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The hijras of India: A marginal community with paradox sexual identity
Sibsankar Mal
January-March 2018, 34(1):79-85
Transgender people in India, commonly known as the Hijras, who claim to be neither male nor female, are socially excluded in Indian society. The uniqueness of Hijras lies not only in their existence beyond social structure but also in Indian society's historical acceptance of that position. This study aims to understand the sociocultural exclusion of Hijras, depending on their gender identity disorder and their paradox sexual appearance. An exploratory cum descriptive research design with a nonrandom purposive sampling including the snowball technique was adopted, to collect information from 51 Hijras at Kharagpur town from the state of West Bengal, India. The study shows that although Hijras have a sort of sanctioned and visible place in Hindu society, but in the contemporary Indian context, it is the gender nonconformity of the Hijra that has a major impact besides lack of a gender recognition, sexual expression, employment, decent housing, subsidized health-care services, and as well as the violence they suffer, especially when they choose to take up formal works. Therefore, Hijras are controversial and minacious community in Indian society and their existence disrupts essential ideas about sex or gender. They need to be recognized as having a space on society's gender continuum. Vertical interventions of rights are greatly needed to address the unique needs of this marginalized group and recognizing them as equal citizens of India.
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The biopsychosocial approach and global mental health: Synergies and opportunities
Emmanuel Babalola, Pia Noel, Ross White
October-December 2017, 33(4):291-296
The biopsychosocial (BPS) approach proposed by Engel four decades ago was regarded as one of the most important developments in medicine and psychiatry in the late 20th century. Unlike the biomedical model, the BPS approach posits that biological, psychological, and social factors play a significant role in disease causation and treatment. This approach brought about a new way of conceptualizing mental health difficulties and engendered changes within research, medical teaching and practice. Global mental health (GMH) is a relatively new area of study and practice that seek to bridge inequities and inequality in mental healthcare services provision for people worldwide. The significance of the BPS approach for understanding mental health difficulties is being debated in the context of GMH initiatives. This paper critically evaluates strengths and weaknesses of the BPS approach to mental health difficulties and explores its relevance to GMH initiatives.
  11,281 1,067 1
Study of mechanisms of coping, resilience and quality of life in medical undergraduates
Mansi Somaiya, Swapnil Kolpakwar, Abhijeet Faye, Ravindra Kamath
January-June 2015, 31(1):19-28
Introduction: The period of undergraduation in the medical field is challenging, and the medical student is exposed to various stressors. Aims and Objectives: This study was designed to identify the mechanisms of coping, resilience and quality of life (QoL) and their correlations in medical undergraduates, so as to find some factors which can help to make some positive changes in medical curriculum. Methodology: Totally, 250 medical students representing all academic years of medical college were provided with questionnaires investigating their sociodemographic profile, coping skills, resilience, and QoL. Using appropriate statistical tests, the parameters were studied along with a search for the factors affecting them. A comparison of all these factors was also done among the students of all the academic years of medical school. Results and Discussion: Problem-solving and fatalism was more in immigrant students than native students of Mumbai. Problem-oriented mechanisms of coping, resilience, and QoL were higher in students doing internship. However, students of 3 rd year part 2 were less resilient, used emotion-focused ways of coping and had a lower QoL. There was a good shift of positive ways of handling stress with an increase in the academic year. Problem-oriented mechanisms of coping positively correlated with resilience and QoL. High resilience was also found as a positive factor for good QoL. Conclusion : Along with the clinical component, an equal emphasis should be given to improve the social and personal life of a medical student helping them to cultivate more problem-based coping and increasing their resilience so as to ultimately improve their QoL.
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Caregiving and caregivers: Challenges and opportunities in India
R Srinivasa Murthy
January-March 2016, 32(1):10-18
Caregiving of persons with mental illness is challenging as sometimes it is demanding and at other times, it is fulfilling to caregivers. In India, family members are the caregivers for persons with mental illness as there are extremely limited alternative facilities and family members are preferred for caring. The changing social milieu in India such as urbanization and nuclear family is placing significant burden on family members. This article will discuss about the emotional dimensions of caregiving, importance of care receivers, utilizing the caregiving situations to address prevention of mental disorders, promotion of mental health, and fight stigma of mental disorders. In India, majority of the research is on the burden of caregiving on family members and there is less or no research on caregiving in different communities, population groups, and develop programs to make caregiving a positive experience on caregivers and caregiving. In India, there is a need to develop systems of sharing of skills, support, and supervision to caregivers in providing care to the individuals with chronic illnesses. This can minimize the stress of caregiving and maximize the positive feelings of caregiving.
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A virtual reality: Technology's impact on youth mental health
Benjamin Ian Perry, Swaran Singh
July-September 2016, 32(3):222-226
2016 will mark as the year when commercially available virtual reality headsets first become available across the world. This is set to be a landmark development and will revolutionize the way we interact with technology, which is already eating up more and more of our time, and is now inextricable from day-to-day life. Adolescents, at a critical stage in both physical and psychological development, are often the first to adopt advances in technology, and therefore also any associated impact on health. We discuss some of the current and important research on the positive and negative implications of technology on the mental health of children and adolescents, and briefly outline how future technological advances may further affect how we diagnose, monitor, and manage our young patients in the psychiatric clinic.
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A survey of suicidality and views on suicide in an Indian sample of adults
Nilamadhab Kar, Jagadisha Thirthalli
July-December 2015, 31(2):100-106
Background: Suicide is a major public health concern in India. There is limited information regarding views about suicide and suicidality in the community. Aims: It was intended to study the suicidal cognitions and behavior in a sample of adults in India along with views about suicide. Methodology: It was a cross-sectional, questionnaire-based, anonymous survey conducted in four tertiary level medical centers. The subjects included patients and their attendants and health professionals in the organizations. The questionnaire included items on suicidal cognitions, suicide attempt history, current and past physical and mental illness, stress, views on suicide and the interventions along with information on the sociodemographic variables. Results: A considerable proportions of participants reported lifetime suicidal cognitions: Life not worth living, 44.2%; death wish, 26.9%; suicidal ideas, 24.6%; made suicidal plans, 12.4%; and 7.1% had a history of suicide attempt. These cognitions were significantly associated with suicide attempt. There was a general awareness of risks and supportive measures. The finding that 29.7% of participants might consider suicide for themselves in certain circumstances suggested the degree of acceptability of suicide in the community. Contrasting views were also present where suicide was considered as a sin by 66.2%, but 10.4% felt that their religion allows it in certain situations. The majority of participants felt that suicide is preventable. Conclusions: Suicidal thought and behaviors were common in the community. The results suggest that there is still a need for public education increasing awareness about the risks, support systems available in the local community and timely help-seeking that may improve the scope for suicide prevention.
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Advocacy in mental health: Offering a voice to the voiceless
P Joseph Varghese
January-June 2015, 31(1):4-8
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Social changes in the 21st century have differentially affected the mental health scenario in the developing world
Harischandra Gambheera
July-September 2016, 32(3):238-242
The effects of social development in the 21st century have affected different countries and different social groups differently. Although social development upgraded life standards of a sector of population, it has affected adversely on poor socioeconomic groups in different parts of the world. Even though the economic status of urban cities in developing countries has gone up, standards of living have not risen parallely. The social structure has changed and risk factors for common mental illness have increased whereas poorly developed mental health services remain unchanged. Resource allocation for the development of mental health services in developing countries still appears to be minimal.
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How are social changes in the twenty first century relevant to mental health?
Krishna M Prasad, Hareesh Angothu, Manila M Mathews, Santosh K Chaturvedi
July-September 2016, 32(3):227-237
Mental health problems occur in a psychosocial context. Social dimensions significantly impact psychiatric practice and research. The twenty first century has seen dramatic urbanization, globalization, rapid advances in technology, and communications. These among several other social changes, such as nature and shift in family systems, newer patterns of relationships, migration, and social mobility will bring about novel challenges for diagnosing and managing mental health problems; nevertheless this may at the same time throw newer means and opportunities to intervene, particularly with the advancements in technology. There is likely to be greater awareness about mental health problems. The rights based and recovery oriented approaches will change the way psychiatry is practiced. Many of these changes will positively impact policies of the government and access to care. This article focuses on the social changes in the twenty first century and the impact this has had and will have on mental health, especially in India.
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Stigma associated with mental illness: Conceptual issues and focus on stigma perceived by the patients with schizophrenia and their caregivers
Aakansha Singh, Surendra K Mattoo, Sandeep Grover
April-June 2016, 32(2):134-142
Among the various psychiatric disorders, schizophrenia is considered to be associated with high level of stigma. The stigmatizing experience is not only limited to the patients but is also experienced by their close relatives. This article reviews the conceptual issues in understanding stigma, mainly in relation to schizophrenia. Further, this article reviews the existing literature in terms of extent and correlates of stigma experienced by patients with schizophrenia and their close relatives. Stigma experienced by the patients can be categorized as public stigma and personal stigma. The personal stigma is further understood as perceived stigma, experienced stigma, and self-stigma. Stigma experienced by caregivers of patients with mental illness is called associative or courtesy stigma and affiliate stigma. A number of tools have been developed for assessment of stigma among patients with mental illnesses and their close relatives. Depending on the type of instrument used to assess stigma, the prevalence of stigma among patients with schizophrenia varied from 6% to 87%. Much of the literature on stigma in the patients with schizophrenia is from developed countries. There is limited literature from India and majority from Southern and Central part of the country. Stigma associated with schizophrenia is highly prevalent across regions and varies according to different sociodemographic and clinical correlates. The experience of stigma among patients of schizophrenia is influenced by the type and severity of psychopathology, insight, coping, causal beliefs, depression, social support, self-esteem, self-efficacy, and self-directness. Stigma influences medication compliance, quality of life, and social functioning. Research is scanty with regard to stigma perceived by caregivers of patients with schizophrenia. Besides the caregiver variables, different patient variables uniquely modify the stigma experienced by the caregivers. Different interventions may reduce the stigma experienced by patients and their caregivers. Studies evaluating stigma experienced by patients with schizophrenia and their caregivers suggest that stigma is highly prevalent among patients and their relatives. Data on correlates of stigma are limited. There is a need for further research on stigma for a better understanding of the concept so as to find ways to reduce it and prevent its adverse consequences.
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From rape to sexual assault: Legal provisions and mental health implications
RC Jiloha
January-June 2015, 31(1):9-18
Sexual assault in various forms has been recognized as a crime by almost all religions and cultures throughout the recorded history. It is a crime against basic human rights of an individual and a most common crime against women in India. In India, "rape laws" began with the enactment of Indian Penal Code in 1860. There have been subsequent amendments, and the main issue of focus remained the definition of rape which has been recently broadened to include a wide range of sexual activities. The inclusion of "marital rape" in the ambit of rape remains a matter of debate. With a long history, the sexual offence in the form of sexual assault has been discussed from legal and mental health perspective in this presentation. Social and psychological impact of sexual assault on the victim has also been discussed.
  5,467 381 1
Are social theories still relevant in current psychiatric practice?
Ajit Avasthi
January-March 2016, 32(1):3-9
Current psychiatric practice is being influenced by advances in the field of molecular biology, genetic studies, neuroimaging, and psychopharmacology and the approach has become "biological." Social theories of mental illness had once revolutionized the field of psychiatry and are currently being somewhat ignored under the dazzle of biological sciences. Main social theories are functionalism, interpersonal theory, attachment theory, stress theory, and labeling theory. Each of these theories had tried to explain the genesis of psychiatric disorders in their own way. However, each theory has its own limitations and critique. Still, for a holistic approach to treat persons with mental illness, it is essential to take a biopsychosocial approach which can only be done if one understands the contribution and relevance of social theories. Nonpharmacological management has been the cornerstone of treatment of any psychiatric disorder and social theories also form the basis of various nonpharmacological modes of treatment. Overall, social theories are still very relevant in current psychiatric practice and should not be neglected. Efforts should be made to integrate social theories with other theories of mental illness for better understanding and treatment.
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Knowledge and attitudes of secondary and higher secondary school teachers toward mental illness in Ahmedabad
Nimesh Parikh, Minakshi Parikh, Ganpat Vankar, Chintan Solanki, Girish Banwari, Prateek Sharma
January-March 2016, 32(1):56-62
Background: Teachers can be trained in early identification of possible mental illness and referral which is well-established in the west and lacking in India. Hence, we attempt to study the knowledge and attitudes of secondary school teachers toward mental illness and probable gender differences in these measures. Materials and Methods: Five hundred and twenty teachers from English medium schools of Ahmedabad city were assessed by a self-reported, predesigned and pretested 25 item questionnaire, the first 15 of which assessed their knowledge about mental illnesses and the remaining 10 pertained to negative attitudes. Results: 79.4% of teachers were 45 years or less, 77.5% were female teachers and 86.9% were married. 76% of teachers scored <7 out of 15 which points toward majority of them having inadequate knowledge. 63.6% scored 5 or more on the negative attitudes questionnaire, which points toward high prevalence of negative attitudes. Females had comparatively more knowledge than males about symptoms and management of mental illness, although there was no significant gender difference in the attitude toward mental illnesses. Conclusion: The knowledge of teachers about mental illness is insufficient, and they hold a lot of stigma against mentally ill as demonstrated by their low score in attitude.
  5,160 596 1
Sexual knowledge, attitude, behaviors and sources of influences in Urban college youth: A study from India
Siddharth Dutt, M Manjula
October-December 2017, 33(4):319-326
Background: The study was undertaken as there is very less literature related to sources of influence for sexual knowledge and attitude toward sex and sexual behaviors of youth in India. Aim: The objectives of the study were to explore sexual knowledge, attitudes, behaviors and the sources of influence and also to examine the relationship between sexual knowledge, attitude and behaviors in the youth. Method: The sample was selected from colleges using purposive sampling method and from the community using snowball method (n = 300). The tools used were sociodemographic data sheet, Sexual Knowledge and Attitude Questionnaire (SKAQ-II) and Sexual Behavior and Sources of Influence (SBSI) scale. Results: Descriptive statistics and correlation was done to analyze the data. The youth had poor sexual knowledge; there was positive relationship between sexual knowledge and attitudes. Sexual behaviors through media and with self or others were found to be low. Internet was found to be the major source for gathering information and was considered the most reliable source. Conclusion: Indian college youth continue to have poor sexual knowledge. Internet is a major source of information and is considered as the most reliable one among youth. More knowledge about sex is associated with liberal attitude toward sex.
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Study of internet addiction: Prevalence, pattern, and psychopathology among health professional undergraduates
Sachin R Gedam, Santanu Ghosh, Lipsy Modi, Arvind Goyal, Himanshu Mansharamani
October-December 2017, 33(4):305-311
Background: Internet has become an essential part of our daily life, especially among adolescents and youth. It is mainly used for education, entertainment, social networking, and information sharing. Its excessive use among health care providers is becoming a major concern. Aims: The aim of our study was to estimate the prevalence, understand the pattern, and to determine the association between psychopathology and internet addiction among health profession undergraduates. Materials and Methods: A cross-sectional study was conducted among 846 students of various faculties from Deemed University. Students were assessed with semi-structured data, Internet Addiction Test and Mental Health Inventory, after giving them brief instructions. Students were classified into normal students and addicted students for comparison. Results: The total prevalence of internet addiction was 19.85%, with moderate and severe addiction being 19.5% and 0.4%, respectively. Internet addiction was associated with gender, computer ownership, preferred time of internet use, login status, and mode of internet access (P < 0.05). It was also associated with anxiety, depression, loss of emotional/behavioral control, emotional ties, life satisfaction, psychological distress, and lower psychological well-being (P < 0.05). Conclusion: Significant association was found between psychopathology and internet addiction. Male gender, login status, emotional ties, and psychological distress were found to be important predictors of internet addiction among students. Hence, these parameters should be taken into consideration while promoting awareness of problematic internet use and educating students regarding healthy internet use.
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”The wind of change…”
Nitin Gupta, Abhijit R Rozatkar
July-December 2015, 31(2):81-83
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Recent developments in community mental health: Relevance and relationship with the mental health care bill
Rakesh Kumar Chadda, Bichitra Nanda Patra, Nitin Gupta
July-December 2015, 31(2):153-160
Community mental health refers to the treatment of persons with mental disorders in the community. In the earlier periods, treatment of patients with mental illness was limited to the mental hospitals or asylums. This paper traces the beginnings of community psychiatry in India from the time Dr. Vidya Sagar initiated his famous experiment of treating patients with mental illnesses along with family members in tents outside the mental hospital, Amritsar. It then discusses the role of the National Mental Health Program and the District Mental Health Program. The role of the United Nations Convention on the Rights of Persons with Disability in leading onto the development of the current Mental Health Care Bill, 2013 is discussed. Authors critically evaluate some of the merits and drawbacks of the Bill as related to recent developments in community mental health in India.
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Integrating persons with mental illness in the society
Rakesh K Chadda, Siddharth Sarkar
October-December 2016, 32(4):313-314
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Restraint and seclusion in India
Sudhir K Khandelwal, Koushik Sinha Deb, Vijay Krishnan
July-December 2015, 31(2):141-147
Psychiatric management in India often includes the practice of restraint and seclusion of violent and difficult to control patients, both in inpatient medical facilities and in places of traditional healing. However, without any informed guidelines and regulation, these practices have flourished from necessary last resort to accepted ways of control. The upcoming draft mental health bill have now provided with a set of basic guidelines for preventing restraint. The scientific literature is also sparse on the subject from India, despite a robust body of evidence being available from the Western literature. This review, summarizes the evidence from India, looks into the causes and outcomes of restraint and seclusion and also discusses methods and stratagems that might be beneficial for reducing restraint and seclusion in the country.
  3,169 369 3
A study to assess the prevalence and pattern of substance use among male adolescents in suburban area of Delhi
Liza Thankam Daniel, Ganesh Krishnan, Sandhya Gupta
July-September 2017, 33(3):208-212
Aim of the Study: To assess the prevalence and pattern of substance use among male adolescents in Sunder Nagari, New Delhi. Materials and Methods: A cross-sectional survey was designed to assess the prevalence and pattern of substance use among male adolescents in New Delhi. One hundred and ten adolescents were conveniently selected from Sunder Nagari, New Delhi. Adolescents aged more than 11 years and able to read and write Hindi or English were included in the study. A structured questionnaire for demographic variables was developed by researchers. To assess the prevalence and pattern of substance use, a structured questionnaire was prepared with the reliability coefficient of 0.94 (test-retest reliability) with a content validity index of 0.90 between the experts. Data were collected from the subjects after getting their written consent. Data analyzed using statistical package SPSS version 17.0. The level of significance was set as P < 0.05. Results: The study findings revealed that nearly more than half (55.6%) of the male adolescents reported the use of one or more substances in their lifetime. About 44.26% of the adolescents started to use substances before 13 years of age. Most common reason specified by the subjects to take substance were to be liked by friends (57.38%), to feel like an adult (24.6%), and few of them reported: “like the feeling of substances” (13.11%) as reason for taking substances. Common substances used by the subjects were any kind of tobacco (77.05%), inhalants (26.23%), and alcohol (11.47%). Most of the subjects were getting substances from their friends (85.25%) and only a few (14.75%) by themselves. Association analyses revealed that adolescents who studied less than 10th standard reported more usage of any kind of substances than who studied more than 10th standard. More prevalence of substance use was seen among adolescents who were from nuclear family. Subjects who had less than two siblings reported more substance use. Conclusion: Early onset of substance use is seen among adolescents. Low educational status and the nuclear family are associated with their substance use. Friends are the key source of substances and their initiation of substance use. Based on these findings, following recommendations can be considered. (i) Maintaining the substance use control through legislation by which controlling of selling substances under 18 years of age and prohibition of substance use in public places seem to be effective and (ii) early onset of substance use calls for effective measures directed against the younger age groups. Therefore, educational intervention at the school level appears to be the most feasible measure to prevent the initiation of substance use among adolescents.
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Understanding emotional turmoil and resolution of disturbed family relationship issues in a suicidal patient
Gurvinder Pal Singh
July-December 2015, 31(2):84-87
In this article, a truly personal experience of a therapist-patient relationship is being described. This is the experience with a patient Ms. A, who attempted a suicidal act. The nature of demands, difficulties, and emotions the therapist was exposed to while managing this patient is depicted. The therapist-patient relationship was believed to influence critical care of the patient, and a positive therapeutic relationship was associated with continuity of care and favorable treatment response. Human emotions are based on ideas, and control of emotional turmoil may be achieved by changing one's ideas. This presentation will describe the need for us to focus on the specific integrative skills required in handling relationship issues in suicidal patients. The intervention efforts focused on decreasing the suffering experienced, while simultaneously building a patient's capacity to cope with difficulties from an emotional perspective.
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Subjective burden, psychological distress, and perceived social support among caregivers of persons with schizophrenia
Elangovan Aravind Raj, Sahana Shiri, Kavita V Jangam
January-March 2016, 32(1):42-49
Background/Objectives: Caregivers of persons with schizophrenia experience more stress due to the nature of the symptoms as well as the prolonged duration of illness. The current study is an attempt to understand the subjective components of burden, distress, and social support in caregivers of patients with schizophrenia in Indian context and its linkage with their sociodemographic profile and patient's illness profile. Methodology: Thirty-two caregivers of patients with schizophrenia from a psychiatric inpatient facility of a multidisciplinary hospital were studied using descriptive research design. Results: The result shows that negative symptoms of patients, subdomains of burden (burden on well-being, marital burden, burden on relations, and burden due to perceived severity) were the predictors of subjective burden. Burden on well-being and respondent's age were predictors of psychological distress. Conclusion: Inclusive treatment services would enhance the quality of life of the caregivers and would help them in ensuring long-term care for the patients with schizophrenia.
  2,957 436 2
Research on family caregiving for mental illness in India and its impact on clinical practice: Are we doing enough to help families?
Subho Chakrabarti
January-March 2016, 32(1):19-24
Families of Indian patients with mental illnesses have always been involved in their care. Such involvement arises both from choice as well as the compulsion of being a part of an inadequately resourced mental health system. Regardless, families have had to pay a heavy price for undertaking the task of providing care. An extensive body of Indian research on caregiver burden in a number of mental illnesses shows that providing care for a relative with mental illness is associated with considerable distress and burden for the family caregiver. However, much of this research has not made the shift from the somewhat outmoded concept of caregiver burden to the currently prevalent practice of considering the caregiving experience in its totality. Moreover, most of the research is not driven by contemporary theories of caregiving such as the stress coping model. Indian psychiatry has also had a long tradition of supporting family caregivers while they provide care for their ill members. Nevertheless, the Indian evidence for the efficacy of formal family-based interventions remains inadequate and lacks methodological precision. Finally, day-to-day practice in clinical settings does not seem to have made use of the ample body of research evidence in this area to help families in distress. Despite all these problems, progress is being made in the area of family caregiving for mental illness in India. Despite all these problems, slow but steady progress is being made in the area of family caregiving for mental illness in India. It can be hoped that some day in the near future, this progress would translate into mental health professionals forging a true partnership with families providing care for those with mental illnesses.
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Involuntary admission and treatment
Anirudh Kala, Kunal Kala
July-December 2015, 31(2):130-133
Provisions for involuntary admission proposed in the Mental Health Care Bill, which is currently before the parliament, are discussed. Concerns about feasibility and cost-effectiveness of the postadmission judicial review, which is a novel feature in the Indian context, are put forward.
  3,032 275 1
Demonetization, economic crisis, and social psychiatry: Learning from the past?
Nitin Gupta
January-March 2017, 33(1):1-4
  2,789 436 1