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Updated: May 2, 2012 17:27 IST

Call to include Psychiatry a separate subject in MBBS curriculum

Radhakrishnan Kuttoor
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Dr Roy Abraham Kallivayalil, national president of Indian Psychiatric Society.
The Hindu
Dr Roy Abraham Kallivayalil, national president of Indian Psychiatric Society.

“There is no health without mental health. Mental health is essential for maintenance of the overall health and well being of individuals and the society at large. It affects the individual's ability to function, to be productive, to establish and maintain positive relationships and to experience a state of well being,'' says Dr Roy Abraham Kallivayalil, new national president of Indian Psychiatric Society (IPS).

In an exclusive interview, the IPS chief told The Hindu that about 14 per cent of the global burden of disease has been attributed to neuropsychiatry disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol and drug abuse, and psychosis.

The number of psychiatrists in India is only 4,000 for 1.2 billion population, one psychiatrist for 300,000 people which is grossly inadequate. ``If we have to achieve a minimum ratio of atleast one psychiatrist for every 1,00,000 people, the number of psychiatrists should be trebled. Providing basic training in Psychiatry to medical graduates, and inclusion of Psychiatry a separate subject in the MBBS curriculum could fill up this huge vacuum,'' he said.

According to Dr Kallivayalil, training in Psychiatry to undergraduate medical students is very important as the knowledge of Psychiatry, mental health and behavioural sciences equips him to deal with various difficult and complex situations during medical practice. This will also help the students to develop proper communication skills and to empathise with the patients and their suffering.

Moreover, proper knowledge of Psychiatry would instill humanistic values in the students, further empowering them to establish and maintain a fruitful professional relationship with the patients, he said.

Depression on the rise

Though the prevalence rate of depression is higher than psychosis in modern times, the number of people treated are far lower due to the limited awareness about depression in the community. The situation is still worse in the rural areas, says he.

Dr Kallivayalil said the mental health infrastructure available in India was largely limited to large size custodial institutions, providing services to a limited group of the population and these institutions too were are a great source of stigma. The stigma in utilising psychiatric services, especially from Psychiatric hospitals, is another major issue concerning the healthcare, he said.

Cost-effective delivery

More than 70 per cent of India's population live in rural areas and a large majority of them avail treatment from primary health centres, especially for financial reasons. If the medical officers at these primary health centres have adequate knowledge in Psychiatry, it will be a great gain for mental health. He said delivering mental health care through primary care would be cost-effective and practical.

MCI decision sought

Dr Kallivayalil said IPS has already moved the Medical Council of India for making Psychiatry a compulsory subject for the MBBS course. There should be a separate theory paper, clinical examination and viva voce, as in the case of various other subjects, he said.

According to him, good training in Psychiatry during the under-graduate course will help the general practitioners to become well equipped, to consider the psychiatric and psychological factors from the outset, to reduce mortality and morbidity due to psychiatric illness, to provide cost-effective and cost-efficient treatment, and to avoid unnecessary investigations.

D /sir
In Bangladesh students have to seat in a board comprising Psychiatrist and internist. They also seat in written examination in a paper of hundred marks comprising Pediatrics, dermatology and Psychiatry .
I think as a Psychiatrist as well as a teacher of a medical college it should be like this in India too.
Thank you Dr Roy Abraham Kallivayalil, new national president of Indian Psychiatric Society (IPS)for speaking about the matter

from:  Dr. Md. Abu Taher
Posted on: Jun 17, 2012 at 19:25 IST

The modern day Psychiatric treatment instead of curing the ailment only aggravates the disease. The drugs prescribed are so strong that induce lethargy and listlessness in the patient. The need of the hour is to adopt a more holistic and spiritual mode of treatment instead of relying on drugs.Dr. Stanislav Groff has done pioneering work in developing a new field of Psychiatry known as transpersonal-psychology. He has laid more emphasis on the spiritual dimension of the human psyche rather than on the physical and mental aspect. Psychiatrists in India are way behind in the treatment of mental illness than their western counterparts.

from:  Umesh Bhagwat
Posted on: May 18, 2012 at 10:37 IST

All illnesses, both physical and mental, have a physical, mental and social component. Unfortunately, the training in India (unlike in the UK and USA) is mainly focused towards addressing the physical component. Doctors in India therefore graduate with poor understanding and knowledge of the mental component of an illness. For example, if a young diabetic becomes depressed because of her illness and turns non-compliant, it becomes important to deal with the depression first. Not all such patients need to be referred to a psychiatrist (especially as there is a stigma attached with seeing a psychiatrist). This would, therefore, be a welcome move.

from:  Suresh
Posted on: May 10, 2012 at 11:46 IST

Congratulations to Dr.Roy for this crucial drive to preserve the role Psychiatry deserves. Being the pioneers in medical science for millenia, India should have shown some courage to beat the stigma of mental illness and steer towards the forefront of modern Psychiatry. Illness can be broadly classified as physical and psychological ( the latter if we admit we have a mind ! ).
I agree fully with Dr.George, Dr.Patel,Dr.Sinha and Thirumugham among many others who can see the dire need for formally introducing Psychiatry as a separate Clinical Suject in the MBBS curriculum.
As a physician I learned that the success in knowing and treating the suffering of any patient that seeks out me would primarily depend upon how much empathy I can develop to help me understand the gravity of the suffering he endures. In order to reach this pristine level of 'shared awareness of another individula's suffering' a newly trained doctor should have the art and skill of Psychiatry. Keep up the pledge.

from:  Dr.M.Das
Posted on: May 10, 2012 at 05:01 IST

This was a timely/topical interview and i share my appreciation to both the reporter and our dynamic ips leader dr.Roy.In a country like india with complex needs and vast human capital/resource, emphasis should perhaps be given to community psychological medicine in terms of training and service delivery close to peoples homes.A network of trained community psychiatric nurses and support workers should form the core with appropiate back up and consultation from the psychiatrists.Ensuring support for family carers is crucial.

from:  dr. mohan george
Posted on: May 9, 2012 at 04:14 IST

I an very happy to see advances in training at undergraduate level.
When I was trained, we were trained as having two kind of psychiatric
problems as major catagory, psychotic and neurotic. Psychiatric
teaching and knowledge in world has advanced much more since then and
current amount of information and clinical knowledge does definitely
merits having more time spent in training at undergraduate level. I am
sure providing psychiatric care is challenging with current shortage
and attempts to increase training at undergraduate level will allow
more doctors to be able to treat patients when specialist are not that
many. Eventually increasing Psychiatrist (MD) residency programs will
need to be done as long term plan. I admire Dr. Roy Kallivayalil's
leadership to bring in the changes that are needed to improve training
about psychiatric illnesses and bridging the gap that will need to
increase number of psychiatrist in India by three times.

from:  Dr. Dilipkumar Patel
Posted on: May 4, 2012 at 05:33 IST

As far as functioning of Modern system of medicine is concerned it is based upon scientific methods and if some ayurvedic medicines (or of any other system of medicine) do prove to be effective by scientifically validated methods it is indeed incorporated in the Modern system of medicine. Such medicines will form the course of Modern medicine as a modern medicine after they have qualified to be effective on parameters of modern medicine rather be called ayurvedic medicine.
There is no American way of treating mental illness. The mainstream medicine in America is Modern Medicine. Modern medicine has been shown to be effective for all medical specialities including Psychiatric illness. In fact the criteria of effectiveness is the current accepted scientific parameters which is used for all sciences and which is responsible for all advancement in today's world.
Inputs of psychology, sociology, religion may be needed but the mainstay of treatment/recovery remains modern medicine.

from:  Dr. S.K.Sinha
Posted on: May 3, 2012 at 23:01 IST

Psychiatry has to be an important part of undergraduate medical education. To achieve this end it has to be an examination subject in the MBBS curriculum. This supported by the fact that 14% of the total disease burden is due to mental and behavioural disorders. So the sooner it happens the better. This will help decrease the treatment gap for mental disorders which at present in India is on average about 95% i.e. 95% of those requiring treatment are not taking treatment.
As far as Ayurvedic medicines are concerned they are a separate system of medicines and are taught to BAMS students. Ayurved graduates should also treat meantal disorders but thru their own system of medicine. If mental disorder is required to be made an exam subject in BAMS curricullum the same needs to be taken up by practitioners of Ayurved with their regulatory council.

from:  Dr. S. K.Sinha
Posted on: May 3, 2012 at 22:51 IST

The most important issue in psychiatric illness is the stigma. When a
patient from a rural area goes to a tertiary level hospital in city
itself puts a mentally ill tag on him by the local community. So, the
chance of him revisiting the tertiary psychiatry service will be

If patient is accepted and managed for basic service at PHC,
automatically the community's view on mentally ill persons changes and
acceptance level and service utilization level improves. This by
itself will minimize the stigma. So, the concept of introducing
psychiatry as a part of MBBS curriculum need to taken into
consideration MCI.

from:  Thirumugam
Posted on: May 3, 2012 at 19:29 IST

I am so happy to see this kind of advancement in Indian Medical Systems. I have been a practitioner in Psychotherapy in US for the past 25 years. I always wanted to serve the Indian population, but staying in US it was difficult to come and establish that. In my seven years private practice there have been a lot of Asian and Indian clients that have come to therapy due to psychological and psychiatric issues. I am so happy to see that the taboo is reducing slowly. India has to look at the social pressure, family dynamics and other socioeconomic pressures that they impose on Individuals is incredibly stressful and has been putting a lot of pressure psychologically. I have instrumental in reducing the gap with generational issues amongst first generation and second generation issues in US. I have been also able to treat anxiety and mild to moderate depression without any use of medication in my therapy practice. Happy to have been able to achieve that. There is so much to do.

from:  Sudha Purihella
Posted on: May 3, 2012 at 01:25 IST

Mental illness indeed has significantly increased all over the world including India. Its awareness, education and treatment are needed. However, the American way of treating mental illness as a medical problem with antidepressant and psychedelic drugs is controversial and debatable. In America, it serves the financial interests of the psychiatric profession and drug industries, but very little of the sufferers of mental illness. Only the most violent cases of mental illness perhaps belong to medical profession- if only to pacify them with drugs. Most cases of mental illness- like the wide-spread depression among seemingly normal people- belong to the professions of psychology, sociology and most important- religion. India has the most ancient wisdom and tradition of spiritual healing of mental illness. It is appropriate that medical education gives some spiritual dimension to human life and mind rather than considering it as mere organic matter to be treated and modified with drugs.

from:  D. Angirasa
Posted on: May 2, 2012 at 21:40 IST

Psych problems are underestimated or not treated in india,this is a MUST in the US,we are trained here in the US in psychiatry as part of medical licensing when we come from india ,agree with the above article,iam glad the medical community is being made aware now,eventually patients will realize and the social stigma will also be considerably reduced,you cannot practice medicine without knowing psychiatry in most of the developed nations,including it in the MBBS syllabus is overdue,congratulate the IPA president in moving the MCI,this truly will help our citizens.

from:  kanna
Posted on: May 2, 2012 at 20:02 IST

There has been a division of opinion in the medical world still in respect of many cases whether the treatment should be given by a neurologist or a psychiatrist. The full functioning of the brain is yet to be understood and research in the area of problems like Schizophrenia is based on either dead persons brains or inadequate understanding. The drugs invented to address these issues have shown to have problem some side effects including bone marrow deficiencies and epileptic attacks. The functions of Serotonin and Dopamine are not yet fully unraveled and there is also a cause and effect confusion. In view of these additional facts it is important to give thrust both as a separate discipline and focus on betterment of research. Ayurveda as an adjunct could be very useful in curing many such disorders with much less side effects. Hence as an innovative and progressive idea Ayurvedic medicines should also be part of such course.

from:  N Kumar
Posted on: May 2, 2012 at 18:55 IST
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