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LETTER TO THE EDITOR
Year : 2015  |  Volume : 28  |  Issue : 3  |  Page : 218-219

Subspecialization in psychiatry: Does it fit with India's need?


1 Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Psychiatry, Institute of Human Behavior and Allied Sciences, New Delhi, India

Date of Web Publication11-Mar-2016

Correspondence Address:
Sujita Kumar Kar
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1357-6283.178607


How to cite this article:
Kar SK, Prakash O. Subspecialization in psychiatry: Does it fit with India's need?. Educ Health 2015;28:218-9

How to cite this URL:
Kar SK, Prakash O. Subspecialization in psychiatry: Does it fit with India's need?. Educ Health [serial online] 2015 [cited 2020 May 29];28:218-9. Available from: http://www.educationforhealth.net/text.asp?2015/28/3/218/178607

Dear Editor,

In the past few decades, subspecialization has gained pace in many medical disciplines, yielding perhaps more efficient and better quality healthcare and research. Having a subspecialization unit can be like having an expensive “ornament” for leading medical institutions, as it implies quality and draws attention.

Going back to the early 19th century, psychiatry separated from the mainstream of general medicine and now has established its unique identity as a major discipline in developing nations.[1],[2] In India, postgraduate courses in psychiatry started in the 1940s.[1],[2] Like other medical specialties, the development of subpecialization within psychiatry is growing. In recent years some premier institutes in India have initiated subspecialization courses in psychiatry, including geriatric psychiatry, child and adolescent psychiatry and de-addiction psychiatry.

According to the World Health Organization Mental Health Atlas (2011), which evaluated the median rate of human resources graduates, the South East Asian Region (SEAR) has 0.02 psychiatrists per 1,00,000 population, which is just above the availability of psychiatrists in WHO category- African region.[3] The country profile of South Africa, 2011, released by WHO-mental health division mentioned about 0.27 psychiatrists per 1,00,000 population which is again better than the average of South East Asian Region as well as that of India. Developing countries like India have many teaching medical institutions without either psychiatric care facilities or psychiatrists. In India, there are two psychiatrists for every 10,00,000 people and hardly 2.05% of the health budget (0.082% of the total budget) is spent on mental health.[4] India is similar to other South East Asian countries in that the percentage of the total health budget spent on mental health is <2.5%.[5] The result is a lack of basic mental healthcare delivery in this region of the world.[3],[5]

Development of any specialty should always be in line with the needs and priorities of the country as well as the availability of resources. The need in developing countries is to increase mental health awareness, to provide basic mental healthcare facilities, to unburden overly-taxed mental health institutions and to create interest among medical professionals in the discipline of psychiatry – only 4% of doctors showed interest in psychiatry and allied medical subjects in the SEAR region).[4]

Currently, developing countries like India also need political commitment, human resource development, accessibility to essential medications, monitoring, and a legislative framework to enhance mental healthcare facilities.[6],[7] In developed countries, mental health care, mental health research, and mental health professionals enjoy greater funding and better infrastructure.[3],[5] Hence, it seems wise to consider subspecialization in psychiatry and allocate resources for the growth of the discipline. Developing countries like India adopt ideas related to mental healthcare concepts and practices from developed countries and attempt to replicate them in their own health systems. However, though it may be good to take ideas from organized mental health systems, it is inappropriate to implement them without a thorough assessment of needs, the feasibility and preparedness of a particular country to assimilate these concepts and practices.

In India, where basic priorities are yet to be met, the rationale behind creating subspecialization is questionable. It is time to rethink priorities in mental health and to plan accordingly. The plan should be based on the country's need. Subspecialization in psychiatry is a noble idea for any country, but should be considered only after basic mental health needs are adequately met.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sharma S. Postgraduate training in psychiatry in India. Indian J Psychiatry 2010;52 Suppl 1:S89-94.  Back to cited text no. 1
    
2.
Nizamie HS, Goyal N. History of psychiatry in India. Indian J Psychiatry 2010;52 Suppl S3:7-12.  Back to cited text no. 2
    
3.
WHO. Mental Health Atlas. Geneva: World Health Organization; 2011. Available from: . [Last accessed on 2014 Dec 12].  Back to cited text no. 3
    
4.
Saxena S. Use of clinical and service indicators to decrease the treatment gap for mental disorders: A global perspective. Epidemiol Psichiatr Soc 2008;17:267-9.  Back to cited text no. 4
    
5.
Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ, et al. Mental health systems in countries: Where are we now? Lancet 2007;370:1061-77.  Back to cited text no. 5
    
6.
Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, et al. Scale up of services for mental health in low-income and middle-income countries. Lancet 2011;378:1592-603.  Back to cited text no. 6
    
7.
Mangham LJ, Hanson K. Scaling up in international health: What are the key issues? Health Policy Plan 2010;25:85-96.  Back to cited text no. 7
    



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