|Year : 2008 | Volume
| Issue : 2 | Page : 80-82
Daycare center attached general hospital psychiatry unit: The felt-need in India for comprehensive mental healthcare services
TM Ismail Shihabuddeen1, Harpreet Mehar2
1 Department of Psychiatry, Yenepoya Medical College and Hospital, Yenepoya University, Deralakatte, Mangalore-575 018, India
2 Consultant Clinical Psychologist, D-4, 4177, Vasantkunj, New Delhi-110 070, India
T M Ismail Shihabuddeen
Department of Psychiatry, Yenepoya Medical College and Hospital, Yenepoya University, Deralakatte, Mangalore-575 018
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Disability in the area of psychosocial role functioning is found to be present even while getting discharged from the hospitals or GHPU's; since the current scenario in India focus primarily on pharmacological/somatic treatment with less emphasis on structured psychosocial therapies/interventions during hospitalization. This poses a challenge for the care givers and burdens them with additional duties of assisting the unproductive family member after discharge. This in turn creates misconception about the progress of the client or the expectation of treatment efficacy. The importance of structured psychosocial interventions during the hospitalization in a GHPU has been discussed elsewhere, however, the premises/existing settings pause as a challenge to introduce such programs even with the awareness of the benefits. It's also noticed that in India, majority of consumers prefer to avail treatment from GHPU than any alternative patters of care. Also, the related publications reveal the availability and the benefits of daycare center attached to a GHPU. This highlights the felt-need of having a daycare center attached to every GHPU in India for improving mental healthcare system of the country.
Keywords: Day care center, general hospital psychiatry unit, comprehensive mental health care
|How to cite this article:|
Ismail Shihabuddeen T M, Mehar H. Daycare center attached general hospital psychiatry unit: The felt-need in India for comprehensive mental healthcare services. Indian J Psychol Med 2008;30:80-2
|How to cite this URL:|
Ismail Shihabuddeen T M, Mehar H. Daycare center attached general hospital psychiatry unit: The felt-need in India for comprehensive mental healthcare services. Indian J Psychol Med [serial online] 2008 [cited 2020 Mar 28];30:80-2. Available from: http://www.ijpm.info/text.asp?2008/30/2/80/48478
| Introduction|| |
During the last two decades, the need to make mental health services more accessible to greater numbers of people with a wider range of mental health problems has become a goal which most public health agencies are aspiring to achieve. Moreover, with the increasing understanding and attention to the promotion of mental health, prevention of mental disorders, and provision of rehabilitation services, there is a demand to develop services in these areas. Various authors , have highlighted the importance of general hospital psychiatric units (GHPUs) in the country's mental healthcare system and India was the first country to introduce psychiatry to general hospitals in 1930.  GHPU is vital for mental health consumers in India and we emphasize the need for daycare center (DCC) attached to every GHPU, taking into account the biopsychosocial approach to mental healthcare. The establishment of DCC programs/structured psychosocial therapies/interventions along with optimal pharmacotherapy facilitates the development of a more comprehensive mental healthcare system in our country.
| Why Daycare Center Attached to a General Hospital Psychiatry Unit ?|| |
There is lots of ongoing debate regarding the need for DCC in the community rather in the hospitals or GHPU. An ideal setting would be to train the clients in their own habitat than in hospital settings. However, we just overdo discussions on psychiatric treatment options available in various conferences and do very little to improve the ward facility or the GHPU scenario for those who come forward for treatment. It is the consumers right to receive comprehensive treatment even during the acute stage of illness where the care giver requires additional support through psychoeducation, supportive therapy, etc. Compared to the West, the situation is different in India. One finds that the major source of care for the persons with psychiatric disability is by GHPU's; may be due to the fact that these units are more accessible, approachable, and less stigmatizing and that families can easily visit and stay with the client. Also, proximity of other medical departments ensures high-quality care if associated with physical problem.  We have good family backup support system which can be retained for better monitoring and for active participation in treatment program rather than complaining about paucity of mental health professionals in India. Generally in India, once the symptom improves the client gets discharged from a GHPU to the community with disability in psychosocial role functioning; simply because the hospitalization does not focus much on skill-development program. Persons with psychiatric disability are usually idle in their homes, and may require assistance or prompting even to do activities of daily living. This eventually poses a challenge for the care givers and burdens them with additional duties of assisting the unproductive family member after discharge. This could deteriorate the family functioning and can even develop negative expressed emotions in primary care givers due to their distress. It may promote revolving door syndrome and ultimately poor progress in functional deficits or disability. This also affects the mental health system of our country. The vicious circle continues unless we aggressively give comprehensive care for those who avail treatment from GHPU.
| Advantages of Daycare Centers to General Hospital Psychiatry Unit|| |
These would be to:
- Provide structured psychosocial interventions during hospitalization with the long-term goal of making the person improve in terms of skills and social interactions so that he/she is reinstated back to the family, employment, etc. as a productive member in the society or community.
- Ensure good compliance behavior of the client and to deal with negative expressed emotions (hostility, criticality, overinvolvement), family burden and distress, support system, and coping skills of the primary care givers. 
- Maintain active participation in various activities with supervision so that the client does not spend time by sitting aloof or sleeping even during day time in the ward when hospitalized (that may lead to forgetting skills of the day-to-day functioning adding to the functional deficits); instead clients' learning and re-learning takes place.
- Conduct group interventions for homogenous or heterogeneous client group or for the care givers group periodically aiming not just on empowering rather on practical solutions here and now. 
- Enable and empower persons with disability to live as independently and fully as possible by facilitating the realization of equal opportunities, protection of rights, and full participation of persons with disabilities.
- Bring awareness in the society so that people with psychiatric disability are not abused, neglected, or discriminated, and to encourage measures to ensure that arrangements are made to ensure proper care and custody of the client after the death of their parents or significant care giver.
| Discussion|| |
Over the past five decades, services for the mentally ill in India have steadily improved; however, the rehabilitation effort still needs further field. From a predominantly mental-hospital-based service, provision has now moved to general hospitals and primary health centers.  General hospitals have had an illustrious role in the evolution of psychiatry. They have provided a rich soil for the growth of inpatient psychiatric units, consultation-liaison psychiatry, psychosomatic medicine, med-psych units, outpatient psychiatric clinics, emergency services, and a whole spectrum of resources for the communities in which they dwell. Shorter periods of hospitalization, the constant involvement of family members, and active treatment strategies have contributed to greater acceptance of these services, and to some extent, a reduction of stigma. Daycare units are being opened in different parts of the country, both in government and private sectors, mostly as attached unit for residential rehabilitation centers. Some of the major field surveys of psychiatric disorders in urban and rural areas of the country carried out during this period showed that mental illness of all types was widely prevalent in the country. In India there is also a lot of stigma associated with mental health disorders and in a general hospital setting people are more willing to seek treatment. However, the treatment often gives less emphasis on psychosocial treatment programs or they hardly refer the client to a DCC/residential care centers for improving functional deficits. Moreover, the reality is that the care giver with burdened experience during hospitalization does not seek alternative patterns of care; may be due to lack of awareness of benefits of structured psychosocial programs or due to the affordability-accessibility-availability factors. And, when we compare the ratio to treatment providers and the treatment users, ideal is to adopt a community by each GHPU's; which is doubtful of happening in the near future. These are the reasons to emphasize on DCC attached to every GHPU, so that maximum benefits can be expected out of comprehensive treatment with adequate team work. If this becomes possible, then there are many benefits for the society and community as a whole.
| Conclusion|| |
Starting a DCC attached to a GHPU is just the need of the hour for providing structured psychosocial interventions along with pharmacological/somatic interventions. This may not require huge funds but rather may require additional effort and zeal from the existing staff. Although ideal would be to have psychiatric rehabilitation specialist/or mental healthcare provider with additional training in rehabilitation to supervise and manage the program. Thus, we can facilitate comprehensive care for the persons with psychiatric disability, which in turn, will contribute to the positive growth of mental health system of our country.
| References|| |
|1.||Bagadia, Deb S, Sharma, Wig, Malhotra S. A general hospital psychiatric unit inpatient facility. Soc Psychiatry Psychiatr Epidemiol 1982;17:155-9. |
|2.||Prakash BB. General hospital psychiatry in India. In: Murthy RS, editor. Mental health in India. Bangalore: People's Action for Mental Health; 2000. p. 140-1. |
|3.||Shihabuddeen I. Eclectic approach to psycho social interventions at General Hospital Psychiatry Unit. Annual National Conference of Indian Psychiatric Society Souvenir, 2007. p. 42-44. |
|4.||Shihabuddeen I, Susan A, Gopinath PS. Brief social skills training in a General Hospital Psychiatry Unit in India. Indian J Psychol Med 2008;30:59-61. |
|5.||Shihabuddeen I, Gopinath PS. Possible PSR interventions in a GHPU in India. Indian J Psychol Med 2003;26:11-4. |
|6.||Isaac M. Trends in the development of psychiatric services in India. Psychiatr Bull 1996;20:43-5. |