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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]

Background: As a signatory of the United Nations Commission on Child Rights, India has enacted laws and policies to protect the child's interests. The Juvenile Justice Act of 2015 addresses the needs and well-being of the most vulnerable children, including those who do not have anyone to care for or have experienced a traumatic upbringing and those who are allegedly in conflict with the law. No research from India addresses these vulnerable children's mental health and well-being. The current paper describes a pilot project to create mental health awareness and improve children's care access in India's Juvenile Justice System (JJS). Methods: Permission was obtained from appropriate governmental agencies in Odisha and Tamil Nadu and Child Care Institutions (CCIs) that consented to participate. A co-creation model was utilized to create youth-friendly spaces and methods to deliver mental health literacy for all stakeholders and access to care. Results: Seven CCIs and 278 children across two states participated in the implementation of the project. 37.8% of the children had resided for less than six months and 34.5% for more than two years in the current CCI. Of the various adverse childhood experiences, neglect was the highest at 76.3% followed by parental issues at 32%. Conclusions: Children in the JJS have many risk factors predisposing them to develop mental health issues. This unique pilot project describes implementing a codesigned and co-created model of delivery of mental health literacy and access to care to this vulnerable group of children. [ABSTRACT FROM AUTHOR]

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]

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 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]

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]

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]

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]

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]

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]

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]

The article focuses on several mental health legislation implemented in Southern Asia. The region, accordingly, covers Pakistan, Bangladesh, Sri Lanka, Nepal, and India. In India and its neighboring countries, for instance, do not have a mental health policy but there are mental health programs and acts with specific areas of focus that are already taking place. One of them is the Mental Health Act of India, which provides that for every 10 admitted patients, a psychiatric hospital must have at least one psychiatrist, one psychologist and three nurses. However, the author sees the Act to be non-existent considering the fact that on the state of Arunachal Pradesh, as an example, it has only one psychiatrist and no psychiatric hospital.

Discusses the prevailing condition in the National Institute for Mental Health and Neurosciences in Bangalore, India. Coping mechanism to the limited psychiatric resources in the country; Clinical services offered; Patient management in the psychiatric hospital.

Telepsychiatry provides a platform for mental health care delivery in rural and remote areas. Hybrid Telepsychiatry model combines home-based telepsychiatry with domiciliary visits by community mental health workers. This involves use of different modes of teledevices which ensures safe and secure clinical platform. Research evidence supports that incorporating this model seems to use the specialist time efficiently where the resources are limited and services need to be catered for larger geographical community. The current telepsychiatry practice in the United States, specifically the hybrid model, has indisputably shown significant benefits in caring for psychiatric patients. Such valuable clinical model and its relevance to current mental practice and also its application in the Indian scenario can be helpful in providing comprehensive multidisciplinary treatment. This review evaluates and highlights the potential risks and benefits of adopting the hybrid telepsychiatry model in the Indian mental health system. [ABSTRACT FROM AUTHOR]

Technology is bringing about a revolution in every field and mental health care is no exception. The ongoing COVID-19 pandemic has provided us with both a need and an opportunity to use technology as means to improve access to mental health care. Hence, it is imperative to expand and harness the tremendous potential of telepsychiatry by expanding the scope of its applications and the future possibilities. In this article, we explore the different avenues in digital innovation that is revolutionizing the practice in psychiatry like mental health applications, artificial intelligence, e-portals, and technology leveraging for building capacity. Also, we have also visualized what the future has in store for our practice of psychiatry, considering how rapid technological advances can occur and how these advances will impact us. There will be challenges on the road ahead, especially for a country like India for instance; the digital divide, lack of knowledge to utilize the available technology and the need for a quality control and regulation. However, it is safe to presume that telepsychiatry will evolve and progress beyond these roadblocks and will fulfill its role in transforming health care. Telepsychiatry will improve the health care capacity to interact with patients and family. The blurring of national and international borders will also open international opportunities to psychiatrist in India, heralding a new wave of virtual health tourism. [ABSTRACT FROM AUTHOR]