|Year : 2018 | Volume
| Issue : 2 | Page : 54-56
APPSYCON Kakinada - “Extending with interventions”
P Srinivasa Teja
Consultant Psychiatrist, Brain Wave Hospital, Nellore, Andhra Pradesh, India
|Date of Web Publication||31-Dec-2018|
Dr. P Srinivasa Teja
Brain Wave Hospital, Nellore - 524 001, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Teja P S. APPSYCON Kakinada - “Extending with interventions”. Arch Ment Health 2018;19:54-6
It is my privilege to take charge as the president of Indian Psychiatric Society (IPS), Andhra Pradesh State branch, for the year 2018–2019. On the very onset, I am very much thankful to the members of society, for unanimously electing me as president. I am also thankful to mentors of the society and senior colleagues who guided me in the election process.
Dear members, today, I am going to emphasise the need and importance of therapeutic interventions in Psychiatry. When we look at the recent past changes that are happening in modern medicine, rapid changes are taking place in the medical sciences. Our understanding about the diseases is rapidly changing from time to time. More and more tools and newer techniques are being added to the specialties.
For example, if we look at radiology, this branch was germinated soon after the discovery of X-ray 120 years back. After a long gap, ultrasound was added. It added color to radiology. Later, computed tomography scan and magnetic resonance imaging (MRI) came into the picture. Now, the radiologists are in the era of functional MRI, positron emission tomography, single-photon emission computed tomography and so on. As a result of the sequential and rampageous entry of diagnostic tools and their applications, the role of a radiologist was made prominent. Now, the question is, what about the radiologist who restricted himself to X-ray or ultrasound alone?
If we look at an ENT surgeon who is still examining the patient with Bull's eye lamp and indirect laryngoscope when others have upgraded to fiber optic tools; similarly, a conventional ophthalmic practice versus fully computerized practice; and if we see any of the medical branches, interventions are playing a major role.
As far as diagnosis and treatment is concerned, today is the era of “interventions.” Interventional radiology as I mentioned earlier… in the same way, interventional cardiology, interventional neurology, interventional urology, and even interventional dermatology is matter today. Now, it is our turn to ask ourselves that “are there any interventions in psychiatry?” The answer is yes! But unfortunately, we are not looking at them.
Among the medical specialties, psychiatry is the branch which deals with mental health. Whether it is a medical illness, psychiatric problem, or some other psychological issue, the outcome is behavioral change that comes under mental health.
When the patient/client needs to get help from the experts, we as mental health professionals are the topmost priority for them. Now, the question is, are we in a position to provide the services as expected by the needy? Based on the observations of current practicing trends, the answer is indistinct.
When we introspect ourselves regarding the treatment patterns, the pattern which we are following is not up to the current trends. We are still treating the patients in the conventional methods, whereas other specialties are practicing with advanced interventions. We are viewing the behavior of individuals from the window of the “medical model” only. Hence, our treatment protocol will be automatically “ill and pill” model. As long as psychiatrists are confining themselves to the ill and pill mode of practice, we are not going to touch the other available choices.
Social concepts are ever changing. At present, people are searching for the alternatives to modern lifestyle challenges.
People are looking back to the natural remedies for their health. They are shifting to new food habits such as organic diet, millet diet, and keto diet. In health sector also, people are preferring indigenous, herbal, ayurvedic, and homeopathic remedies to allopathy. There is a significant swing toward yoga and meditation to promote their positive health. People are not hesitating to spend time and money for whatever they want.
Taking the current trends of the society, even in psychiatry, people are preferring the natural and alternative methods of treatment. We need to change our views according to the social demand. Although we are aware of the theories of interventions, still we are not able to implement it in practice.
Unfortunately, many of us are considering that nonpharmacological therapies are not our cup of tea. I think, we ourselves are imposing some sort of resistance to consider the wider options that are available. Psychological therapies are well designed, studied, and standardized. Studies showed that cognitive behavioral therapy (CBT), rational emotive CBT, rational emotive therapy, and mindfulness are proven to be equally effective when compared with pharmacotherapy. Depression, anxiety spectrum disorders, dissociative disorders, and other nonpsychotic disorders which were previously called as neurotic disorders can be dealt effectively with interventional modalities of treatment. In certain behavioral conditions, they are the only choice.
If we make ourselves blind to alternative options and confine only to ill and pill mode, we cannot emphasize the importance of psychiatry to patient community as well as to our own medical fraternity. This does not mean that we are not updating. Whatever we are upgrading is only restricted to the field of pharmacotherapy. Whatever knowledge we are gaining, whatever skills we are learning, and whatever worth we have, the final and common mode of delivery is just a prescription.
As far as mental health is concerned, psychiatric medicines are being prescribed not only by psychiatrists but also by other clinicians. About 70%–75% of the psychiatric medicines are being prescribed by other clinicians such as general practitioners, physicians, neurologists, neurosurgeons, gastroenterologists, and so on. In such case, people cannot find much difference in the prescription, between a psychiatrist and a nonpsychiatrist.
In this scenario, except ECT, there is no scope to show our own, unique specialty skills. Then what is the specific role of a psychiatrist? Are we only for diagnosis and issuing prescriptions? In that case, what will be fate of psychiatry in future?
On the one side, our nonpsychiatric colleagues are largely sharing our work, and on the other side, we have left the interventions to nonmedical persons. If we consider clinical psychologists who are in the field, their number is not sufficient to fulfill the demand. There are hardly < 10 clinical psychologists in both Telugu states. There are only six seats for clinical psychology available in Telangana and no seats in Andhra at all.
With the lack of qualified professionals in clinical psychology, untrained qualified professionals like us are making the field empty. Then, how will the gap be fulfilled? As we all know that, society will always try to maintain its equilibrium. The existing gap is being filled with self-claimed experts such as counseling psychologists, hypnotherapists, motivational trainers, and NLP practitioners. They are considered as qualified and authenticated by the public. All this is happening because we are reluctant to enter the field which is actually ours.
We as psychiatrists only have the scope to deliver the highest professional services for the psychological problems. Very few of our colleagues are working in the fields such as BT, CBT, psychotherapy, marital therapy, sex therapy, and other special areas. It has to be adopted by many of us.
To do the psychological interventions, a psychiatrist does not need to do any special courses. We are capable and can directly get into the field with little training. Now, the issue is how to get trained?
Like in advanced counties, we do not have the training centers and fellowship trainings. Whatever we know about the therapies so far is mere theory. I wish IPS has to play a major role in arranging workshops and training programs regarding this aspect.
As a president, I will work for the society in my level best with the help of my team and I will try to do my best to encourage, arrange, and work out regarding the training programs.
Long live IPS, Jai Andhra and Jai Bharath.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.