Mental health has gained increasing global recognition over the past two decades, with better drugs and an emphasis on neurobiology. It has emerged as a cherished specialty among young doctors, with more people seeking help resulting in demand for mental health services ever up surging. Unfortunately, many parts of the world still battle with a severe shortage of qualified psychiatrists.
While WHO recommends 3/100000, many countries have less than 1/100000 practicing psychiatrists. This gap has led to a potentially dangerous trend, “the emergence of non-psychiatrists” (general practitioners, spiritual healers, and even laypersons) attempting to provide psychiatric care, considering routine consult by super-specialists of other disciplines who boast in maintaining patients for years both globally and our UT is not an exception as well. There could be some good intentions, but such practice raises serious ethical, medical, and societal concerns.
Be it known that Psychiatric disorders are complex and require specialized training to diagnose and treat. Ironically, in our daily practice, we witness many doctors with no formal mental health degree putting themselves in roles offering mental health advice, prescribing psycho tropics, and offering therapies.
In the absence of a psychiatrist, general physicians may treat depression or anxiety, but should be ideally only for upto a quick referral. It is astounding to observe social media influencers giving mental health advice with no clinical grounding, which is reprehensible and unpardonable.
The risk of a non-psychiatrist as a lead man, from being ignorant of the specialty, is his misunderstanding of mental illnesses catalyzing to misdiagnoses and misfortune. A prime example can be a “bipolar disorder”, a major mental illness, treated for depression, and in the process switching to Mania with worsening of symptoms. Another major risk in continuum will be “Inappropriate Medication Use”.
The psychiatrists, being fully trained to understand psychopharmacology vs the non-specialists prescribing medications without adequate knowledge, raise serious risks of side effects and drug interactions. At the ethical level, Non-psychiatrists practicing beyond their scope breach medical ethics. Patients have a right to competent care, and when not provided, litigation ensue, and in the worst case, losing trust in mental health systems entirely could be catastrophic.
Several factors contribute to this issue of crosspathies, foremost could be the shortage of psychiatrists; as per study, India has a psychiatrist deficit of 77%. Stigma, Cost, accessibility and making general physicians more appealing than specialized professionals contribute to mayhem since they attract most patients by glorifying the stigma of being treated by psychiatrists, all against a trained psychiatrists.
Further as per studies, GP sees 25% of patients who have diagnosable Mental illness at presentation, and whooping 40% is seen by a Neurologist. The line between neurologist and psychiatrist has blurred of late, but ICD classification is clear on separating psychiatry and Neurology by designating different chapters.
Frankly speaking in India and our UT being no exception there is acceptance by society and medical fraternity to neurologist treating a psychiatry patient but it needs to be cleared that a psychiatrist treats more than psycho tropics and beyond and hence ethical justification of a neurologist seeing a pure psychiatric patient will be contentious. However a multidisciplinary approach in Neurological conditions showing mental health co morbidity is more clinically and ethically plausible.
What could be Solutions to this quagmire? Probably a better system in place, rigorous training, and clear guidelines. Psychiatry, a nuanced field, may inadvertently help non-psychiatrists to miss subtleties in diagnosis and treatment, making responsibility and error fixing murky.
In low and middle-income countries, the idea of recruiting non-psychiatrists known as “Task-shifting” temporarily justified if proper training, Public Education, and Tele-psychiatry health platforms are strengthened to make a proper “fill the gap” but strictly under radar.
To conclude, the intention to help those suffering from mental health issues should never be undermined. Only qualified professionals should offer relevant services. Non-psychiatrists acting as psychiatrists can inadvertently do more harm than good, and it is high time the sufferers and influencers know about it.
(Author is Formerly Nodal officer, Mental Health, Kashmir. Sr Consultant Psychiatrist at DHS. Sr Psychiatrist at Hamad Medical Corporation, Doha, State of Qatar. Currently visiting Consultant Psychiatry (Florence/ Noora hospital, Srinagar. Feedback: [email protected])
