For the last 8 years NIDUS-UK and its predecessor, Hamlet-GIP, has been supporting the development of a new comprehensive mental health service, the Mahatma Gandhi Institute for Comprehensive Mental Healthcare, in Guntur, Andhra Pradesh Province, in central India.
Dr Ibrahim Khaleel, the director of the Institute has just sent us this update.
September 2016 Update
The Mahatma Gandhi Institute for Comprehensive Mental Healthcare (MGICMH) was set up in February 2010 with the support of Hamlet GIP UK trust (subsequently NIDUS-UK) also affiliated to Imperial College London. MGICMH is run under the management of Empower charitable trust and receives appropriate income tax benefits under sections 80G and 12AA of IT Act.
Since its inauguration, up to the end of August 2016 the unit has seen 4500 new patients with mental health problems. On average three new patients are seen every day with 10 follow up patients also attending.. The unit also includes 13 inpatient beds but the occupancy rate is about 30-40%.
Most of the patients present with anxiety and depressive disorders but the unit also sees many others with alcohol dependence, schizophrenia, bipolar disorder, obsessive compulsive disorder, personality disorders, adjustment disorders, dementia, ADHD, autism and intellectual difficulty. The unit also carries out IQ assessments for preoperative screening of young children for cochlear implant procedures, couple therapy for marital disharmony, and a smoking cessation service very similar to that in the UK. There are also groups for patients with alcohol dependence taking place on a weekly basis. In addition psychological therapies such as counselling, CBT, group therapy and social interventions along with drug treatments, are provided for psychological disorders.
The income for the unit mainly comes from charging patients who are able to pay. We also charge low income patients a nominal rate (for daily labourers 50p per opd appointment & £2.50 (was increased last year from £1.5) for an inpatient bed. Other income sources include donations from individuals and organisations.
Since June 2014 the unit has been able to break even and is able to run the institute on a cost-neutral basis. With the help of Hamlet-GIP/ Imperial College / NIDUS UK we have been able to set up basic in-house laboratory facilities since January 2014, and there is also an in-house dispensary for patients who attend the hospital.
The main challenges we still face in Guntur is the general lack of awareness of mental disorders (mental health literacy) and continued stigma associated with mental disorders. The other challenge is the presence of the existing referral system in private sector in India, where rural medical practitioners expect about 30% of total treatment cost as an incentive to refer patients. This leads the referrer deciding what are the treatment costs. The unit has to overcome this unsatisfactory referral system and we are doing this with the help of television adverts, conducting awareness camps, bill boards, the help of some other doctors and the internet.
MGICMH has conducted training sessions in mental health for medical officers in government service in the Guntur district. In 2015, in order to raise awareness of mental disorders the institute started training housewives from both urban and rural sectors. As a consequence of the highly competitive environment in education, there has been huge pressure on school children to perform better. On a few occasions stress this has led to suicides in young people between the ages of 15 and 18. To combat this the unit has been carrying out several stress management sessions in secondary.
The long term vision of the unit is to develop a service model which can combine our current services with the longer term care of patients suffering from hypertension, diabetes, hypercholesterolemia, depression, schizophrenia, schizoaffective disorder and bipolar affective disorder. Many of these medical conditions have comorbid mental health conditions and at present stigma is preventing these from being addressed.
In a country like India where it is difficult to deliver comprehensive healthcare to patients, an approach which combines physical and mental healthcare is desirable and eminently feasible. After all, psychiatrists have already received physical health training to address routine health issues during their medical training. We just need to refresh some of these skills in leading a new way of providing care.