Академический Документы
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2013
CONTENTS
BIPA CHAIR REPORT Professor Sab Bhaumik
BRITISH INDIAN PSYCHIATRIC EDUCATIONAL LINK PROJECT Dr Subodh Dave & Dr Sridevi Sira Mahalingappa
BIPA NEWSLETTER ! One word of caution. This was the rst newsletter for which we decided not to approach specic people to write on specic topics. We took the view that the newsletter was now mature enough for people to voluntarily send in their contributions. However, even though this process was started quite early and a number of requests were sent out to the membership by the Executive seeking articles for publication, the response has not been particularly enthusiastic, to say the least! While this is in part a reection of the pressures we are under, it is still worth reminding ourselves that in exactly such times, organizations like BIPA can be of assistance to us and the newsletter provides a mouth-piece for us to publicize your achievements as well as to highlight your specic difculties. It goes out to all the membership and thus generates a fair degree of publicity for the issues you wish to bring to the attention of colleagues. We hope you bear this in mind when the request for articles reaches you
2013 from the Executive and consider taking a couple of hours off your busy day to pen a few words about an issue or project which concerns you. The response and interest you generate might be a pleasant surprise! Finally, we wish to thank the BIPA executive for their continued help and support in producing this newsletter and for their patience and forbearing with us. Please provide us with your honest feedback which is always immensely helpful to improve the quality of this newsletter, and also to ensure that it remains relevant to the needs of the membership. For those of you attending the annual conference, hope you have a great meeting. From the editorial team Piyal,Ranjit and Sridevi
BIPA NEWSLETTER ! We also had a successful CPD event at NIMHANS, Bangalore in January 2013. The event was very well attended and extremely well received and with the focus of the talks on Psychotherapy, Dementia care and Rehabilitation Psychiatry. Our MoU with IPS has been signed during the ANCIPS conference and our relationship with Indian Subcontinent has been signicantly strengthened through this process. Many of you will be well aware of our forthcoming Annual Conference which will be held at Daventry Court Hotel on 8th 9th June 2013. The programme is very attractive with a clear theme on current issues in Psychiatry and the speakers include Professors Sue Bailey, Dinesh Bhugra, Indira Sharma, Simon Wessely and Lawrence Mynor-Wallis, amongst others. I sincerely hope that most of you will be able to join us in this meeting and I wish to take the opportunity to create a members forum to identify the key issues in clinical practice that BIPA members are facing at present. BIPAs support is there for you and we plan to strengthen this further with establishment of a hotline and members feedback forum. With the changing economic and nancial climate, life has not been easy for many of us and I am aware that many of you are facing enormous pressure at workplace and are required to do much more for much less. The morale of NHS Trust staff particularly has been rather low and it has affected more vulnerable groups including the BME staff group. BIPA is keen to address the issue of discrimination to our members, create opportunities for our members to progress in their careers and to support our members through difcult times. BIPA belongs to
2013 you and it is expected that you will spend a little bit more time in making BIPA better as an organisation with transparency and accountability. I am very keen that our members make signicant effort in improving access and quality of service for BME communities suffering from mental health problems and we will endeavour to support you in making this happen at your workplace. Our international links work in India should be based on clear objectives, strategic direction and local population needs and BIPA is willing to provide nancial support and resources for worthwhile projects abroad. Very soon you will be asked to provide submissions for projects that you think is going to improve quality of care for patients in other countries and also in improving standards of teaching and training in other countries. Please keep your eyes on the website for this purpose. Finally, I request you all to consider sharing good and innovative practices that some of you have developed and are using in your services. It is important that our organisational reputation is built on a quality focus, innovative practices and transcultural research. Embracing leadership in all these areas is essential for personal and organisational growth. I wish you all the best and look forward to meeting you at Daventry on the 8th 9th June 2013. Professor Sab Bhaumik President British Indian Psychiatric Association
Reection
DR VINOD KUMAR LUNAWAT
CRHT service is a relatively new addition to mental health resources. This service is unique as it helps individuals stay in their natural abode who will otherwise be admitted and treated in an inpatient unit to contain the risk and resolve their crises. I started with a CRHT service in 2009 with no prior experience of it although the service was introduced to this area in 2005. I was initially amazed that the team was working to contain the risks in the community as this was never tried before. The team included members with varying degrees of experience and knowledge and hence their own anxiety level varied in trying to help individuals in the community. Some of the members would often quip We are in crisis in response to difcult situations related to these individuals. I eye-witnessed varying reactions from panicky feelings to sense of hopelessness. My initial excitement of working with the new service was turning into dismay. Our team was dealing with a full range of complex and difcult patients and many of them were presenting to us repeatedly. We found that such patients invariably resulted in frustration and sense of hopelessness among team members. Some of the team members even felt unable to help the developing crises. However members were encouraged to be honest about how they felt about crises as without this, engagement with patients would become more difcult. With support, their condence and self esteem improved which reected well on their self awareness. As a senior psychiatrist, I was leading a multidisciplinary team of a variety of professionals: Nurses, Social Workers, Psychologists, Psychosocial intervention therapist, Social and Time Recovery Worker, Support Workers, Trainee Psychiatrists Introspection about the past made us feel that most of the frustration was generated by complex need patients who were presenting to the service repeatedly which often led to less experienced members feeling useless and incompetent. These complex need patients included: Severe mental illness with frequent crisis, Personality disorders, Dual diagnosis and substance misuse, Self harm, Victims of domestic violence, Eating disorders, Young people, Culturally diverse groups. It was therefore important to look deeper into this group to get to know these individuals so that we could identify them early and reduce their repeated presentations. My brief study on the subject provided us with important information about the nature of this patient group. But this was not the end of the crisis for us
BIPA NEWSLETTER ! as it was important to act to reduce their repeated visits, otherwise challenges would continue and it would continue to generate sense of desperation and panic amongst team members. Managerially, we ran the risk of being regarded as inefcient. Our further evaluation revealed that the team was focusing more on the here & now approach. We were doing well in containing the risk. However, learning from one crisis to reduce their repeated presentations was not done effectively. Therefore it was decided to encourage patients and their carer to reect on what should be done to reduce their repeated visits to CRHT service. Many of the patients and carers would argue that they felt unsupported when they needed it most as either they did not have a designated care co-ordinator or he/she was not available, or did not have a team to contact at the beginning of their difcult situation. Some were even of the opinion that they did not know what to do and therefore difculties simply got worse and slipped into a full blown crisis thus resulting in another visit to the service. Therefore, they were unable to see the light at the end of the tunnel. There was a strong sense of realisation among patients and their carers that they should have greater involvement in the management of crises and their future progression. Teams which had responsibility for continuity of care were involved and meetings involving the teams and the service users and their carers were encouraged so that unanimous care plans could be drawn up.
2013 The service users were encouraged to contact their care coordinator or their respective community teams early in their crisis and not employ maladaptive coping strategies. After using these interventions over a period of time, the team felt that these interventions apparently went well with the patients, as we could see crisis boards, which show the number of service users with the team at any given time, appearing less congested. We have also seen crisis workers coping well and their frustration appearing less. On the other hand, managers and service planners appeared less pressured. The team as a whole received more appreciation from not just service users and their cares but also from the management. One of the service directors even commented, We are doing well. This certainly augurs well for achieving the goals of the organisation in the current environment of results orientated service planning. Overall, our effort has resulted in greater satisfaction among all concerned. We therefore feel that we should be more proactive in dealing with future crises and not just at the point of presentation. We should also have regular meetings of the
members of the team to discuss difcult emotions about not just service users but also about themselves so that selfawareness of the difculties is encouraged and then dealt with effectively to produce better results.
BIPA NEWSLETTER ! The one trainee that rated the course differently from other marked all domains as satisfactory. None of the attendee mentioned any concern about any of the aspects of the course. All attendees remarked that they will recommend the course to their friends. Three of the attendees had attended a popular private course; during informal feedback they reported the BIPA course to be as good as or even better than the private course. Follow up emails from our Egyptian collaborators have suggested a high degree of satisfaction amongst the attendees. Future Directions BIPAs initial foray into examination preparation for overseas graduates has been successful. This course has provided BIPA with a foundation based on which BIPA can further built on and pursue its aim to extend support to overseas graduates training in Psychiatry in the United Kingdom. Similar courses can be
2013 conducted here in the UK. BIPA already has a lot of expertise between its members and has access to experienced examiners. It may be relatively inexpensive to set up the course but we may still need minimal nancial contribution from the attendees. Setting the course will need signicant preparation and pre-course workup by organizing members. Conducting such a course will consolidate BIPAs position in providing educational support to its trainee members. It will offer trainees the opportunity to have high quality training at a fraction of the cost that they would incur in going to a private course. For BIPA, this may also result in an increase in its membership enrolments by trainees. British Indian Psychiatric Association in collaboration with Egyptian Psychiatric Association, Early Career Psychiatrists Section, 1517th August 2012, Cairo, Egypt
BIPA NEWSLETTER!
2013
India link details We have established links with two medical colleges in India. GSMC and King Edward Memorial Hospital, Mumbai is a municipal hospital catering to the inner-city poor. Up to 1.8 million outpatients and 78,000 inpatients are treated at KEMH annually, vast majority of them being signicantly underprivileged, are treated totally free of cost. Despite such large numbers, referral patterns and epidemiological data indicate that psychiatric morbidity is being missed. Professor Parkar, the lead link in Mumbai, sought a link with UPTU to improve psychiatric education at GSMC.
BIPA NEWSLETTER ! Long-term goal: Improved patient care for patients at KEM Hospital and at Mysore Medical College Hospital with better psychiatric skills in medical students is the ultimate goal of the project. Dr. Ramanathan Ganapathy, Consultant Psychiatrist. Dr. Kavita Das, Consultant Old age Psychiatrist Dr. Somshekara Shivashankar , Consultant Psychiatrist Dr. Rehan Siddique, Consultant Psychiatrist
2013
What can be done in future? The links aim is to initiate a sustainable and scalable project to improve the teaching of knowledge, skills and attitudes in medical schools across India. Currently there are more than 313 recognised medical colleges in India with about 35,000 students joining the medical colleges every year1.The State of Maharashtra where we conducted this project has a decit of psychiatrists by 40.74%2.There is also a signicant shortage of medical teachers, especially in psychiatry in most medical colleges. This project is our rst step towards developing capacity of medical teachers. This year, the programme has been extended to other medical colleges in Karnataka. A two-day interactive train the trainer programme has been organised at Mysore Medical College for the professionals with the role or interest in Medical Education in Psychiatry. This course will emphasize on experiential learning and will help them to improve skills and condence as Trainers and Educators. Projects like this will produce tangible results but we will need more volunteers with an interest and experience in medical education to make this a successful enterprise. If you are interested in becoming a volunteer with this educational link project then please contact project lead at Subodh.Dave@derbyshcft.nhs.uk
Acknowledgements: Prof. Shubha Parkar,; Prof. Ajita Nayak, A/Prof. Jahanvi Kedare and other staff + residents of GSMC, Prof. Reg Dennick,University of Nottingham and Derbyshire Healthcare NHS Foundation Trust Dr Raveesh, Dr Sindhura Mohan Teaching is only meaningful if it improves patient experience and outcomes References: 1.Shridhar Sharma( 2010). Postgraduate training in psychiatry in India J Psychiatry. January; 52(Suppl 1): S89S94. 2.M. Thirunavukarasu and P. Thirunavukarasu(2010). Training and National decit of psychiatrists in India A critical analysis . Indian J Psychiatry. January; 52(Suppl 1): S83S88.
Link participants: Dr. Subodh Dave, Clinical Teaching Fellow and Consultant Psychiatrist. Dr. Mary Wheatcroft, Consultant Child & Adolescent Psychiatrist and Clinical Teaching Fellow. Dr. Sridevi Sira Mahalingappa, Consultant in Liaison Psychiatry Dr. Vijender Balain , Locum Consultant Psychiatrist.
Picture from train the trainer workshop at KEM hospital January 2012
An excellent workshop on Leadership and Consultant Interview Training was conducted by Prof Sab Bhaumik & Prof Dinesh Bhugra on 16 March 2013 at Leicester. This workshop was well attended and received very good feedback from the delegates. BIPA will be conducting more workshops on this topic in future ,planned for one in London in October 2013 and Cardiff in February 2014. Please watch out for the future dates at http:// bipa.org.uk/main/
BIPA NEWSLETTER !
2013
Global Population Aging The worlds population is undergoing a dramatic shift in age structure, with rapid population aging among its most notable characteristics. The worlds population aged 60 and older is currently 760 million people, representing 11% of total population.By2050, it is expected that 22% of total population, or 2.0 billion people, will be aged 60 and older. Population Aging in India With 1.21 billion inhabitants counted in its 2011 census, India is the second most populous country in the world. Currently, the 60+ population accounts for 8% of Indias national population, translating into roughly 93 million people. By 2050, its 60+ population share is projected to climb to 19%, or approximately 323 million people. Trends and Challenges Population aging has substantial capacity to diminish the productive capacities of national economies. Regardless of the effect on the economy as a whole, population aging will lead to increased need for elder care and support, at a time when, in developing societies like India, traditional family-based care is becoming less the norm than in the past. In addition, a higher share of older people will affect budget expenditures (less for education, but more for health care) and may affect tax rates. The elderly dependency ratio (the number of persons aged 60 or older per person aged 15 to 59) will rise dramatically from 0.12 to 0.31, largely as a result of fertility decline and increasing life expectancy. At the same time, Indias older population will be subject to a higher rate of non-communicable diseases (like dementia , heart disease, hypertension, diabetes, cancer, problem of joints ), a higher share of women in the workforce (and thus less able to care for the elderly), children who are less likely to live near their parents, and a lack of policies to deal these issues. In response to increasing elderly number, a joint report by United Nations Population Fund (UNFPA) and Help Age International said, "in order to realize their right to enjoy the highest attainable standard of physical and mental health, elderly persons must have access to age-friendly and affordable information and services that meet their demands,". The population trend in Assam Population of Assam is 31 million. The size of elderly population is given below. Size of elderly population (aged 60+) and their share in total population in States and Union Territories (Source: Population Census 2001 ) Number (in thousand) of persons aged 60 & above for different State/ sub-population in the state UT % of elderly India Assam Kerala 7.4 5.9 10.5 Persons 76622 1560 3336 Females 38854 760 1851 Males 37768 801 1484 Rural 57445 1361 2479 Urban 19178 199 857
Among major states the overall old-age dependency ratio varied from 8.4% in Delhi and 10% in Assam to more than 15% in Himachal Pradesh & Punjab and 16.5% in Kerala. The National Policy on Older Persons (NPOP), India was announced in January 1999 to reafrm the commitment to ensure the wellbeing of the older persons. The Policy envisaged State support to ensure nancial and food security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of their lives. I did my primary medical qualication from Assam, and visit regularly. My research suggests that the work around the issues of older people varies a great deal between states, on the one hand signicant developments have happened in the south of India and comparatively in Assam, the work has been bitty and dismal. Older peoples mental health is a neglected subject and stigma is a major issue. What did we do? Two charitable organizations,Cascade, founder and president, Prof Dipesh Bhagabati, Head of Dept, Psychiatry, Guwahati Medical College, Assam and Nevida Healthcare, founder and chair, Dr Kavita Das, Consultant Old Age Psychiatrist, UK, collaborated and held a 8
BIPA NEWSLETTER !
2013
symposia, titled OLD AGE HEALTH-DEMENTIA REVISITED, on 30th March 3013 , Guwahati, Assam, with the view to increase awareness and talk of issues in relation to dementia. Both organizations, registered in Assam, India, are passionate about working on mental and physical health and well-being issues of older people. Key outcomes The main goals of the symposia were to: Offer learning opportunities about dementia to health professionals working in the eld of older people mental health. Promote the exchange of ideas and experiences in relation to dementia and develop learning projects. To bring the groups, working with older people, together to focus on problems and solutions, sharing information and networking. The talks on the subject were contributed by, Dr. Kavita Das, (DEMENTIA CARE PATHWAY and CARING FOR CARERS: What do they need?), Prof. Dipesh Bhagabati, Psychiatrist, Guwahati Medical College, Assam (Old Age Psychiatry-beyond today and Old age Psychiatry in Hospital setup), Associate Prof. Nilakshi Mahanta, Clinician, Guwahati Medical College, Assam (Old Age Psychiatric services in the Indian context) and Dr Chandana Sarma, Social Anthropologist, Guwahati University, Assam (Aging In An Urban Context). The symposia was attended by more than 150 delegates, comprising of Psychiatrists, Psychologists, Nursing staff, local NGOs working in the eld of health and social care, staff from old age homes, service users and carers. In the Panel Discussion: Ask the experts session, the audience was interactive and participated very well and provided food for thought for further anticipated work. We received good feedback. The event also received very good press and media coverage. The future. The two organizations, Nevida Healthcare and Cascade, will continue to collaborate and work in the eld of Old Age Health, in Assam. We hope to conduct further Awareness Programmes and activities for older people, care-givers and those who work with older people eg community health workers, staff in old age homes and nursing staff in hospital setting. Furthermore we would concentrate on Skill Development Programmes eg. Train the Trainer programme, for key stakeholders working in Old Age Health. We would also encourage formation of Senior Citizen Association or Support Groups. We also envisage research
BIPA NEWSLETTER !
2013
ANCIPS 2013
DR.A.RAMAKRISHNAN
The ANCIPS 2013 was held in Bangalore from 1013th of January 2013. BIPA had a session on the 11th and that was well attended by more than 70 delegates. The rst topic was Psychotherapy and its relevance to practicing psychiatrists by Dr Graeme Whiteld, Consultant Medical Psychotherapist (in CBT), Leicestershire Partnership NHS Trust, UK, the second talk was on Schizophrenia by Dr Hemant Bagalkote, consultant psychiatrist, Nottinghamshire Healthcare NHS trust and 3rd topic was Management of dementia patients with BP SD, UK perspective by Dr Hari Subramaniam, Consultant Psychiatrist, Leicester and Indian perspective by Prof Shaji, from Medical College, Trichur, Kerala. Dr. Anand Ramakrishnan, Honry Secretary, BIPA. IGPI Award for leadership 2013 The Indo Global Psychiatric Initiative appreciates and honours the excellent leadership and vision of Prof. Anand Ramakrishnan, an executive of British Indian Psychiatric Association for the genesis and growth of IGPI.
BIPA NEWSLETTER !
2013
Poems
You Know I Am A Psychiatrist
( To be taken with a pinch of salt) I know nothing about the soul Or how emotions extract their toll. ( Emotions have no role in psychiatric assessment) I could well be called a drug dealer, (We are trained to prescribe mainly drugs) But I am called a soul healer. (psyche= soul, iatreia = healing) You know I am a psychiatrist I have trained for many years To talk mental sense to my peers. (To discuss in psychiatric language) I can now decide who is mentally ill, Who needs therapy and who needs the pill. You know I am a psychiatrist. I am well versed in ICD 10, That Depression occurs less in men. ( Depression occurs more in women) Have little clue of my own stress, (Psychiatrists are under stress-Dr Bhaumick) Or if I am myself in a mess. (Psychiatrists have Highest rate of suicide among doctors) You know I am a psychiatrist. I do not know if anyone can be mad, (Madnessin laymans language) But I can diagnose SAD and BAD. (SAD= Seasonal Affective Disorder) (BAD= Bipolar Affective Disorder) I do not know what anger or grief can do, (Only predisposing, perpetuating and precipitating factors). How soul can treat the mind, I have no clue. (Psychiatrist= soul healer) I am a psychiatrist you know. I believe I am the best, (Western Psychiatry is the only one we have) Because I am trained in the West. Now I learn I can be ill with Grief, ( Reference: DSM V) And only medication can give me relief. You know I am a psychiatrist. !By$Dr$Pradeep$K$Chadha,$BIPA$Member.,$26,$Lu:ellstown$Avenue,,$Castleknock,,$Dublin$15,$Ireland.
The Wait
Kavita Das
There is a beautiful story, Sans the meaning. Know not why I feel lonely, Even in a crowding. There are many words spoken, Sans the voice, Am I waiting for you in vain? Dare I make the choice. There is an intense emotion, Sans the feeling.
Life is a confused potion, Why I see the sadness owing? There are wishes I keep all day, the reality. O Time! Lend a hand to lay, I wait for you tirelessly. There is the morning sun, its sooth. O Beloved! Please take the turn, And come to your...forgotten lover.
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BIPA NEWSLETTER !
2013
Ge#ng&used&to&the&silences
Nilamadhab Kar
Here is how I would live After you Its a practice Preparation Rehearsal Its not that You are old and inrm No more needed, or You are living beyond Your sale by date, or You are expendable, or People can live without you Nor that you are living A borrowed life It is not for you It is for me That I plead, for you To leave your home Our home Me And live in an old age home For me Yes, it sounds horrible But, it has come to this, my dear I am not growing younger With shaking hands, Dwindling condence Muddled mind Before I realize I have become old and invalid Its for me To take a gasp of air Before I lose sight Of the shoreline Of an island That we always wished to visit In life, in our life Its for me To stretch my legs Take an afternoon nap To sleep a while more In unhurried early mornings To take my tea on the bed, With the pajamas on and Idle newspapers 12
There are carers Who can take better care of you Than me, And when my time comes When I can no more manage Tying my shoelaces or making a tea May be I will join you there too I wish you could be around me Taking care When I would have forgotten everything For dementia or for whatever But its not like that Its my opportunity, I am the one destined To look after But I am sure; you would have done the same Taken my care, in the best way possible I know, after you Our nest is empty, I am all alone Children have left long back Exploring distant skies Honing their skills ying, and Building their own niche Teaching their little ones to y Its not easy Living a life In our home, without you I am preparing for the role Getting used to now, to silences And its not easy The poem is for all the elderly as they prepare to cope sending their spouses to old-age homes and start living a life all alone. Correspondence: Nilamadhab Kar, Consultant Psychiatrist, Black Country Partnership NHS Foundation Trust, Steps to Health, Showell Circus, Low Hill, Wolverhampton, WV10 9TH, UK, Email: kar.nilamadhab@yahoo.com