My impressions of Psychiatry in India
( Guest post by Sarah Orr, Medical Student, Kings College, London)
I am a medical student from London; having spent four weeks shadowing psychiatrists in Pune I would like to share my thoughts on the experience.
I compared my visit to the Trimiti Clinic with my experience of the National Health Service (NHS) and psychiatry in the UK. The social and cultural observations I made are likewise based from a background of the familial and social structures present in the United Kingdom. This article will cover similarities and differences between these perspectives, without intending to criticise or judge either one.
On arrival to the clinic I saw that the furnishing had more character and warmth than UK clinics; I am more used to clinical shades of white and blue. The informality of the setting was also new to me; comfy sofa chairs with a coffee table instead of a desk and upright chairs. The former may help people to share more of their feelings and concerns as they feel more comfortable.
The way the clinic was run is also different. In India there appear to be few waiting lists; patients are seen when they wish to be seen. The doctors work much longer hours to accommodate this. These doctors see far more patients than their UK colleagues. They also have far less paperwork. This may reflect the lack of litigation; everything British doctors do is scrutinised by colleagues and I think that the patients might be more likely to sue their carers.
The patients themselves differ from what I would expect. On the first day I saw patients ranging from the ages of seven to early twenties. This meant that the child psychiatrist would see their patient from their early years up to adulthood and beyond if they wished – providing a great continuity of care. In the UK, psychiatric patients are moved to adult services at the age of about 18 regardless of what they would prefer. This may entail longer waiting lists with a difficult transition to an unfamiliar service. Many patients are likely to be lost in this system; this has cost some families dearly as their children struggle without treatment.
Children are seen with a variety of problems in India, not all of them psychiatric. This gave me the impression that the psychiatrist is seen as a well of knowledge and source of advice for all areas of life; more than just a doctor to prescribe treatments. In England patients are only seen by the psychiatrist after having seen a range of other professionals (social workers, GP, mental health nurses) – the doctor is made relatively inaccessible through a network of referrals.
The family in India is much more involved in treatment – I have rarely seen a psychiatric patient on their own. Most often they are accompanied by at least two relatives, sometimes three or four. These family members are enlisted to help aid the recovery of the patient through education about their condition and its management alongside more practical help (such as ensuring the patient completes tasks and takes medication). This support network is much more extensive than in the UK where “nuclear” families with few children or single parents are becoming more common. It seems we may suffer from this; our psychiatric patients are often alone and struggling to manage their illnesses. Few are in employment. However, the family involvement seen in India may come at a cost; it seems to be difficult to maintain privacy in this setting. Parents are aware of relationships and information shared with the doctor – this may cause them to make their own decisions based on their beliefs of what is best for the child. For this reason the child’s own choice may be at risk. On the other hand this may mean that they are kept safe from the impulsive decisions young adults sometimes make.
Overall I had a lovely experience; all the staff were friendly and kind, the work was interesting and I have learnt a great deal. India is a fascinating country as are its people.