christian Medical College, Vellore. The views expressed are personal)

http://www.thehindu.com/opinion/lead/in-search-of-a-revolutionary-road/article4419552.ece

 

 

 

 

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SMHC murder: suspicion falls on cellmate

17-Dec-2012

Police seek court’s nod to take his buccal swabs

THIRUVANANTHAPURAM : The city police on Tuesday said they suspected that one Suresh Babu, a 38-year-old inpatient, was responsible for the murder of a 60-year-old Andhra Pradesh native, tentatively identified as Venkateshappa, at the State Mental Health Centre (SMHC) here on December 4.

A magistrate court had referred Venkateshappa to the SMHC after the police arrested him near Kilimanoor on December 2 on the charge of behaving violently in public.

Investigators said that Venkateshappa and Suresh Babu, a native of Thirupuram near Poovar, were confined in the same cell. Hospital janitors found Venkateshappa dead on December 4 afternoon. The SMHC authorities reported the matter to the local police and transferred the body to the Medical College Hospital mortuary.

The police initially reported the incident as a case of suspicious death. A subsequent forensic examination confirmed murder. Injuries on neck and head had caused his death.

Satnam’s case

The police said Venkateshappa’s death could not be compared to the custodial death of a law student from Bihar, Satnam Singh, at the same institution early this year. The Crime Branch, which probed Satnam Singh’s murder, had arraigned six persons, including hospital staff, as accused in the case.

It had blamed the illegal practice of using “cured” patients, mostly convicts or under-trials, to subdue violent inmates as the reason for Satnam’s death. In comparison, the police said, so far, no SMHC staff had been found to have any role in Venkateshappa’s murder.

The prime suspect in the case, Suresh Kumar, had been reported missing from his house at Poovar for over a month.

A magistrate court had sent him to the SMHC after the Museum police detained him on the charge of showing aggression in public. His wife told the police that Suresh, a manual labourer, had been under psychiatric care for long. He was often sleepless but rarely violent, according to her. The police said they had sought the court’s permission to take “buccal swabs”, from the cheek of the suspect, to extract his DNA for comparison with the “debris”, (skin, hair, blood, etc.), collected from the body of the victim, particularly his fingernails. Forensic pathologists, who conducted the post-mortem examination on Venkateshappa’s body, told the police that multiple actions of aggression and defence had preceded his death.

They have ruled out the use of any weapon or blunt instrument in the murder.

The police would question the doctors and staff at the SMHC as part of their investigation on Monday. Circle Inspector, Peroorkada, R. Pratapan, headed the investigation.

The State police have contacted their counterparts in Karnataka and Andhra Pradesh to locate Venkateshappa’s address. So far, no one has claimed his body.

http://www.thehindu.com/news/cities/Thiruvananthapuram/smhc-murder-suspicion-falls-on-cellmate/article4209135.ece

 

17-Dec-2012
A disgrace to Kerala, says expert

KOLLAM : Roy Abraham Kallivayalil, national president of the Indian Psychiatric Society, has called for urgent intervention of Chief Minister Oommen Chandy in the state of affairs of the State Mental Health Centre in Thiruvananthapuram following the death of two inmates in four months. Dr. Abraham told The Hindu on Sunday that the murders had brought disgrace to Kerala. A 64-year-old mentally challenged man, identified as Venkateshappa, was killed at the SMHC on December 4. In similar circumstances, Satnam Singh Mann was killed in August this year.

Dr. Abraham said Venkateshappa’s murder was a crime against humanity. The forensic ward of SMHC, where Venkateshappa was admitted, had only 24 cells. Each cell would have at least 60 to 65 patients. Often, these patients became violent.

Dr. Abraham said the failure of the authorities to post enough personnel to supervise the ward was criminal negligence. This meant that they gave little value to patients’ lives. The State had taken custody of Venkateshappa and it was duty-bound to protect him. Instead of knee-jerk reactions such as transferring the hospital superintendent, committed efforts with long-term goals, must be made, he said.

• Says there are few supervisors at mental centre
• ‘It was duty of the State to protect victim’

 

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