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   2015| July-December  | Volume 31 | Issue 2  
    Online since January 6, 2016

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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.
  13,044 1,061 1
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.
  13,187 756 3
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.
  6,848 526 3
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.
  6,455 424 1
”The wind of change…”
Nitin Gupta, Abhijit R Rozatkar
July-December 2015, 31(2):81-83
  2,415 4,425 -
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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Capacity to consent in mental health care bill 2013: A critique
Suresh Bada Math, Sydney Moirangthem, KR Krishna, V Senthil Kumar Reddi
July-December 2015, 31(2):112-118
Mental capacity refers to the ability of an individual to make one's own decisions. Decision-making capacity has been described as the “key to autonomy” and an important ingredient of informed consent. Limited or impaired mental capacity embarks on a minefield of ethical and legal issues, which doctors need to be aware of while dealing with a particular patient. The objective of this article is to critically analyze the provisions of “capacity to consent” in Mental Health Care Bill (MHC Bill 2013), under the framework of the United Nations Convention on the Rights of Person with Disabilities (UNCRPD 2006). This article also attempts to offer a practical legal framework and some concrete suggestions, for psychiatrists operating in an ethically and legally challenging area of mental capacity. Some of the highlights include attempts to translate aspirations of the UNCRPD into MHC Bill 2013, which were out of context given the available resources, the family structure of our society, and inadequate research inputs. However, there is a need to introduce the capacity to consent to the MHC Bill 2013 after comprehensive research and to study the impact of such a revolutionary idea on the family aspects of our society. There is an urgent need to formulate and validate a capacity assessment tool for our population. The MHC Bill needs to consider the repercussion and impact of capacity to consent, thereby making room for the compulsory community treatment order empowering affected family members in providing much needed treatment for persons with mental illness.
  4,188 481 -
Tranquilizing Stigma: Identifying Advocacy Interventions Based on Subjective Experiences of Stigma among People with Schizophrenia
Santosh Loganathan, R Srinivasa Murthy
July-December 2015, 31(2):88-99
Background/Objectives: Research on stigma interventions focuses on general public attitudes and overlooks patients' subjective experiences of everyday stigma arising from significant others. Mental health advocacy has rapidly progressed in western countries, but still continues to be in its early stages in low- and middle-income countries. With this background we looked for possible sources/areas to formulate anti-stigma interventions based on the individual subjective experiences of stigma. Methods: Stigma experiences were assessed by conducting interviews with 200 patients suffering from schizophrenia attending psychiatric services in urban and rural settings. Using ATLAS.ti the narratives were analyzed qualitatively and a final analytical web was created to make associations. Using thematic content analysis we identified themes that could possibly have implications for anti-stigma interventions. Results: Five different areas were identified based on the objectives: Interventions to target key stakeholders such as family members, service providers, nongovernmental organizations/voluntary organizations and people with schizophrenia itself are identified. Interventions could target media personnel, administrators and planners and mental health professionals too. Conclusions: As observed from the results, stigma has multifaceted origins and consequences; and hence interventions too need to occur at these multiple levels with concerted co-ordination.
  3,519 391 -
Suicide and crisis management
BS Chavan, Shikha Tyagi
July-December 2015, 31(2):123-129
Suicide among the general population is a major public health problem and thus is a cause of concern for India. Since suicide is the outcome of multiple factors including socioeconomic, cultural, religious, and political; intervention and prevention strategies will vary from region to region. The legal framework and guidelines in a country can influence the suicide rate by eliminating barriers to mental health services, by adopting and strictly implementing policies on access to firearms for persons with risk of suicide, providing services for treatment of substance abuse patients, and by training of school personnel so that they can identify and assist vulnerable youth in accessing help. Mental Healthcare Bill (MHCB), 2013, will soon become the guiding law for the treatment and rehabilitation of persons suffering from mental health issues. Although MHCB has been criticized on many fronts, it still has laudable provisions that attempt to address reducing treatment gap through the proposal of availability of minimum mental health facilities at primary health center, proposing comprehensive treatment facilities including rehabilitation and the proposal to remove attempted suicide from Section 309 of IPS, etc., which might contribute in suicide prevention and other mental health crisis situations.
  3,520 339 2
Mental Health Care Bill 2013: The Place of Electroconvulsive Therapy
Bangalore N Gangadhar, Channaveerachari Naveen Kumar, Jagadisha Thirthalli
July-December 2015, 31(2):148-152
Electroconvulsive therapy (ECT) is one of the oldest medical treatments in psychiatry. The practice has evolved over the years, and the indications have become better defined now. Notwithstanding these, it remains a highly regulated and scrutinized practice. Indian laws specifically related to ECT do not exist till date though this would change if the purported mental health care bill 2013 becomes the law of the land. ECT gets both direct and indirect mention at various places in the bill with far-reaching consequences impacting patients, families, and the professionals. Ban on “ECT as an emergency treatment option” and on “unmodified ECT” is being sought. In addition, ECT in minors is slated to come under stricter regulation. ECT could also get implicated under the “advance directives” provisions of the bill. This naturally has triggered vociferous debates throughout the country between the supporters as well as detractors of ECT. A number of ethical, professional, logistic, and clinical concerns are being discussed. In this background, we attempt to critically evaluate the bill with regard to ECT in the background of the existent scientific and legal literature. We provide possible future directions with regard to ECT practice and its regulation.
  3,508 292 -
Mental Health Care Bill, 2013 and United Nations Convention on the rights of persons with disability: Do they go hand in hand?
Santosh K Chaturvedi, Chethan Basavarajappa, Ashfak Ahamed
July-December 2015, 31(2):107-111
This article is an effort to examine how far the proposed Mental Health Care Bill (MHCB), 2013 addresses the issues raised under the United Nations Convention on the Rights of Persons with Disability (UNCRPD). This was performed by examining different documents and publications related to the proposed MHCB, 2013 and position statements and views expressed by different stakeholders. Although the proposed MHCB, 2013 is far advanced for its time, there are some gaps in its alignment with the UNCRPD. However, the proposed Rights of Persons with Disability Bill (RPWDB), 2014 addresses many of the issues pertaining to the UNCRPD. Thus, the essence of the UNCRPD is covered jointly by the MHCB, 2013 and the RPWDB, 2014.
  2,714 370 -
The curious case of the advance directive in psychiatry
Alok Sarin
July-December 2015, 31(2):119-122
As discussions around the Mental Health Care Bill 2013 gain pace, one aspect of the bill, which is the Advance Directive, has perhaps not been discussed enough. The present essay is an attempt to explore different aspects of the advance directive in psychiatry, to understand the implications better. The article attempts to look at the conceptualization of the advance directive, questions regarding implementation, and possible unintended consequences. In doing so, it interrogates the larger question of ideology that drives the concept of the advance directive in psychiatry.
  2,666 311 1
Leave and Discharge: Legalising Science of Psychiatry and the Art of Caregiving!!
Savita Malhotra, Ruchita Shah
July-December 2015, 31(2):134-140
The central theme and guiding principles of Mental Health Care Bill (MHCB), 2013 are “individual autonomy and protection of rights” of persons with mental illness. It has endeavored to address the rights of persons with mental illness. Pertaining to “leave and discharge,” the Bill provides for legal mechanisms and mandates for discharge of independent patients and their detention beyond 30 days; discharge of patients under supported admissions; leave of absence; discharge planning; role of Mental Health Review Boards (MHRB); nominated representatives; psychiatrists, medical officer, and other mental health professionals; and police. MHCB seems to be inspired by and modeled on Western laws borrowing several concepts and provisions such as that of MHRB and nominated representative. In this context, there are four major areas where the provisions of MHCB are either unenforceable without severe negative repercussions or nonviable. Close clause by clause analysis reveals that MHCB emphasises on individual autonomy and right to freedom at the cost of compromising other important fundamental rights such as to health and dignity. First, the Bill completely neglects the role of the most important resource, Indian family system; creating more hurdles for patient and family; even putting them on opposite sides of the legal fence. Second, though MHRB is meant for protection of rights, unlike the Western laws from where the concept is drawn, it has gross under-representation of psychiatrists, leaving medical decisions to the judiciary, and other nonmedical professionals. This seems to be a retrogressive step. Third, the periods for which detention is allowed under each section is clinically ill-informed and seems arbitrary (not even similar to Western laws!). Finally, several of the provisions including that of discharge planning cannot be implemented in practice unless, through its mental health policies and programs, the government creates community-based resources, and services of substantial quality.
  2,261 192 -
Plica neuropathica: Looking at the sociocultural mirror
Hemanta Dutta, Soumik Sengupta, Subhashish Nath, Kushal Tamuli
July-December 2015, 31(2):161-162
  1,870 182 -