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The Case to Expand Psychiatric Education for MBBS Students

The Case to Expand Psychiatric Education for MBBS Students

Photo: Diana Polekhina/Unsplash

The 2016 National Mental Health Survey found that close to 14% of India’s population required active mental health interventions and 2% suffered from severe mental disorders – giving India the dubious distinction of having one of the highest prevalence of mental illnesses in the world. One in seven Indians has been found to be suffering from a mental illness of varying severity – double the disease burden found in 1990.

These numbers get more alarming when we factor in the lack of mental healthcare professionals in India. India is estimated to have 0.75 psychiatrists per 100,000 people. The desirable ratio is at least 3 psychiatrists per 100,000 people (high-income countries have about 6). Even the resources that are present aren’t equally distributed. While about 65% of India resides in rural areas, 75% of trained healthcare personnel and other medical resources are concentrated in urban areas. The northeastern states, Uttarakhand and Chhattisgarh in particular severely lack human resources in this field.

Apart from being a healthcare issue, these numbers also spell out an economic issue. The prevalence of depression and anxiety disorders among Indian workers is expected to reduce productivity to the tune of up to $1.03 trillion from 2012 to 2030, offsetting the demographic advantage of having a young population.

Given this, it’s hard to believe the Indian government spends only 0.34% of its GDP on healthcare, and a fraction of that on mental healthcare. Bangladesh spends almost eight-times more of its healthcare budget on mental health. The corresponding number for developed countries is around 5% on average.

India obviously needs to build capacity to have more mental healthcare personnel. The country currently has about 9,000 psychiatrists. Given its current population, it should have at least 36,000. This said, adequately trained primary care physicians can manage many people’s issues and refer only people with severe mental illnesses to psychiatrists. The Live Love Laugh foundation’s ‘Doctors Programme’ has trained more than 2,100 primary care physicians to recognise and treat common mental illnesses this way, recognising that primary care physicians and doctors who aren’t psychiatrists can bridge the care gap.

In addition, a relatively inexpensive way to rapidly increase the number of physicians catering to mental illness is to train undergraduate MBBS students to correctly recognise and manage common psychiatric afflictions. At the moment, the training they receive is lower in level in both developed and developing nations.

This isn’t a novel idea either – it has found expression and support since the 1960s, but hasn’t been implemented yet. At present, 20 hours are allocated for psychiatry during the entire course, with an optional posting before the final professional exams, and a two week clinical posting during the internship year. Psychiatry is tested as a part of medicine, and its weightage is small enough that one can get through the MBBS programme without studying it.

Apart from increasing the workforce capable of competently managing psychiatric conditions, a greater emphasis on psychiatric training could make for better doctors overall, because of the complex overlap of mental and physical illness. Mental illness often has some physical symptoms that neither the patient nor the doctor may attribute to the real cause, and a growing body of research is showing that both mental illnesses and the drugs used to treat them can cause chronic conditions like heart disease.

Given the prevalence of mental illness in India, it is likely that a clinician encounters a subset of patients with psychiatric comorbidities irrespective of their area of focus. Knowing how to factor them and the drugs prescribed for them can improve the competence of medical care provided.

One group of people that can greatly benefit with better mental healthcare is, in fact, the community of doctors. Doctors around the world experience levels of depression, anxiety disorders and burnout far higher than the general population. There is also a known association between depression among doctors and poorer quality of healthcare dispensed – and it’s only compounded when physicians themselves are reluctant to seek mental healthcare for themselves, even when they show outward signs.

There are many reasons for this; but doctors in one survey raised concerns about being perceived as “weak” by their colleagues and their patients as a common roadblock. Since the health habits of doctors have been known to inform their health-counselling practices as well, it’s very important that undergraduate psychiatric training addresses these problems within the medical community as early as possible.

In doing this successfully, we can expect a cohort of doctors that are better advocates for their patients as well as their communities.

Sumedha Sircar is an intern-doctor at KMC Manipal and consults for Suicide Prevention India Forum. She is dedicated to learning about sociodemographic determinants of health and science communication.

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