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MHCA mandates monthly reporting to the MHRBs of restraints imposed on the PwMI in the MHEs (Section 97). CB-MH services must be strengthened by effectively implementing DMHP and CB-MH services for ensuring the rights of PwMI to receive treatment in the least restrictive environment. Sir, The Mental Health Care Act, 2017,[1] was implemented in the country for ensuring the rights of persons with mental illness (PwMI).[2] Since its launch, it has been critiqued by the scientific community, highlighting its shortcomings and issues with implementation.[3]-[5] However, such critiques did not explicitly highlight the issues with the implementation of the MHCA in routine clinical discourse. [Extracted from the article]

Background: Mental health issues are common among college students, and structured services have been proven to enhance outcomes. Despite increased enrolment for higher education in India, college mental health services remain sparse. JEEVANI is the first structured state-wide college mental health service in India. This paper describes its framework and provides an overview of its functioning during the initial five months. Methods: In 2019–2020, the Directorate of Collegiate Education, Government of Kerala, implemented the program in 66 colleges catering to approximately 60,000 students. Qualified counsellors were trained to identify issues and provide interventions and early referrals, using a stepped-care approach. They conducted awareness programs to promote mental health and reduce stigma. Results: The services were accessed by 2,315 students during the assessment period (October 2019 to February 2020). The beneficiaries were predominantly females (54.1%). Over a third (38.8%) belonged to the lower socio-economic strata, and 2.5% had significant vulnerabilities. Although no syndromal diagnoses were made, anxiety and depression were the most common presentations. The counsellors provided 3,758 individual sessions and facilitated support for students who reported academic difficulties or interpersonal issues. Severe mental illness was detected in 54 students, and referrals for specialist mental health input were initiated in 68. Conclusion: Describing the framework, sharing the technical material, and providing an overview of its functioning from a resource-constrained setting in India may encourage higher education institutions in low- and middle-income countries to consider similar projects. [ABSTRACT FROM AUTHOR]

Background: Cognitive behaviour therapy (CBT) is an empirically supported psychotherapy with applications across psychiatric disorders. The demand for nonpharmacological interventions is increasing in the developing world. Unfortunately, existing resources are unable to cater to treatment and training needs. Methods: The aim of the current paper is to provide a description of the format of a series of CBT training workshops and their clinical impact in a psychiatric tertiary care center in north India. Over a period of nine years, nine training workshops were conducted. CBT concepts and skills sets were inculcated in faculty and student participants, using teaching strategies based on adult learning techniques. Results: The workshops resulted in a tremendous increase in the number of patients taken up for CBT. While therapeutic and training outcomes were not systematically assessed, the naturalistic outcomes (60 out of 85 patients completed therapy; improvement reported by >90% of the completers) are encouraging and showcase capacity building by means of CBT training in these workshops. Conclusions: CBT training workshops are an effective way to impart CBT skills and, therefore, to build CBT expertise in a resource-poor setting. [ABSTRACT FROM AUTHOR]

In this brief paper, we will look at whether doctors who experience mental health difficulties require specialist treatment services. This said, we acknowledge that not all would subscribe to the view that doctors are "different", and debating this issue is crucial in answering the question we pose in this paper - "Are specialist treatment services needed for doctors with mental health problems?" 19 Brooks SK, Gerada C, Chalder T. The specific needs of doctors with mental health problems: Qualitative analysis of doctor-patients' experiences with the Practitioner Health Programme. [Extracted from the article]

Background: India has the second-largest population of elderly in the world. Serious mental illness (SMI) is a subset of the mental disorders that result in significant functional impairment and is usually long term. Persons with SMI face several challenges in their old age that are different from the issues faced by younger people with SMI. Understanding the problems faced by elderly individuals suffering from SMI is fundamental for planning programs to address them. The SENIOR (Support Systems Evaluation of Neuropsychiatric Illness in Old age) project is a study aimed at evaluating the problems faced in obtaining mental health care by elderly persons having SMI in the Kerala state of India. Aim: To describe the scientific methodology of the SENIOR project. Methods: This study employs mixed-methods cross-sectional design among a minimum sample of 768 SMI patients identified through cluster sampling from three districts, and Focus Group Discussion among mental health program officials. Discussion: This paper presents a methodological model to assist researchers in future field epidemiological studies on mental illness. Assessing service needs and barriers to access for the most vulnerable among the mentally ill will help the policymakers make evidence-based decisions to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has a profound impact on people with existing mental disorders, augmenting the prevailing inequalities in mental health. Methods: In order to understand the status of telepsychiatry in India and the role of artificial intelligence (AI) in mental health and its potential applications, a scoping review was done between March 2020 and May 2020. The literature review revealed 253 papers, which were used to derive the primary framework for analysis. The information was then reviewed for ideas and concepts, which were integrated with evidence from gray literature and categorized under broader themes based on the insights derived. Finally, a thematic framework was developed for discussion to tailor scientific information for decision-makers' needs. Results: Review findings are summarized under the following headings: changing patterns of health-seeking behavior, origin and evolution of telepsychiatry, possible applications of telepsychiatry and AI, technological features, and AI models in mental health. Conclusions: Though there are several potential opportunities, the time is not yet ripe for telepsychiatry and AI to be adopted fully in the field of mental health care. But it is time that we develop indigenous proprietary technology and test and validate it. With many solutions offered by telepsychiatry and AI, psychiatrists must choose an appropriate tool based on their requirements, availability of resources, and feasibility of deployment. Harmony between conventional care and technology-based care must be reached gradually. [ABSTRACT FROM AUTHOR]

Family interventions have been an integral part of mental healthcare in India for several decades. This paper highlights the need for an emerging change in the nature of family interventions in India—from generic interventions for heterogeneous caregiver groups to interventions addressing particular needs based on family stages and structures. It makes a case for recognizing the experiences and needs of one such group, that is, families affected by parental mental illness with children in their care and summarizes the current status of research on this topic in the Indian and global context. It presents implications for future research in India and discusses preliminary ideas for professionals working in adult mental health settings to address the needs of children and families affected by parental mental illness. [ABSTRACT FROM AUTHOR]

Background: Telemedicine Practice Guidelines, 2020 and Telepsychiatry Operational Guidelines, 2020 can be potential game changers in the practice of medicine in India. They provide legal grounds for the practice of telemedicine. The economics of setting up and running telepsychiatry services vis-à-vis in-person services in India is discussed in this paper to aid the practitioners in understanding the costs involved in each of these modalities. Methods: Costs for various hardware, software, real estate, and human resources are collated from various sources. Telepsychiatry vs. in-person setup is compared for the costs involved. Results: Telepsychiatry consultation will cost much lesser to that of in-person consultation. Conclusions: Telepsychiatry is an economically viable option. There are many benefits and hurdles in telepsychiatry practice. It is a step towards providing psychiatric services at the doorstep in compliance with the Mental Healthcare Act 2017, upholding the rights of persons with mental illness. It will benefit the practitioner, the patient, and the society. [ABSTRACT FROM AUTHOR]

This article explores the significance of compassion in mental healthcare and its potential to enhance well-being. It acknowledges the gap between theory and practice in implementing compassion in real-world settings and examines how compassion is understood in different cultures. The article also discusses the role of compassion in the broader healthcare system, emphasizing the importance of equal access to services. It concludes by highlighting the relevance of compassion in mental healthcare and the benefits it can bring to both patients and healthcare professionals. The article suggests various strategies to cultivate a compassionate environment, such as training workshops for mental health professionals, considering clients' perspectives, incorporating compassion-based training in education, promoting conversations that inspire hope, and embracing the concept of narrative medicine. It also emphasizes the role of community care in supporting individuals with mental health conditions and underscores the need for compassionate leadership in healthcare organizations. Additionally, the article briefly explores the relationship between capitalism and compassion and calls for discussions on creating a just society. The authors stress the necessity of empirical research on compassionate mental healthcare. [Extracted from the article]

This article explores the need for innovative approaches to psychotherapy in India, specifically in terms of adapting existing models and introducing new ones that are culturally and socially responsive. It introduces Cognitive Analytic Therapy (CAT) as a potential model that can be used in the Indian context, emphasizing its transdiagnostic and whole-person approach. The article provides case examples to illustrate how CAT can be applied in therapy sessions, highlighting the importance of a collaborative and authentic therapeutic relationship. It also acknowledges the challenges of implementing psychotherapy in a system with limited access to trained professionals and calls for further research on the effectiveness of CAT in the Indian population. [Extracted from the article]

Blended Psychotherapy: Treatment concept and case report for the integration of Internet- and mobile-based interventions into brief psychotherapy of depressive disorders. Depression is among the commonest mental health disorders, affecting over 322 million people worldwide, and is the single largest contributor to health loss.[1] In India, depression affects one in every 20 individuals, and most of the affected neither seek nor have access to treatment.[2] Technology-driven self-help and guided psychological interventions have shown promising results and could be a low-intensity and low-cost strategy to cater to a larger number of individuals seeking mental health care.[3] This assumes great importance in the context of scarcity of trained professionals to offer psychological interventions and observations that a significant proportion of individuals seeking treatment for common mental health concerns may receive only pharmacological interventions, despite voluminous literature suggesting the utility of psychological interventions.[4] Graph Internet-based interventions have been assessed in substantial research in the last 20 years, and several meta-analyses demonstrate their effectiveness in treating various psychiatric disorders, including depression and anxiety.[5], [6] Different formats of internet-based interventions have been studied. Blending online therapy into regular face-to-face therapy for depression: Content, ratio and preconditions according to patients and therapists using a Delphi study. [Extracted from the article]

No.ComponentWestern CounsellingYogic Counselling1Paradigm of counsellingThe modern psychotherapy and counseling techniques are based out of a reductionist paradigm which attempt at explaining the entire system in terms of individual parts and their interactions.The Indian psychology is based on the holistic paradigm. The origin of concepts of yoga-based philosophical counselling can be derived from the traditional Vedic and Upanishadic literature from 2700 bc, also known as the preclassical period[1] of yoga. With increased focus on well-being and increased scientific research in the field of yogic sciences, the modern context views yoga as a complementary and alternative therapy in combating metabolic, psychosomatic, and mental health disorders, by addressing the root stressor.[8] Components of Yoga Yoga traditionally has eight limbs ( I Ashtanga Yoga i by Patanjali). [Extracted from the article]

Los Angeles, http://smhp.psych.ucla.edu/pdfdocs/nurses/unit1.pdf 31 Andrews FT, Avarachan A, and Daniel J. A descriptive study to assess the availability and utilization of school health services in government schools as reported by the school health nurses working under school health scheme in New Delhi. 8 Parikh R, Michelson D, Sapru M. Priorities and preferences for school-based mental health services in India: A multi-stakeholder study with adolescents, parents, school staff, and mental health providers. Worldwide, an estimated 13% of youth under 18 years of age have significant mental health problems. SP sp [1] SP , sp [2] SP sp Also, a significant percentage of mental health issues have their onset below 25 years of age. School mental health sustainability: Funding strategies to build sustainable school mental health programs: Washington, DC; Technical Assistance Partnership for Child and Family Mental Health. [Extracted from the article]

Background: Mental Health apps (MH apps) could help address the huge unmet mental health care need of developing countries. This study aimed to explore potential ethical, data safety, and privacy issues associated with using MH apps for depression. Methods: A cross-sectional assessment of the top 50 MH apps (by Google Play store search result ordering) for depression available in India was conducted in November 2021. Results: Most apps were listed under the category of health and fitness (54%). The median number of total and dangerous permissions requested at the time of download was nine and three, respectively. Privacy policy in English was available for 76%. The average length of the privacy policy was 2171 words, and the mean Flesch-Kincaid reading grade level was 12 (much higher than the recommended cut-off of eight). Important features relevant to safeguarding consumer confidentiality, including names of third parties with which user data could be shared (42%), explicit consent before sharing data with third parties (16%), and assurance regarding the collection of de-identifiable data (11%), were missing from the majority of privacy policies. Conclusion: There is an urgent need to improve the accessibility and usability of privacy policies by app developers, with the active involvement of other stakeholders. [ABSTRACT FROM AUTHOR]

The application of these counseling techniques derived out from the Ramayana in a clinical population would be the next step toward developing an evidence base and an indigenous counseling framework. In counseling psychology/psychotherapy, most often, the counsellor is in a position of power to deliver the counseling to clients and not vice versa (e.g., psychoanalytic psychotherapy and behavior therapy). Thus, there is a distinction between the counseling delivered in the epics and that conducted in counseling psychology, based on the theoretical background under which the counseling method is delivered. [Extracted from the article]

The World Health Organization (WHO), in its world health assembly (WHA), 2012, resolved that "there is need of a comprehensive, coordinated response from the health and social sectors at the community level to address the issue of burden of the mental illness."[1] India being a signatory to it, launched her national mental health policy (NMHPolicy) in 2014.[2] The policy was in concordance with WHO's mental health (MH) policy, plan, and program (2005), and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD, 2007). 11 Mental health policy, plans, and programmes (updated version 2) (Mental Health Policy and Service Guidance Package), https://www.who.int/mental%5fhealth/policy/services/2%5fpolicy%20plans%20prog%5fWEB%5f07.pdf?ua=1 (2005, accessed December15,. For instance, universal access to MH care can be realized through effective implementation of the provisions of MHCA (2017), particularly early setting-up of the MHRB across the country (requiring a collaborative effort from both the state and center), which will ensure right-based MH services. [Extracted from the article]

The Mental Health Care Bill - 2013 has been introduced in Rajya Sabha and is now waiting for enactment. The Bill entails unprecedented measures to be undertaken by the Government ensuring everyone right to access mental health care and treatment from services run or funded by the Government. The Government is to meet the man-power requirement of mental health professionals according to international standard within a period of ten years. Various rights of persons with mental illness have been ensured. All the places where psychiatric patients are admitted and treated including the general hospital psychiatry units (GHPU) are to be registered as mental health establishments. Unmodified ECT has been banned and ECT to minors can be given only after approval from the Mental Health Review Board. This article advocates for exemption of GHPU from the purview of the Bill, taking into consideration impediment created in the treatment of vast majority of psychiatric patients who retain their insight into the illness and seldom require involuntary admissions. It is also advocated to reconsider ban on unmodified ECT and restriction placed on ECT to minor which are very effective treatment methods based on scientific evidence. In our country, family is an important asset in management of mental illness. But requirement of seeking approval from the Board in many of the mental health care decision may discourage the families to be proactive in taking care of their wards. The Board and Mental Health Authorities at the central and the state levels are authorized to take many crucial decisions, but these panels have very few experts in the field of mental health. [ABSTRACT FROM AUTHOR]

After that, the therapists could assist the patients in creating the appropriate Bitmoji (Snapchat, Santa Monica, CA, USA) image to match it closely with the perceived AVH, to ensure smooth facilitation of the sessions. Schizophrenia reduces the quality of life and academic and vocational performances of affected individuals.[1] It affects about 20 million people worldwide.[2] One of its hallmark symptoms is auditory verbal hallucinations (AVH), wherein the patients hear voices that are particularly threatening, commanding, and abusive in nature, thus adding to the already existing derogatory effects.[3] Although Clozapine is one of the benchmark treatments amongst antipsychotic medications, unfortunately, 20% to 50% of patients do not respond to it and suffer from treatment-resistant schizophrenia for years.[4] Another first-line and evidence-based treatment exercised for AVH is cognitive behavioral therapy for psychosis (CBTp).[5] Various randomized controlled trials (RCTs) and meta-analyses have shown that CBTp has moderate effects in ameliorating the symptoms and enhancing the quality of life.[5]-[8] Because the available pharmacological and psychological interventions depict modest effects on AVH outcomes, further clinical research is required in this domain. One-year randomized trial comparing virtual reality-assisted therapy to cognitive-behavioral therapy for patients with treatment-resistant schizophrenia. [Extracted from the article]

The increased levels of psychological distress in the population and the disruption of traditional mental health services during the COVID-19 pandemic have widened the mental health treatment gap that already existed even prior to the onset of the pandemic.[2] Additionally, there is significant stigma attached to mental-health-treatment seeking, especially in low- and middle-income countries.[3] The culmination of these different factors has provided a fertile ground for the mushrooming of mobile health apps for mental health disorders and wellbeing.[4] People advocating the use of mental health apps (MHapps) often describe the potential of these apps in delivering mental health services discretely to people living in even remote and rural locations, in turn reducing the huge mental health treatment gap. Rapidly increasing smartphone ownership among the majority of the world's population and increasing internet penetration through relatively cheaper mobile data usage plans have led to the development and popularization of various mobile applications (apps).[1] These apps are third-party software apps that utilize mobile and/or other related devices' hardware (e.g., wearable sensors, such as a smartwatch) along with or without internet communication technology and enable users to perform a wide range of different tasks related to varied fields, such as trade, commerce, education, entertainment, or health, through their smartphones. Do mental health mobile apps work: Evidence and recommendations for designing high-efficacy mental health mobile apps. [Extracted from the article]

APSWP and the representatives of the 20 institutes are seeking RCI regulations and registration for PSWs and call for the support of our fellow mental health colleagues - psychiatrists, clinical psychologists, and mental health nurses to make this possible. If RCI recognizes the psychiatric social work profession, the rehabilitation interventions by PSWs also would be recognized as per the RCI Act 1992/2000,[29] which allows anyone to practice as a "rehabilitation professional" with its registration only. Broader Roles and Functions of PSWs in the Field of Mental Health PSWs play an important role in the multidisciplinary team of a mental health care institute and have multiple roles and functions. Initially, PSWs were not included under the NCAHCP Act.[25] It was under the recommendations of associations of social work professionals (who do not cater to PSWs only) that PSWs were later included under its purview. [Extracted from the article]

The COVID-19 pandemic has affected the physical health of individuals as well as their emotional and mental health. To conclude, COVID-19-pandemic-related stressors seem to have further aggravated the ongoing challenges faced by transgender people. All national health frameworks and strategies should consider the benefits of health promotion strategies and service accreditation standards for providing culturally appropriate services for transgender communities, with their advantages to the transgender communities taken into account. [Extracted from the article]

Background: Identification of barriers to mental healthcare seeking among medical students will help organize student mental health services in medical colleges across India. This study was conducted to estimate the prevalence of depression, anxiety disorders, and suicidal behavior among medical students and to identify the potential barriers to mental healthcare seeking among them. Methods: In this cross-sectional observational study, the medical students from a medical college in South India were asked to complete a structured pro forma for sociodemographic details, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Questionnaire (GAD-7),and Suicide Behaviors Questionnaire-Revised (SBQ-R). The barriers to mental healthcare seeking were assessed using the mental health subscale of Barriers to Healthcare Seeking Questionnaire for medical students. A cut-off of 15 was used for determining the presence of depression on PHQ-9. A cut-off of 10 on GAD-7 indicated the presence of anxiety disorder, and a cut-off of 7 on SBQ-R indicated suicidal risk. Results: Out of the 425 participants, 59 (13.9%) were found to have depression (moderately severe or severe) and 86 (20.2%) were found to have anxiety disorders (moderate or severe). A total of 126 (29.6%) students were found to have a suicidal risk. Preference for informal consultations, concerns about confidentiality, and preference for self-diagnosis were the most commonly reported barriers to mental healthcare seeking. Students with psychiatric disorders perceived more barriers to mental healthcare seeking than students without psychiatric disorders. Conclusions: One-fourth of the medical students were detected to have depression and/or anxiety disorders. Establishing student mental health services, taking into account the perceived barriers, will go a long way in improving medical students' mental well-being. [ABSTRACT FROM AUTHOR]

This article discusses a community-based public health initiative called "Stories against stigma: A walking tour of NIMHANS" conducted at the National Institute of Mental Health and Neurosciences in Bengaluru, India. The tour aimed to reduce stigma and discrimination towards persons with mental illness (PWMI) by providing in-person social contact and educational information. The study involved a baseline assessment of participants' attitudes and knowledge about mental illness before the tour, as well as a feedback form to assess the impact of the tour experience. The majority of participants reported a positive shift in their attitude towards mental health and appreciated the opportunity to address misconceptions about PWMI through direct interactions with professionals. The article suggests that walking tours like this could be organized at other mental health establishments to combat stigma and improve mental health literacy. [Extracted from the article]

Dementia is the main cause for clinically significant cognitive impairment among older people. Merely their medical condition was often cited as evidence of impaired decision-making capacity.21 Clinicians shall therefore give due importance to documentation whenever a diagnosis of dementia is made. Driving and Dementia It is pertinent to note that several people with dementia drive vehicles, as having a diagnosis of dementia is not enough to stop someone from driving. [Extracted from the article]

Patients'/caregivers' perspectives on telemedicine service for advanced cancer patients during the COVID-19 pandemic: An exploratory survey. To the Editor, Since the onset of the COVID-19 pandemic, telemedicine is being used at a massive scale but without assessing the satisfaction and feedback of patients and their caregivers, i.e., the service users. Patient Satisfaction with use of telemedicine in university clinic of psychiatry: Skopje, North Macedonia during COVID-19 pandemic. [Extracted from the article]

Psychiatry teachers can play a crucial role, particularly in enhancing the quality of psychiatry training in medical colleges, especially when the stigma attached to mental illnesses is enormous. Such managerial skills could be incorporated into the Psychiatry training curriculum of the young trainees,[9] or psychiatry teachers themselves can undertake such courses as a part of continuous professional development. [Extracted from the article]

Using token economy and monetary incentives as reinforcers is an evidence-based practice in psychiatry. Using work indicators can be better suited for moderate- to high-functioning clients, as the strategy reinforces work differentially by assessing various performance-related outcome measures. [Extracted from the article]

We postulate that sensationalist media coverage and public statements by mental health professionals may also contribute to a potentially volatile situation in the aftermath of a celebrity suicide. With regard to Mr Rajput, statements were made by mental health professionals around the world about his mental health and speculating upon reasons for his suicide, including discussion of personal details and relationships. Several public figures, mental health professionals, and lifestyle advisors have appeared in news coverage, discussing their personal relationship with or proffering a professional opinion of Mr Sushant Singh Rajput. [Extracted from the article]

40 years ago, on 2 April 1979, Time magazine published a dramatic cover story titled "psychiatry's depression", arguing that psychiatry was experiencing a life-or-death identity crisis and needed to find new directions in order to survive.[[1]] The article documented recruitment difficulties into the profession, a dearth of real knowledge about mental illness, interminable debates about the effectiveness of established psychological therapies, and the emergence of any number of eye-catching pseudo-therapies in the 1960s and 1970s. The Time article also noted continued problems with psychiatric hospitals and standards of care but nonetheless concluded that new research in the neurosciences now positioned psychiatry - as ever - on the cusp of a brave new era. Despite these problems, many of which persist today, Clare advised against an excess of gloom and remained optimistic about the prospects for neuroscience, declaring in 1995 that "there has never been a more exciting or a more demanding time to be in psychiatry."[[3]] How psychiatry responds to this situation should and will be the greatest single factor shaping psychiatry's future. [Extracted from the article]

Background: Yuva Spandana (YS) is a youth mental health promotion program implemented across all 30 districts of Karnataka. Yuva Parivarthakas (YPs - youth change agents) are trained to provide mental health promotion services to any "youth with issues" through Yuva Spandana Kendras (guidance centers) situated within district stadiums across Karnataka. Aim of the study was to evaluate the change (comparing before and after training) in different learning domains (cognitive – knowledge, affective – attitude, and psychomotor – practice) among trainees (YPs) attending YS training. Methods: Quasiexperimental study design was utilized for this study. A semistructured interview schedule was developed and used before and after the training. Data were analyzed by descriptive statistics. The difference in change of mean score was assessed using the paired t-test. The shift in the proportion of trainees post-training in the three domains was assessed using McNemar's test. Results: The mean (±SD) age of trainees was 27.5 ± 3.3 years. Majority of them were males (63.8%), had completed bachelor's degree (53.4%), and were residing in rural Karnataka (77.7%). The knowledge and attitude scores significantly improved (P < 0.001) post-training, without significant improvement in practical skills. Conclusion: It is recommended that future training programs need to be focused on creating opportunities to YPs in order to increase their practical skills to work with youth having issues. [ABSTRACT FROM AUTHOR]

There is a strong body of evidence which points to the utility of psychological interventions in the field of mental health. Innovations in the field of mental health directed at improving access to mental health services have tended to typically focus maximally on supply-side- barriers. These include innovative ways of improving the supply of mental health professionals offering a range of interventions, the supply of trained non-specialists offering basic psychological interventions, early identification and timely referrals in general/primary health services, and reducing structural and organisational barriers. Moreover, about 70% of the users reported that they had no exposure to mental health services at any time in the past, and only about 12% were currently seeking mental health professional services. [Extracted from the article]

To the Editor, Work has multiple clinical and socioeconomic benefits for persons with mental illness and developmental disabilities (henceforth referred to as Persons with Mental Health Challenges [PwMHC]), such as having a daytime routine; enhancing physical and psychological well-being, self-esteem, and quality of life; promoting socialization, positive self-identity, and recovery; and decreasing symptom severity, rehospitalization rates, duration of hospital stay, and family burden.[1]-[5] Work programs form a vital component of psychiatric rehabilitation services at many Indian psychiatric rehabilitation settings, including daycare and residential centers, tertiary care psychiatric hospitals, and general hospital psychiatry units.[4]-[6] A daycare-based "profit-oriented" work program (named Green Skills Program [GSP]) was conceptualized at a tertiary care psychiatric hospital. Certain fundamental limitations concerning work culture, functioning-levels of PwMHC referred for the program, and product sales need to be addressed systematically to make GSP a sustainable model. Alternately, settings such as "sheltered workshops" or "vocational training centers" with productivity or "profit-oriented" work culture might be better suited for profitable and sustainable work programs run with PwMHC. [Extracted from the article]

Background: The use of mobile phone technology to support various components of health care delivery (often referred to as mHealth) is on the rise. Little systematic information, however, is available on user felt needs and barriers to mHealth approaches among people with severe mental illness (SMI). Our objectives were to elicit user needs, preferences, and barriers to using mobile phones for health care service delivery among people with SMI. Materials and Methods: A cross-sectional study was carried out among 75 subjects with SMI between August 2017 and October 2017. All patients had a minimum illness duration of two years or more and a Global Assessment of Functioning score of less than 70. Information on user perspectives was elicited using a 10-item structured questionnaire, to assess mobile phone usage patterns, felt needs, barriers, and preferences, developed for use in patients with SMI. Results: Majority of the patients reported using mobile phones and were favorably disposed to mHealth approaches. Voice calls (n = 47, 62.7%) were the most preferred mode of service delivery. The most preferred service frequency was twice-weekly (n = 31, 41.3%), followed by once-weekly (n = 22, 29.3%). Majority (n = 47, 62.7%) reported no barriers to mobile phone usage, whereas 14 (18.6%) perceived a lack of necessity of mobile phones as a service delivery medium. Reminders about medication and appointments through mobile phones (n = 35, 46.6%) were the most felt needs, followed by crisis helplines (n = 27, 36.0%) and information about mental health services (n = 22, 29.3%). Conclusion: These findings support the use of mHealth approaches in resource-constrained settings and provide specific inputs to refine the modalities of mHealth service delivery. [ABSTRACT FROM AUTHOR]

The article offers information on the transcript of the panel discussion that was held at Annual Conference of Indian Psychiatric Society South Zonal Branch in Tirupati, Andhra Pradesh on 26th October, 2018. It mentions panel discussion involved three experts from different states and working backgrounds to discuss this important topic including postgraduate training in psychiatry, a mandatory child case in the final examination, and de‑emphasis of descriptive psychopathology.

The article focuses on the new competency-based curriculum for medical graduates of the Medical Council of India (MCI). It refers to the curriculum's focus on providing standards and framework for measuring performance and learning the critical competencies needed for the success in clinical practice.

Introduction: There is an unmet need for continuity-of-care is well known for those with severe mental disorders (SMDs) after acute care at hospitals in India. The "Sakalawara Rehabilitation Services (SRS)" functioned from March 2014 at "Sakalawara Community Mental Health Centre" (SCMHC) of "National Institute of Mental Health and Neurosciences," Bengaluru, India in the concepts of residential care (half-way-home) with the aim to develop a replicable model. Aim: To review the inpatient records after the initial 2 years of experience in residential care at SCMHC. Methodology: Retrospective file review of inpatients at SCMHC from March 2014 to March 2016 in a semi-structured proforma designed for the study. Ethical committee of NIMHANS Bengaluru has approved the study. Results: The total number of inpatients during this period was 85. It was found that Schizophrenia spectrum disorders were the most common diagnosis among these patients. The activity of daily living and psycho-education were the most common individual interventions. The majority of families underwent structured family psycho-educational interventions. This review also demonstrated the feasibility of tele-aftercare in continuity of care after discharge of patients. Conclusion: SRS kind of residential set-up is feasible and demonstrated effectiveness in maintaining continuity of care of SMDs. There is a need for better structured and customized interventions. There is further a scope for tele (video) aftercare for those with SMDs. [ABSTRACT FROM AUTHOR]

Mental, neurological, and substance abuse disorders cause huge burden. The available resources to tackle the huge burden are insufficient, inequitably distributed, and inefficiently used, which results in a large majority of people with these disorders receiving no care at all. Advances in technology can be used to address the concerns. At present, technology is utilized in online psychological interventions and mobile apps in the United States of America and United Kingdom. In India, technological advances are utilized in telemental health, mobile apps, software aiding psychological assessment and retraining, training for mental health professionals, and information delivery to general public. Although this would be cost effective, digital divide, ethical and legal issues have to be addressed for better penetration of the health technologies to the persons in need. [ABSTRACT FROM AUTHOR]

Background: During the past years, significant efforts have been made to explain the biological backgrounds of obsessive-compulsive disorder (OCD). Cortical-subcortical and neurotransmitter models are used for explaining the symptoms of OCD, so our hypothesis is that brain's transcranial direct current stimulation (TDCS) can regulate the brain activities of the OCD patients. Thus, based on the mentioned issues, this research seeks to investigate the efficacy of TDCS in treatment-resistant patients who suffer from severe OCD. Materials and Methods: The present study is a clinical trial research which was based on the available sampling method, 42 treatment-resistant patients who suffer from severe OCD were selected as research's samples (2015-2016). Medical intervention protocol in this study is TDCS cathode type that was done in 15 sessions for 3 consecutive weeks (each session was conducted for 30 min daily). Yale-Brown Obsessive-Compulsive Scale was used for evaluating the efficacy of TDCS method during the 1st, 5th, 10th, and 15th sessions and it was also used for checking the 1st and 3rd monthly follow-up phases. Results: Variance within-group analysis (repeated measure) showed that the mean differences in the different stages of evaluation are significant (seven stages of evaluation). Conclusion: TDCS can be introduced as an appropriate, strong tool for regulating the brain - behavioral systems and it can also be introduced as a suitable alternative treatment for treatment-resistant patients who suffer from severe OCD. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Treatment usually consists of serotonergic medications along with exposure therapies. Danger ideation reduction therapy (DIRT) is an alternative therapy predominantly for washing compulsions and focuses on reduction of danger ideations. DIRT was tried on Ms. S. with a history of OCD for 15 years and improvement was noticed on Yale-Brown Obsessive Compulsive Scale, Padua Inventory, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale after 15 sessions of DIRT though she was not fully symptom-free. Thus, DIRT was found to improve OCD symptoms and improved her insight into illness. [ABSTRACT FROM AUTHOR]

Background: Psychotropic medications are the mainstay of treatment in psychiatric disorders and are associated with ADRs which affect the compliance and treatment course. Previous studies have looked at the frequency, profile of ADRs and their management aspects. However, the systematic comparison between IP and OP was lacking even though there is a prescription pattern difference. Hence this study was aimed to compare the proportion, pattern, severity and resolution of ADRs once detected. Methods: This is a hospital based, prospective follow up study done in the psychiatry ward and outpatient setting for a period of 6 months. A total of 491 patients (200 IP, 291 OP) who received psychotropics were monitored in the study. UKU side effect rating scale was used to detect ADRs, WHO -- UMC scale for causality, Modified Hartwig and Siegel Scale to assess severity of ADR and CDSCO suspected ADR form for reporting it. Results: Out of 491 patients who were recruited for the study, 83 patients developed ADRs (34 IP, 49 OP, P = 0.963). The mean number of ADRs per patient was found to be higher in IP (IP-2.17±1.14, OP-1.65±1.12, P-0.01). Severe ADRs were observed to be higher IP (IP-67.64%, OP-38.7%, P-0.014) which was statistically significant. There is no statistically significant difference in distribution of ADRs across all age groups (P-0.475). Conclusion: The study results emphasises the need for active pharmacovigilance so that ADRs are detected and managed at the earliest, hence reducing the morbidity and improving compliance. There is also need for systematic long term, multicentric study to further examine and correlatethe observations of our study. [ABSTRACT FROM AUTHOR]

Aim: In a resource-poor country such as India, telepsychiatry could be an economical method to expand health-care services. This study was planned to compare the costing and feasibility of three different service delivery models. The end user was a state-funded long-stay Rehabilitation Center (RC) for the homeless. Methodology: Model A comprised patients going to a tertiary care center for clinical care, Model B was community outreach service, and Model C comprised telepsychiatry services. The costing included expenses incurred by the health system to complete a single consultation for a patient on an outpatient basis. It specifically excluded the cost borne by the care-receiver. No patients were interviewed for the study. Results: The RC had 736 inmates, of which 341 had mental illness of very long duration. On comparing the costing, Model A costed 6047.5 INR (100$), Model B costed 577.1 INR (9.1$), and Model C costed 137.2 INR (2.2$). Model C was found fifty times more economical when compared to Model A and four times more economical when compared to Model B. Conclusion: Telepsychiatry services connecting tertiary center and a primary health-care center have potential to be an economical model of service delivery compared to other traditional ones. This resource needs to be tapped in a better fashion to reach the unreached. [ABSTRACT FROM AUTHOR]

A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical know how, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services. [ABSTRACT FROM AUTHOR]

Recent studies from India have challenged the fact that the majority of the people who die by suicide have severe mental illness; they have demonstrated its frequent links to environmental stress, social, cultural, economic, and political correlates. Suicide, a complex phenomenon, is a final common pathway for a variety of causal etiologies. Nevertheless, psychiatry continues to argue for curative solutions based on the reductionistic biomedical model, rather than support public health measures to manage the larger sociocultural, economic, and political context. While psychiatry and curative medicine help many people in distress, specific mental health interventions are unlikely to impact secular trends in the rates of suicide. The reduction of population rates of suicide requires a range of public health measures. [ABSTRACT FROM AUTHOR]

Background: A diagnostic tool designed as part of a telepsychiatry application for diagnosis and management of child and adolescent psychiatric disorders in India was developed considering the paucity of trained child psychiatrists and mental health professionals in India. Materials and Methods: The diagnostic tool consisted of screening and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria-based diagnostic algorithms for 18 psychiatric disorders seen in childhood and adolescence. Accuracy of diagnoses and feasibility of use of the tool was examined by comparing it with detailed semi-structured clinical evaluations by a qualified psychiatrist with 50 psychiatric patients (children and adolescents). Statistical Analysis: Descriptive analyses and paired t-tests were conducted to compare the mean number of diagnosis generated by the two interviews. Sensitivity, specificity, positive and negative predictive values were computed for the screening and the diagnostic sub-modules of the tool, compared to the clinical diagnoses. Kappa coefficients were computed to assess agreement between the diagnoses generated by the diagnostic sub-module and the clinical diagnoses. Results: The screening sub-module had high sensitivity, high specificity and negative predictive values for all disorders. For the diagnostic sub-module, there was moderate (kappa-0.4-0.6) to substantial agreement (kappa > 0.6) for all the disorders, (except psychosis) and high sensitivity (barring a few disorders) and specificity for almost all the disorders. Positive predictive values were found to be acceptable to high for most disorders, with consistently high negative predictive values. Conclusion: The new tool was found to be comprehensive, reasonably short and feasible. Results showed acceptable level of accuracy in diagnosis generated by the tool. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess mortality and its correlates among psychiatric inpatients of a tertiary care neuropsychiatric hospital. Given the background that such a study has never been undertaken in India, the findings would have a large bearing on policy making from a mental health-care perspective. Materials and Methods: The medical records of those psychiatric inpatients (n = 333) who died during their stay at the National Institute of Mental Health and Neurosciences in past 26 years (January 1983 to December 2008) constituted the study population. Results: During the 26 years, there were a total of 103,252 psychiatric in-patient admissions, out of which 333 people died during their inpatient stay. Majority (n = 135, 44.6%) of the mortality was seen in the age group of 21-40 years. Most of the subjects were males (n = 202, 67%), married (n = 172, 56.8%) and from urban areas (n = 191, 63%). About, 54% of the subjects had short inpatient stay (<5 days, median for the sample). In 118 (39%) of the subjects, there was a history of physical illness. Leading cause of death were cardiovascular system disorders (n = 132, 43.6%), followed by respiratory system disorders (n = 45, 14.9%), nervous system disorders (n = 30, 9.9%) and infections (n = 31, 10.1%). In 21 (7%), cause of death was suicide. Conclusions: Identifying the factors associated with the death of inpatients is of utmost importance in assessing the care in a neuropsychiatric hospital and in formulating better treatment plan and policy in mental health. The discussion focuses on the analysis of different factors associated with inpatient mortality. [ABSTRACT FROM AUTHOR]

Globally, telepsychiatry has been around since the 1950s. It is in the COVID era that it has gained the relevance and much-needed momentum amongst mental health care professionals. Given the restrictions imposed by the global lockdown owing to the fear of contracting the virus, the ease of access and safety offered by telepsychiatry makes it both appealing and "the new normal." Despite some hesitation from mental health professionals, there is adequate research to support the role of telehealth services in the management of various mental health disorders. As with any formal system, the practice of telepsychiatry is regulated by professional guidelines to show the way forward to both health provider and seeker. The manuscript examines the ways telepsychiatry is redefining our virtual conduct. It emphasizes the evolving "netiquette" needed to navigate online consultations. It also elucidates the challenges faced by health professionals, and possible ways of maneuvering and circumventing the same. Telepsychiatry, a dynamic process which is interactive and personalized, adds a third dimension to the practice of modern medicine. It is here to stay. So, it is not a question of "if" instead "how soon" we can adapt to and get conversant with this revolutionary mode of connection, communication, and consultation, which will make all the difference. [ABSTRACT FROM AUTHOR]