The National Mental Health Policy 2014 discusses integrated care that creates space for the inclusion of the domain in a routine hospital care
By Dr Prakriti Poddar
In an ideal world, whatever the doctor communicates to a patient would be well understood and accepted. The patient would follow the treatment regimen and doctor’s advice religiously and would prioritise commitment to personal health before other responsibilities and duties.
However, self-responsibility and ownership of personal health are most lacking in human beings. The legal framework, workspace, socio-cultural and family ecosystems, and our personal choice force us to compromise on health.
There are also a number of factors, which cause hindrance in effective communication about and adherence to treatment regimen. Factors such as age, education, various belief systems, financial, work and other issues put enough mental pressure on an individual to compromise on health.
All these factors do not only compromise health but also impact mental health. A fact, which is not well acknowledged or realised enough, is that most victims of any major disease, including their family members, are in need of counselling. This also means they need guidance, support systems, checks and balances to guide them, motivate them, and keep them on track of the treatment regimen and associated lifestyle.
Is it feasible?
Does our stretched and burdened healthcare infrastructure have space to allow an integrated mental health assessment in routine hospital care? The answer is “No”. The Indian healthcare system is already undergoing a massive transformation with major Government initiatives and policy revisions on one hand and on the other; there is an acute shortage of healthcare and even mental healthcare professionals and related infrastructure. Additionally, one has to keep in consideration the cost burden it will have on the healthcare delivery system.
But then can nothing be done? The answer is “No” here too. Just that because we have major hurdles does not mean that we should not move ahead. The groundwork for an integrated mental health assessment in routine healthcare can be started now.
What integrated mental health assessment should be?
However, before we begin we need to have clarity on what we need from the system of integrated mental health assessment in the routine hospital care. The system as such should be prescribing a mental health assessment to regular patients to identify if they exhibit from an array of behavioural problems to mental health issues that ordinarily may miss the general physician’s notice. This will not only give visibility to the individual challenges but can also equip the doctors to take the right measures for ensuring best possible treatment outcomes.
Herein lies the need to relook at the national health policy and mental health policy. It is to be underlined here that just like our constitution which has directive principles for the Indian state to move towards, integrating mental health assessment also needs to be a set of directive principles. Instead of making the integration of mental health assessment with healthcare delivery a law that has to be implemented across the board, it should be designed at present on the lines of a directive principle. Service providers implementing it will receive added benefits and credits. This will also keep space for improving and upgrading the laws associated with it.
The challenges: Feasibility and acceptability
Why it has to be directive in nature is because of two major challenges: feasibility and acceptability. We have already discussed certain challenges associated with feasibility. The subject of acceptability pertains to whether an individual would be willing to undergo an assessment. Being a subject of tremendous stigma in the Indian society, most likely individuals would not choose to undergo a mental assessment test. Making it mandatory will be of hindrance to the primary treatment.
The National Mental Health Policy 2014 discusses integrated care that creates space for the inclusion of the domain in a routine hospital care. This means healthcare facilities should have mental healthcare service as a part of their offerings and put adequate focus in creating awareness around the subject. If a person (or family members) identifies certain symptoms or realises the need to consult an expert, the healthcare facility will provide accessibility to the person by providing the service.
However, treating these patients is done in silos. The focus gradually needs to shift to integrating mental health assessment and treatment along with other diseases. The basic way to achieve this is to make the inclusion of a questionnaire or patient information form pertaining to mental health compulsory.
The form can be designed by the experts of the industry or the ethical review board of hospitals, can be disease specific, and should be easy to understand and familiar language. However, it should not be compulsory for the patient to fill it.
As the patient load is too high in hospitals, the form can be implemented for specific cases and diseases; for instance, in IPD cases or when the patient is undergoing critical treatment for example HIV, cancer, surgical cases, etc.
The Indian medical education system is more focused on gaining medical expertise. The thrust on patient counselling and dealing with ethical challenges and emotional matters still need major focus. Educational systems, training, and curricula should be upgraded to equip doctors, nurses, and healthcare staff to identify mental health challenges and address them.
The larger vision
We need to be in a position to create a class of counselling experts who along with varied operational training are equipped to guide and evaluate patients’ progress, keeping in consideration the disease profiles.
Integrating mental health assessment with routine hospital care can go on to play a massive role in countering stigma and the bias associated with mental health challenges. It can play a crucial role in mapping out a national mental health profile that can lead to better policy making on a number of healthcare-related laws. In terms of case-by-case patient treatment, it will ensure that healthcare providers and patients both try to identify reliable and capable support systems who can physically and mentally help the patient on the part to recovery. In terms of countering deadly diseases such as cancer and HIV as well as trauma cases, such support systems can help drive crucial positive health outcomes. It will also necessitate the need to construct and mobilise public support systems for such patients, which are largely absent at present or are working in silos.
Mental health is intricately linked to our physical wellbeing and both affect each other. While a disease may be only related to a body part or an organ system, mental health has overarching affect on the body. An integrated mental health assessment in routine hospital care is the way forward to achieve our objectives of holistic health.