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Government of India

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October 7, 2016

Dignity in Mental Health

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Author : Dr Smita N. Deshpande

World Mental Health Day (October 10)  and  World Mental  Health Week (09 October  – 15 October 2016)

The ideal concept of health encompasses physical, mental, social and spiritual health. Physical health without enjoying full mental health, leads to loss of social and spiritual health as well. India has a large population of people affected with mental disorders. At least twenty people per every thousand are thought to be afflicted with major mental illnesses which significantly affect health, productivity and social integration not only of the people themselves but also of their families- since stigma against mental illness is rampant. Childhood mental disorders are another untended chunk. Children with mental retardation, autism, and learning disorders often remain undetected. Suicide is another huge problem although the causes of suicide are multifactorial.

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Trained mental health personnel are too few to attend to these problems. The District Mental Health Programme (under National Mental Health Programme), now integrated into the National Rural Health Mission, aims to plug this gap to some extent but the issues relating to manpower and financial shortages are yet to addressed. Contrarily, there is a paucity of jobs in this sector which leads to large scale brain drain.

Nevertheless the Government of India was always aware of the importance of mental health as part of overall health issues. India’s National Mental Health Programme is ambitious in its reach and scope.

World Mental Health Day

Encouraging positive mental health, and not just treat mental illness, has been the aim of the World Federation for Mental Health (WFMH) since its inception. The WFMH spearheaded the idea of World Mental Health Day on October 10 every year and was formed at the instance of the first Director-General of the World Health Organization (WHO), Dr. George Brock Chisholm, a Canadian psychiatrist.

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The driving principle of the WFMH is to ‘promote among all peoples and nations the highest possible level of mental health in its broadest biological, medical, educational, and social aspects’ as cited at their website:  http://wfmh.com.  Today through its activities such as World Mental Health Day and Week, the WFMH continues its drive to improve awareness and remove prejudice about mental disorders. India has been a voting delegate of the WFMH since its inception.

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The first World Mental Health Day was observed in 1992, as a tool to draw attention to the need for mental health education, awareness and advocacy. Messages for World Mental Health Day indicate the work that still needs to be done for integrating the mentally ill into society. Messages such as ‘Dignity in mental health’ (WMHD 2015) emphasized ensuring the dignity and rights of the mentally ill. The theme for 2014 was “Living with schizophrenia”. Schizophrenia is a serious mental illness which causes significant disability, and frequently leads to stigma, discrimination and deprivation of rights.

In many countries including India, this Day and Week are observed by organising activities centred around focussing on the need for early detection, treatment, inclusion and empowerment of the mentally ill. Since mental illness deeply affects family members as well, they are also contribute in advocacy.

Mental health organizations, professionals, teaching institutions, advocates and mental health personnel undertake several activities to generate awareness about the issues relating to mental health.

This year’s World Mental Health Day message is Dignity in Mental Health: Psychological and Mental Health First Aid for All.

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All of us have to face traumatic situations, and many have to face crises – for instance sudden loss of a loved one, failure, sexual or other abuse, rape or accident. Immigration has led to widespread, traumatic displacement of people all over the world. India itself faces a large influx of legal and illegal immigrants displaced due to difficult life circumstances. Many Indians who went abroad for livelihoods are being sent back to an uncertain future.

Anyone facing a crisis event is vulnerable to great emotional disturbance leading to anxiety, depression, increased risk of substance abuse, increased need for care and support, social impairment and psychological distress. People facing such trauma need several different kinds of help from different sectors- police, primary health care, even teachers in schools, neighbours, and social workers in case of child or woman abuse.

In stressful situations, the first priority is of course protecting life and limb through effective first aid. But usually this needs to be supplemented with psychological or psychosocial first aid to ensure early and optimum recovery. What does such first aid comprise of?

Psychological first aid emphasizes support and practical assistance, listening without forcing the person to speak. Assessing the immediate needs and concerns of the person, appropriate social and community based help needs to be provided.

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Such empathetic listening and caring comes naturally to many people but others feel uncomfortable while still others may turn away or react negatively. Hence training in psychological first aid, without going into the history of antecedent events, needs to be provided immediately. Psychological first aid must have a large social and ‘reality’ based component as well- for instance ensuring safety, food and security, locating lost relatives, calling upon existing social supports for the person and so on.

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The World Health Organization developed a one day training manual for psychological first aid which is widely used. In disasters, it needs to be the first response after saving life. Subsequently it should be supplemented with structured community support, care of the vulnerable population such as those at extremes of age, the disabled and mentally ill. For those with more severe issues, trained mental health care will be necessary.

Psychological first aid should be an essential component of training of disaster health workers, and of those who are often called upon in crises such as the police, firemen, or emergency health care workers. This could prevent escalation of healthcare needs and improve outcome for both survivors and workers in crisis situations.

Let us hope that this year’s World Mental Health Day succeeds in bringing this important training to the fore.

*Author is Professor & Head, Department of Psychiatry & De-addiction Services; Centre of Excellence in Mental Health, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi. Also member of Council for National Institute of Mental Health and Neurosciences.

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THE JOURNEYS OF AIIMSONIANS

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Author : V. Srinivas

While it is widely acknowledged that AIIMS is India’s apex Medical Sciences University, celebrating its Diamond Jubilee this year, the JOURNEYS OF  AIIMSONIANS who collectively constitute the greatest pool of medical excellence of the Nation, are a fascinating subject of study. For these extra-ordinary men and women who undergo their education at the Institute and serve till retirement at 65, it is a very long journey marked by seriousness of purpose, a deep sense of commitment, willingness to work in complex areas of medical education, patient care and research. The Senior Faculty of AIIMS have, by their mercurial brilliance earned high respect for the Institute and individually attained a leadership role as flag-bearers of excellence both in India and abroad.

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The AIIMSONIANS are unique individuals because they have set out to do something significant, work on important problems, have the courage to pursue independenti201610630.jpg thoughts, are high achievers at a young age, have a tremendous drive, are willing to work longer hours than contemporaries with equal ability, have high emotional commitment to their profession and have the capacity to present their achievements to the world. This author asked 5 of them if it was worth it? For they had an option to serve in many other Institutions of the country and abroad, and the common refrain has been that “It was worth it”. The highest national recognitions have been bestowed on several AIIMSONIANS, being with   Dr.  V. Ramalingaswamy felicitated three times with Padma Awards including the Padma Vibhushan.

The AIIMSONIANS toil long hours in operation theaters, clinical work, research Laboratories and Classroom Teaching. Roughly 40 percent of their time is devoted to patient care, 40 percent to research work and 20 percent to teaching.

The Institute provides the flexibility to devote a higher amount of time to any of the trinity of goals of Medical Education, Research and Patient Care to best achieve their end objectives. That AIIMS stands at the apex of the Medical Universities in India for several years now, is a tribute to the exacting standards the AIIMSONIANS have set for themselves.

AIIMS MBBS 1st Batch, 1956

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High Achievers at a Young Age

The AIIMSONIANS journey usually begins as an MBBS student at the age of 17 or 18. They are young, intense, scholarly and represent the highest meritocracy. They complete the MBBS in 4 ½ years followed by a year of internship. This period is marked by an attachment with Community Health Center Ballabhgarh and PHC’s Dayalpur/ Chainnsa their first exposure to actual direct patient care after years of didactic and clinical teaching sessions. They hold pleasant memories of the first phase of their lives where they graduated after being intensely competitive. There are several doctors who join AIIMS as Junior Residents, Senior Residents and as Faculty who also become part of AIIMSONIANS.

Prof Balram Airan, Chief of the CT Center, the senior-most AIIMSONIAN currently serving in AIIMS, was part of the team of cardiac surgeons that conducted India’s first heart transplant in 1994. Prof Balram joined the Institute in 1970 aged 18. Prof Vinod Paul, the Head of Department of Pediatrics joined the Institute in 1972 aged 17. Prof Peush Sahni, the Head of Gastro Intestinal Surgery joined the Institute in 1976 aged 18. Prof Nikhil Tandon, the Head of Department of Endocrinology joined the Institute in 1981 aged 17. Prof Sandeep Agarwal, Professor in the Department of Pediatric Surgery joined AIIMS in 1981 aged 18. They came straight from the Schools to the most intense medical institution of India.

They needed support to cope with the transition, which AIIMS provided them. The faculty student relationship was quite open. Students have been the Nerve Center of the Institute Universe. They had a local guardian from faculty to look after them in the initial years AIIMS had became their second home.

The graduation is followed by admission to the MD or MS programs in medical or surgical disciplines and 3 years of work as Junior Residents. There is also an option of a 5 year MCH course. This is followed by selection of a professional discipline for the DM or MCH program. It is only after 11 years of intensive study do the AIIMSONIANS reach the faculty appointment as Assistant Professor. Their choice of selection of disciplines at the MD and MS stage and then at DM/ MCH stage are often based on their areas of interest in which they would like to dedicate their careers. The prevalent view in AIIMS is that surgeons are more doers and physicians are more intellectually curious.

Prof Balram was inspired by Prof Gopinath to take cardiac surgery. Prof Paul was inspired by Prof O.P. Ghai for joining Pediatrics. Prof Peush Sahni inspired by Prof Samiran Nandy joined the GI unit when it started surgical procedures. Prof Nikhil Tandon chose to be a physician instead of a surgeon and endocrinology satiated his curiosity for laboratory work. Prof Sandeep Agarwala chose Pediatric Surgery because of his emotional commitment to pediatrics and surgery.

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Work on Important Problems

High recognition comes from taking huge responsibility. The AIIMSONIANS work amidst a high meritocracy and a strong peer group pressure. Younger colleagues are encouraged to challenge and question. There is the opportunity of establishing state of the art laboratories and pursue research questions. The Physicians pursue largely clinical research, translational research, public health and district based models in collaboration with State Governments, Government of India Institutions like Department of Biotechnology, Indian Council of Medical Research, the International Organizations like the World Health Organization and the UNICEF.

If it is an important Medical Problem, one can be sure that there is an AIIMSONIAN working on it in AIIMS – such is their fierce motivation and emotional commitment to the societal cause. They are highly driven individuals, each one of them, and AIIMS provides them with the academic freedom for their creativity to blossom.

Work Longer Hours than contemporaries

The work hours in AIIMS are far longer than what are seen in most Government Institutions. Genius is 99 percent perspiration and 1 percent inspiration. The AIIMSONIANS are willing to work long hours intelligently and with a seriousness of purpose. There is tremendous emotional commitment and passion to enable AIIMS continue on a path of excellence.

AIIMS represents Indian society, its varying sections, each one of them coming for health care, and each one of them finding a panacea. There is no comparable representative institute in India.

Prof Balram’s passion for long work hours hasn’t come down even after 45 years of joining AIIMS. Prof Peush said he has a passion to return to the Alma matter the enormous amount of learning that he attained in the Institute. Prof Paul said translational research keep him motivated. Prof Nikhil felt there was enough excitement to keep him going at high pace even after 35 years at the AIIMS. Prof Sandeep said his dream is to contribute to pediatric surgical services in India given the chronic shortages.

Presenting their Achievements to the World

An AIIMS faculty attends a minimum of one international seminar outside South Asia and 4 seminars in South Asia. They get 40 days of conference travel to present their work in National and International Fora. AIIMS has a number of collaborations with major global institutes where frequent exchanges and joint research work is pursued. The AIIMSONIANS write papers by the hundreds, address global community in conferences, conduct workshops and head research teams.

Prof Paul has worked with WHO and UNICEF on advocacy for neonatal health. Prof Nikhil has been a part of a complex narrative of global efforts to fight diabetes. Prof Sandeep has represented AIIMS at the World Congress of Pediatric Surgeons, the American Congress of Pediatric Surgeons and the European Congress of Pediatric Surgery. Despite their presence at the global high table of medicine, they are simple men, sharing the empathy of India’s poorest of poor.

Conclusion

An AIIMSONIAN’s journey in AIIMS is roughly 45 years. From student years to retirement, the journey is one of high accomplishment, high visibility and high meritocracy. The traits described above makes them AIIMSONIANS. Their collective positive energy makes AIIMS, India’s apex Medical Sciences University.

*Author is a senior civil servant, an IAS officer of 1989 batch presently serving as Deputy Director Administration, AIIMS New Delhi.

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