Year : 2019 | Volume
: 61 | Issue : 2 | Page : 115--116
Distance training for the delivery of psychiatric services in primary care
Department of Psychiatry and Director, NIMHANS, Bengaluru, Karnataka, India
Dr. B N Gangadhar
Department of Psychiatry and Director, NIMHANS, Bengaluru, Karnataka
|How to cite this article:|
Gangadhar B N. Distance training for the delivery of psychiatric services in primary care.Indian J Psychiatry 2019;61:115-116
|How to cite this URL:|
Gangadhar B N. Distance training for the delivery of psychiatric services in primary care. Indian J Psychiatry [serial online] 2019 [cited 2019 Mar 22 ];61:115-116
Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/2/115/253831
In the early 1960s, medical institutions in India introduced postgraduate diploma courses in psychiatry and soon afterwards, master's degree courses. Nevertheless, despite the availability of effective and affordable treatments for patients with psychiatric disorders, the delivery of psychiatric services in our country continued to be a challenge. This led a senior psychiatrist, the late Prof. NN Wig, to observe, pithily, that mental health is too important a matter to be left only to psychiatrists.
The central problem is that undergraduate medical education in India does not adequately train medical graduates to deal with the complexities of assessing and treating different forms of mental illness and disability. This necessitated the development and standardization of short term training modules for the District Mental Health Program (DMHP). Such training showed promise; doctors who received such training demonstrated skills that were reasonably sufficient to offer treatment for the mentally ill in primary care centers. Such training was even extended to general practitioners in cities, with successful results.
This “despecialization” of psychiatric care through primary care doctors was a novel approach. However, the approach generated controversy; psychiatrists were concerned that 2–3 years of specialty education was being reduced to a 2–3 month crash course. Some even equated psychiatric practice after short-term training with quackery. Nevertheless, the merits of such training are gaining ground.
There were many reasons for the success of the short-term training courses. Psychiatric care became more widely available. Patients had access to psychiatric treatment at even primary care levels. Patients received psychiatric care early in the course of illness. The quality of care was adequate.
There were other benefits, too. Awareness about mental illness and its treatment increased in the community. The stigma of having to visit a mental hospital or a psychiatric clinic did not arise when such treatment was offered in primary care centers that treated general medical conditions, as well. Mental healthcare therefore came into the mainstream of general health care. Thus, an unexpected objective was achieved, that of integrating mental health care with general health care in line with the dictum that there is no health without mental health. Mental health care was no longer limited to the domain of psychiatrists.
Let us stop for a moment, now, and think back; what drove the primary care training initiative? It was the failure to provide adequate training in psychiatry in the undergraduate medical curriculum. What has been the progress in this area?
Several attempts were made to incorporate formal psychiatric training into undergraduate medical training but with incomplete success. The Medical Council of India had recently revised the MBBS curriculum to include improved training in psychiatry. This is a positive for the future. But what about the tens of thousands of medical graduates who are presently serving in primary care in government and private sectors; will they not need additional training?
In this regard, the DMHP continues to provide training, as described earlier. Although the training is effective, it is associated with an important limitation. Training modules are 1 week to 3 months in duration, and trainees need to relocate to a central location for this period, away from their clinics. Many practitioners find this discouraging. The training, therefore, cannot reach everybody. So what might be the alternatives?
In this regard, NIMHANS has adopted digital technology in an excellent example of how a challenge can be converted into an opportunity through innovation. Initial attempts applied distance training through internet services to empower service providers in the competent delivery of deaddiction services. This success prompted an extension of distance training to training of medical professionals in mental health skills for application in primary care. The distance education mode of training methods ranged from clinical case conferences to hand-holding support and culminated in the development of separate diploma courses in Community Mental Health for doctors, psychologists, social workers, and nurses through the NIMHANS Digital Academy. The Honorable Union Minister of Health and Family Welfare inaugurated this Academy in June 2018.
In parallel, Manjunatha et al. demonstrated the use of telemedicine as a teaching facility. This resulted in what is now called “on-consultation training.” Primary care doctors sought help (consultation) from specialists to manage their psychiatric patients. In addition to providing specific guidance in real time, the specialists imparted training to enhance the skills of these doctors for the management of the psychiatrically ill. Thus, the primary care doctors acquired case-specific and general skills in psychiatric care and have been utilizing these skills in their practice.
In summary, distance clinical training is not only feasible but also effective and efficient. It is popular among the end users. It has saved time for both trainees and trainers. Some of the trainee doctors even utilize their travel time for connecting into training sessions, thus optimizing time management. It is expected that mental health services from primary care doctors will enhance awareness about mental health issues and their treatment in the community. It is envisaged that tele-training will continue through periodic Continued Medical Education sessions. It is hoped that tele-training will soon be more formally recognized, such as by state medical councils for the award of credit points.
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