A focus group study of Indian psychiatrists' views on electroconvulsive therapy under India's mental healthcare act 2017: 'The ground reality is different'
Richard M Duffy1, Gautam Gulati2, Vasudeo Paralikar3, Niket Kasar3, Nishant Goyal4, Avinash Desousa5, Brendan D Kelly1
1 Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
2 Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland
3 Department of Psychiatry, KEM Hospital Research Centre, Pune, India
4 Department of Psychiatry, Academic Section, Central Institute of Psychiatry, Ranchi, Jharkhand, India
5 Department of Psychiatry, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, India
Prof. Brendan D Kelly
Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A
Source of Support: None, Conflict of Interest: None
Background: India's Mental Healthcare Act, 2017 (MHCA) greatly restricts the use of electroconvulsive therapy (ECT) in minors and bans unmodified ECT. Indian psychiatrists have raised concerns that these measures may deprive certain patients of life-saving treatment. This study describes the perspectives of Indian psychiatrists on how ECT is dealt with in the legislation. Methods: We conducted nine focus groups in three Indian states. We explored the positive and negative implications of the MHCA and discussed its implementation, especially in relation to ECT. Results: Many of the themes and concerns commonly discussed in relation to ECT in other jurisdictions are readily apparent among Indian psychiatrists, although perspectives on specific issues remain heterogeneous. The one area of near-universal agreement is Indian psychiatrists' affirmation of the effectiveness of ECT. We identified three main areas of current concern: the MHCA's ban on unmodified ECT, ECT in minors, and ECT in the acute phase. Two broad additional themes also emerged: resource limitations and the impact of nonmedical models of mental health. We identified a need for greater education about the MHCA among all stakeholders. Conclusion: Core concerns about ECT in India's new legislation relate, in part, to medical decisions apparently being taken out of the hands of psychiatrists and change being driven by theoretical perspectives that do not reflect “ground realities.” Although the MHCA offers significant opportunities, failure to resource its ambitious changes will greatly limit the use of ECT in India.