JOIN USAccording to the National Health Profile released recently by the ministry of health and family welfare (MHFW), there is a need to address the abysmal doctor-population ratio in the country.
The public health and minimum essential clinical interventions require about 0.1 physicians per 1,000 population and between two and four graduate nurses per physician. The shortage of trained health care professionals is more felt in the field of mental health.
A recent study by ICMR (Indian Council of Medical Research) reveals that, in India, the rate of psychiatric disorders in children aged between 4 to 16 years was about 12 per cent. Every year only 550 doctors passed out in the discipline of psychiatry.
This amounts to a shortage of 87 per cent. The shortage of psychiatrists and psychiatric social workers are to the extent of 67 percent and 96 per cent respectively.
According to a recent report by the MHFW "Seven per cent of the population suffers from mental disorders. Over 90 per cent remain untreated. There is less than one psychiatrist available for every four lakh population.”
Currently the mental health workforce in India is composed of trained professionals in the fields of psychiatric social work, clinical psychology, psychological counselling, medicine (including psychiatrists) and psychiatric nurses.
Good mental health is an essential ingredient in our well being. In its mental health action plan for Europe, WHO recognised that “Mental health and well-being are fundamental to quality of life, enabling people to experience life as meaningful and to be creative and active citizens.
Mental health is an essential component of social cohesion, productivity and peace and stability in the living environment, contributing to social capital and economic development...”
Professional manpower
Mental health treatment and care does not rely on high-tech equipment or facilities. Mental health services provision is reliant on the professional manpower who deliver the services. One unique feature of manpower is that it cannot be stored for future use.
This necessitates regular and consistent preparation of manpower. It is important to have a scientific approach in our planning for mental health workforce.
The possibilities of manpower auditing and manpower forecasting should be fully explored.
Some of the well developed health care systems like the National Health Services (NHS) in UK forecast their future demand for mental health workforce by considering the need, demand, service targets, and population ratio.
In the need based approach, NHS use epidemiological information to estimate the future occurrence of mental disease cases in population where as in the demand based approach future demand is predicted from current demand.
The service targets approach allows for constraints like health care capacity and technology on the supply side and the ability and willingness to pay for health care on the demand side. Population ratio approach focuses on population growth predictions.
Psychiatric nursing is a very essential component within the mental health workforce. The ideal nurse patient ratio should be 1:5 in psychiatric care.
The possibilities of tele nursing for providing patient care could be explored. At the governmental level there should be a sincere effort for conducting more psychiatric nursing courses.
Under the 12th Plan the MHFW has planned to start counseling services in colleges where students have identifiable mental disorders like depression and anxiety.
To provide professional counseling those with post graduate degree in psychological counseling only should be appointed.
Currently many colleges employ people with a 3 months certificate course in counseling and graduates in social work.
Mental health systems in developed countries focus on prevention and early intervention. The vision statement on the mental health policy of the Government of Ireland says “service providers should work in partnership with service users and their families, and facilitate recovery and re-integration through the provision of accessible, comprehensive and community-based mental health services.”It will take many more years for us to reach that level.
It is important to maintain a separate standardized mental health workforce data base that is updated annually. The government should also expand funding of mental health services research.
Emigration of doctors and nurses could be reduced if they are provided better financial and non-financial incentives. We should not turn out to be a nation using its scarce resources to supply skilled health manpower to the rest of the world jeopardising our own health care system.