presidential address
Presidential Address
Address delivered at the ANCIPS 2009 in Agra on 9th January 2009
The Vision:
Nonpharmacological treatment
The training in non-pharmacological management of psychiatric disorders is abysmally poor in India. Although very few teaching institutions impart the know-how of cognitive behaviour techniques and basic psychotherapeutic skills, majority of the practitioners employ 'common sense' psychotherapy. The upswing of psychopharmacological research has provided a generation of 'pill pushers' relegating the very essence of good doctor patient relationship and non pharmacological management principles. It has to be remembered that a 'psychological mattress' is essential for a 'pharmacological pillow'.
The time is ripe to initiate skill development in cognitive behaviour therapy (CBT) and other non –pharmacological management strategies.
Child Psychiatry
It is estimated that as many as one in five children and adolescents may have identifiable mental health disorders requiring treatment. Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. A hostile, threatening or uncomfortable environment provides the breeding ground for many negative perceptions with resultant emotional and behavioral disturbances. Families and communities, working together, can help children and adolescents with mental disorders. A broad range of services is often required to meet the needs of these young people and their families.
Child psychiatry training in India is available only in very few centres. Most of the postgraduate training centres do not address psychological/ psychiatric issues in a desired format thanks to the lack of proper training in that specialty. The cry for a super specialty in child psychiatry didn’t impress the authorities. However, the NIMHANS model of child psychiatry specialization is a welcome step.
There is urgent need to pool the available child psychiatrists of India and to initiate time bound, focused training workshops.
Geriatric Psychiatry
The elderly population in our country will increase from 7.6 million in 2001 to 137 million by 2021. The feelings of loneliness along with the natural age-related decline in physical and physiological functioning are catalysts to psychological disturbances. Services catered to the comprehensive array of psychological, cognitive and physical problems of the elderly have to be provided. The only reliable morbidity data is on dementia and its estimated prevalence is 33.9 per thousand in rural and 33.6 per thousand in urban population above 60 years. Recently 10/66 dementia research group has contributed to our understanding about the prevalence, caregiver burden, and service delivery of dementia subjects. The departments of geriatric mental health at Lucknow, NIMHANS at Bangalore, BYL Nair Hospital at Mumbai and a private psychiatric centre at Varanasi have to be congratulated in their efforts on geriatric care.32-35
The geriatric specialty wing of IPS should organize focused workshop to help psychiatrists in identification, assessment and care of the elderly.
Addiction Psychiatry
WHO estimates suggest that there are 60-70 million alcoholics in India out of which 50% are "hazardous drinkers" and require treatment. The age of initiation to alcohol has come down from 19 years in 1986 to 13.5 years in 2006. Studies have revealed that the revenue generated from the industry (216 billion) is less than the revenue lost due to alcohol-related health problems (244 billion). In a report for WHO, a multi-centre collaborative study – ‘Injury and Alcohol’ at NIMHANS Bangalore, it was found that the proportion of injuries ‘linked’ to alcohol use was 58.9% of all injuries. Alcohol related injuries include road accidents (46%0, violence (24%), falls (24%) and others (6%). 36, 37
Kerala leads in per capita consumption of liquor at a whopping 8.3 litres [pushing Punjab to second place (7.9 litres)] as against four litres in the rest of the country. Kerala has been emerging as one of the largest consumer of alcohol in the world. The sale of Indian Made Foreign Liquor (IMFL) in Kerala has jumped to Rs 3,669.49 crore during 2007-2008 from a mere Rs 81.42 crore in 1987-1988. The state had received revenue of Rs 2,914.28 crore from the KSBC (Kerala State Beverages Corporation) alone as its share, besides crores of rupees from bar licenses. Kerala, the most literate of Indian states, often quoted as ‘Gods own country’ ranks high in suicide rates, accidents and alcoholism. One really wonders whether the ‘God’s own country’ will be swallowed by the devil’s advocate-alcoholism. 36, 38, 39
Addiction to heroin (1 million), abuse of cannabis/ cannabis products, psychotropics, and other ‘over the counter’ (OTC) drugs delineate unbridled regulation at sale outlets, and inefficient legal measures.
The addiction specialty section, I hope, will pay more attention in training psychiatrists on substance use disorders, educate the society on the evils of drug abuse, and advice the policy planners.
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