Maharashtra’s public healthcare system is facing an acute dearth of mental health professional with more than half of the posts of psychiatrists vacant. Of the 177 sanctioned positions of psychiatrists in 34 districts across the state, 91 are yet to be filled, data obtained by Hindustan Times from the Directorate of Health Services (DHS) has revealed.
These vacancies are across the state’s four regional mental hospitals located in Thane, Pune, Nagpur as well as in all the district hospitals, which also house the teams of the District Mental Health Program (DHMP) funded by the Center in the state’s program to address farmer suicides.
According to the DHS, of the 85 sanctioned positions of Class I psychiatrists, 69 are currently vacant. All the 33 posts of Class II psychiatrists are filled. Under the DHMP, which is a part of the Center’s National Mental Health Program , there are 41 sanctioned posts, but only 30 are filled while 11 remain vacant. Seven out of the nine posts under the Prerna Prakalp program are also currently vacant.
At a time when the Covid-19 pandemic has exacerbated mental health issues, a shortage of mental health professionals in Maharashtra will have an impact on patients going undiagnosed and untreated. While a few may seek help from private practitioners, many would fall in the gap and never seek medical help at all.
“We have been constantly trying to fill the vacant posts, but many of the psychiatrists who come for interviews don’t eventually take up the postings,” director of DHS. “In order to tackle the shortage of psychiatrists, we have started mental health training for MBBS doctors from the primary health centers in districts,” she said. This training began in November 2019.
One of the possible reasons for the vacancies could be that the salary bracket of psychiatrists in Maharashtra is lower than the Center’s. The classes indicate seniority, work experience but some of the Class I positions have been vacant for the past several years. “Class I psychiatrists at the National Institute of Mental Health and Neurosciences that falls under the Union Health Ministry will have starting salaries of about ₹1.5 lakh,” said Dr Arun Mar wale, president of the western region of Indian Psychiatric Society, an organization of psychiatrists in India with over 7000 members. In Maharashtra, the salaries of Class I psychiatrists start from ₹85,000 and Class II starts from ₹65,000. “Because of the lower payment , many psychiatrists prefer getting jobs in the private sector,” he said.
Marwale said that the government should also ensure that postings are given in the doctors’ home districts. “Often, a doctor from the Marathwada region gets posted all the way in Konkan or vice versa. If the government shows some consideration in giving postings closer home, more doctors will be willing to join,” he said.
Many HT spoke to said that their duty often includes administrative work. “Instead of attending to psychiatric patients, I spend more time visiting courts for medico-legal cases, visiting jails and giving out disability certificates,” said a Class II psychiatrist in a district hospital in the Marathwada region. District hospitals have one post of Class I and Class II psychiatrist each. But since he joined in 2016, there has been no Class I appointment.
“Mental health ailments have increased tremendously over the years but the government is perhaps still not seeing the issue of vacant posts of psychiatrists as priority,” a psychiatrist who has a private practice in Latur’s Udgir taluka since the past 11 years. “Contrary to popular belief, more patients have started coming forward to seek medical help after recognizing signs of mental distress. Having more psychiatrists will help cater to this increased burden of mental illnesses,” said Attar.
“many numerous people with mental illnesses, especially in rural Maharashtra, are below the poverty line. When government facilities lack specialists, the patients are forced into the private sector, which they cannot sustain, and eventually drop out of the treatment,” said psychiatrist and Ramon Magsaysay Awardee Dr Bharat Vatwani. “The pandemic has worsened the financial status of people, and in the absence of strong government health services, we are at the risk of an enormous number of patients dropping out of treatments or not being diagnosed at all,” he said.
In a first, DHS analyses footfall at district mental health out patient departments during the pandemic
s the pandemic tore through the globe starting March last year, with Maharashtra facing a high daily caseload and case fatality ratio compared to the rest of the country, the state’s medical machinery deployed most of its attention to containing the spread of Sars-CoV-2. This year, the state has also launched heightened efforts to ensure vaccination of all adults. In November, officials at the Directorate of Health Services (DHS) collated the number of people accessing mental health Out Patient Departments during the pandemic.
And, in a first, they also collected the type of conditions that people were seeking help for. This was done to understand the pattern of patient footfall and design better interventions.
Need for care
The World Health Organization defines schizophrenia as a chronic and severe mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self and behavior. Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (false beliefs).
However, a high out patient department turnout or admissions do not necessarily mean a higher incidence of schizophrenia in the state.
According to data from the Global Burden of Disease Study published in The Lancet Psychiatry, nearly 3.5 million people had schizophrenia in India in 2017. However, compared to other mental health diseases, its prevalence was still lower. The data showed that the prevalence of depressive disorders and anxiety disorders was around 3.3% and bipolar disorder was around 0.6%, while the prevalence of schizophrenia was around 0.3%.
An 2018 study carried out among youth in rural and urban parts of Pune showed that the prevalence of depression, anxiety, and stress among them was 54%, 60%, and 44%, respectively. Another 2020 study conducted among the farmers in the Vidarbha region showed that anxiety, insomnia and somatic problems were the highest reported by farmers. In effect, the studies carried out in communities reveal that anxiety and depressive disorders are higher. The turnout at the out patient department indicates otherwise — and there’s a good reason for it.
“Schizophrenia patients get identified more easily compared to those with other mental health ailments, and are therefore more likely to be brought in for medical intervention,” DHS director. “This is a common trend we have observed, even as the overall burden of mild to severe depression, anxiety disorders are likely to be much higher in the state compared to schizophrenia. The Covid-19 pandemic has further worsened the situation,” she said.
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