Preamble
The rationale for a post of this nature on MouthShut was a blog by another member on this platform,eliciting from members,the name of the best psychiatrist,or psychologist,in Delhi or NCR region - a poser that set me thinking,which then culminated into this post.
An Area of Concern
Mental health has been a matter of great concern the world over,including in India.Mental illnesses range from depression in various forms to major psychotic disorders.As per a report in'The Hindu' dated May 2,2012,the number of psychiatrists in India is only 4,000 for 1.2 billion of our population,or one psychiatrist for 300,000 of our people,which is grossly inadequate.And here again there is an urban-rural divide in treatment facilities available,which I will not touch upon here.Of equal concern are epidemiological studies,recorded by'The Indian Journal of Psychiatry' of 2010,of reported prevalence rates of various psychiatric disorders ranging between 9.5 to 370 per 1000 amongst our population.The aforesaid statistics highlight both a severe manpower crunch of doctors in the field of mental health,as well as prevalence of mental illness,on a fairly large scale,in our country.
Some Useful Tips
Sometime or the other,some of us may have had occasion to visit,or may in future,need to visit a psychiatrist for giving psychiatric care to a family member,relative,office colleague,or friend.
Here are some tips which readers may find useful.These tips are based on my personal experience of consulting various psychiatrists in Mumbai,Bangalore and Pune,for many years,for a close family member.Though these life events were stressful,there have been many useful takeaways,some of them of which I record here for the benefit of MS readers.
Firstly,though there are some good clinical psychologists and counsellors around,my first preference would be a psychiatrist,rather than a psychologist for mental disorders.Only a psychiatrist, who would be an MBBS,DPM, or ideally an MD(Psychiatry) or MD(Psychiatric Medicine),or with some other specialisation in this field can,and would prescribe medicines and psychotropic drugs like anti-depressants,tranquilisers,or sedatives, over long-termor administer ECTs(electro-convulsive therapy).A psychologist can counsel,but cannot generally prescribe medications.And occasionally,there are also some quacks around who pose as'psychologists',which is not the case with psychiatrists,who are licenced to practise through various State Medical Councils,in India.
Many a time,neurochemical imbalances have a role to play in the illness,on account of heredity,and other related factors,and the illness is not merely reactive.In such cases,medications are equally important,along with counselling or cognitive therapy,and a psychiatrist should, logically be,in my view,your first port of call.Though the reputation of the psychiatrist is important,I suggest you choose someone who is not too busy,so that sufficient time is given to you and the patient,during your meetings(sessions).Also,to the extent feasible,ideally choose someone good,who is somewhat not too distant from your home,or somewhat easily accessible from your residence,as some patients get disturbed or distressed,while travelling over long distances,or on account of inordinate waiting time at the clinics or hospitals.
Secondly,choose a psychiatrist from whom getting appointments should not take more than a couple of days,as the treatment may necessitate a few visits or several visits,depending on the psychological tests,and assessments,made by the doctor concerned,and the severity of the patient's illness.Also remember that visits would sometimes have to be impromptu,in case of an emergency.
Thirdly,the psychiatrist should,in an emergency,be available on his personal or official,for direct consultation,with regard to medicines or clarifications.If the patient is severely distressed,it may not be practical to immediately take him/her to the clinic/hospital,till he/she stabilises.Very busy or eminent psychiatrists sometimes are not so available.Their assistants or receptionists at clinics may not put you through.Or they still might.Again,it all depends.It is useful to know the protocol,well in advance.
Fourthly,the psychiatrist should be attached to a hospital,or if practising independently, he should have tie-up with a hospital.This is for an emergency situation.Most hospitals/clinics allocate separate wards,or quarantine patients with mental disorders,as a matter of policy and precaution.
Fifthly,it is always a good practice to jot down on a piece of paper all symptoms of the patient,and create a patient history of sorts,when you visit the psychiatrist,from time to time.Also certain medications may not suit certain patients.Please request the psychiatrist for a suitable alternative.He would definitely oblige
Sixthly,psychiatric care is costly,whether it is the consultation or the hospitalisation, where undertaken,and one needs deep pockets.So plan your budget for a worst-case scenario. Insurance companies and most mediclaims generally do not cover claims resulting from consultations or hospitalisations from mental illnesses.
Seventh,it is important to monitor the medicine intake,moods,condition,drug levels in blood(through tests)of the patients regularly till they reach the stage of remission(absence of illness).Not taking medicines regularly,or missing the doses can lead to serious relapses.
Last,but not the least,and the most important,illnesses of the mind can be extremely stressful emotionally(almost always),and financially(many a time) for both the patient and his near and dear ones.It sometimes does cast a shadow on family and social,and other inter-personal relationships.So most important beyond everything that I detailed above,is the care,concern,and empathy,one needs to show to the patient at all times.And giving family support and assurance to the patient that the illness is curable over time.Unlike abroad,where visiting a psychiatrist is on the same par as visiting a dentist,a certain stigma attaches to mental disorders,in India.And no one is more aware of this than the patient!
The Sixty-four Thousand Dollars,and the Million Dollars Questions
How does one find a good psychiatrist?
You could in the first instance seek a reference from your family physician(this is easy) or friends and relatives(this may be a bit difficult… to acknowledge mental illness in the family). In Mumbai,and Pune, there are many private clinics.In Bangalore too,there is NIMHANS and Manasa and others. In Tier I and Tier II cities,one can also visit the website of reputed hospitals like Fortis, Apollo,or other private hospitals.Or you have a choice of going to a private independent practitioner,listed on the net.These independent practitioners(psychiatrists) are available at dedicated times at their clinics,mostly on all weekdays except perhaps Saturdays and Sundays.However,please remember that in the case of reputed hospitals,some of the psychiatrists are available only on particular days of the week.The upshot of this is that once you get locked in to that doctor,you can go for repeat visits(a common occurrence in this sort of illness) only on those days that this particular doctor is available at the hospital.If the patient falls ill suddenly on a day that the doctor is not available,this may be a problem.
Further,the timings of whichever doctor you consult,must accord with the work /home/other schedules of the patient,you yourself,or any other family member accompanying the patient.
Is the best psychiatrist in town necessarily the best for you?
Opinions tend to differ.Some would say yes,others say no.My view is that there is no best-fit–all psychiatrist.All psychiatrists,being highly trained professionals,are good.But remember that the mind is an enigma,(some call it the Dark Continent)and it takes time to unravel its workings,for anyone,including psychiatrists.Most medications prescribed take time(at least 3 weeks) to start giving results,and the treatment too takes time.The approach and treatment protocol for children,for the young,for women,and the elderly would also,many a time differThe so-called best psychiatrist may,because of his busy schedules,(too many patients,medical conferences and the like)sometimes not be able to give you quality time,or quick appointments.And I say this with some personal experience.Many years back,I used to take my family member to one of the most reputed,and then probably the best psychiatrist in Mumbai.He was really good,but then some top Bollywood stars started consulting him for their box-office flops,and for their relationship breakups.He was still receptive to me,but he became extremely busy,getting his appointments took time,so I discreetly switched over to a less reputed,but equally effective psychiatrist,and my family member was none the worse for it.
Again,on certain occasions,and for certain patients,in my view,it may also be a' trial and error' process.A psychiatrist,and his treatment and medications,for patient A,and A’s comfort level with the psychiatrist,may not necessarily be the same,or work for patient B,so if there is no improvement,say after 6 months,or over a year,one may explore opting for a switchover to another competent psychiatrist.This is easier said than done,for many times,the patient and his family too,would have by then,developed a dependency relationship with the present psychiatrist.However,as a matter of caution,doctor shopping(going from one psychiatrist to another) is best avoided,as frequent change of psychiatrists,and medication may be distressing for the patient.
Recently,with sexual liberation,and sexual preferences and practices,coming out of the closet,there is a tendency among some psychiatrists to add the tag of'sexologist' to their area of practice.This,in my view,is only a marketing strategy,and does not detract from their core areas of expertise like depression,bipolar/schizo-affective disorders,schizophrenia,OCDs(obsessive compulsive disorders)and many other forms of illness.So please do not be deterred by this tag,even if the problem on hand,for you or your family friend is'not' related to sex,but something else.You may still visit them,if they have a specialised qualification in psychiatry.In any case,remember that you have the'trial and error' method to fall back upon.
Acknowledgement
My sincere thanks to all of you readers,who took time out to read this longish post.I hope that at least,some among you,would have found,or will find it useful.I wish you,your family members and friends,the very best of physical and mental health at all times.
I also wish to place on record my sincere gratitude,and obligation to all the psychiatrists,hospital support staff,and medical practitioners,I have had occasions to interact with,over the years.Not to forget some other close family members,innumerable friends,and office superiors,who reached out to me.Their ready and willing presence,or assurances,when my family member was ill,made it a lot easier for me,to tide over some of the most difficult,vulnerable,and stressful moments of my life.
Lastly,this post would not be complete,without recording my appreciation for some of the most revolutionary advances made in modern medicine - a veritable boon for psychiatrists,patients,relatives,and other care-givers,in the timely management,and cure of mental illness.
