Dr Prakriti Poddar, expert in Mental Health, Director Poddar Wellness, recommends prescribing MHE to regular patients to identify if they exhibit behavioural problems that ordinarily may miss GPs’ notice
Ownership of personal health is most lacking in human beings. The legal framework, workspace, socio-cultural and family ecosystems, and our personal choice force us to compromise on health. Factors such as age, education, various belief systems, financial, work and other issues put enough mental pressure on an individual to compromise on health.
All these factors do not only compromise health but also impact mental health. A fact, which is not well acknowledged or realised enough, is that most victims of any major disease, including their family members, are in need of counselling. This also means they need guidance, support systems, checks and balances to guide them, motivate them, and keep them on track of the treatment regimen and associated lifestyle.
The challenges: Feasibility and Acceptability
Can our burdened healthcare infrastructure allow integrated mental health evaluation (MHE) in routine hospital care? The answer is “No”. The Indian healthcare system is already undergoing a massive transformation with major government initiatives and policy revisions on one hand; and on the other, there is an acute shortage of healthcare and even mental healthcare professionals and related infrastructure.
Then can nothing be done? The answer is “No” here too. Just because we have major hurdles does not mean that we should not move ahead. The groundwork for an integrated MHE in routine healthcare can begin now.
The subject of acceptability pertains to whether an individual would be willing to undergo such an evaluation. The National Mental Health Policy 2014 discusses integrated care that creates space for the inclusion of the domain in a routine hospital care where patients are treated in silos.
Integrated mental health evaluation
In an integrated MHE in the routine hospital care system, the system should be prescribing a MHE to regular patients to identify if they exhibit from an array of behavioural problems to mental health issues that ordinarily may miss the general physician’s notice. This will not only give visibility to the individual challenges but can also equip the doctors to take the right measures for ensuring the best possible treatment outcomes.
Instead of making the integration of MHE with healthcare delivery a mandatory law, it should be designed at present on the lines of a directive principle.
The way forward
The basic way to achieve this is to make the inclusion of a questionnaire or patient information form pertaining to mental health compulsory. The form can be designed by the experts of the industry or the ethical review board of hospitals, can be disease specific, and should be easy to understand and familiar language. However, it should not be compulsory for the patient to fill it.
As the patient load is too high in hospitals, the form can be implemented for specific cases and diseases; for instance, in IPD cases or when the patient is undergoing critical treatment for example HIV, cancer, surgical cases, etc.
The Indian medical education system is more focused on gaining medical expertise. The thrust on patient counselling and dealing with ethical challenges and emotional matters still need major focus. Educational systems, training, and curricula should be upgraded to equip doctors, nurses, and healthcare staff to identify mental health challenges and address them.
The distant vision
We need to be in a position to create a class of counselling experts who along with varied operational training are equipped to guide and evaluate patients’ progress, keeping in consideration the disease profiles.
Integrating MHE with routine hospital care can go on to play a massive role in countering stigma and the bias associated with mental health challenges. In terms of case-by-case patient treatment, it will ensure that healthcare providers and patients both try to identify reliable and capable support systems that can physically and mentally help the patient on the part to recovery. An integrated MHE in routine hospital care is the way forward to achieve our objectives of holistic health.