Psychiatry outpatients

I also spent a day in the psychiatry outpatient clinic at RUHSA. There was an interesting mix of problems which presented, from anxiety to psychosis, as well as clearly organic problems. These, because they present with psychiatric symtpoms, for example depression in low thyroid disease and epilepsy with post ictal states, are managed by psychiatry. Apparently, the endocrinologists will not treat low thyroid until physical symptoms appear, despite the blood tests for hypothyroidism being positive. So their threshold for treatment is much higher than the UK. If someone needs treatment for hypothyroidism with only psychological symptoms, like lethargy, depression etc, they need to come to the psychi docs.

Another interesting difference was the presnce of "proxy" patients. People came to the clinic not for themselves, but arrived to talk about their family members who had psychiatric symptoms. This is acceptable practice here and in some cases, although it clearly compromises patient confidentiality, you can see the point of it. The doctor in charge of the clinic was Dr Ruby, a lovely colleague of Dr Annie's, who comes from the tertiary hospital for one day a week. She was much more patient-centred than I have ever seen in India, including actually shooing people away from the clinic area so she could talk to the patients without people, including family, earwigging.

Patients themselves rarely came alone, they always had someone with them, a family member who usually looked after them in some way at home. A youth with learning difficulties and psychosis was brought in by his father, a woman with schizophrenia was brought in by her husband and another man with schizophrenia, who is resistant to taking treatment, was brought in by his two sisters. He is still working as a rickshaw driver and does not want to take medication but has some quite disabling psychotic episodes. Dr Ruby made some plans with the sisters to covertly give him his medication in food. Of course there is no sectioning here, but then it is not really needed because the ethics of informed consent is not well practiced.

The clinic was fascinating and being held in a room once a week in a general hosptial is easier for people to come without feeling the stigma than going to a known mental hospital. So now the establishment of the medical side of the mental healthcare project has been established, there is medical backup for follow up and the good news is that VRCT has agreed funding for an OT for one year to start the mental health care community project, which means that the community part will also be able to start now. I will be keeping close tabs on what is happening and even if I am not in India, as I think commmunication is going to be better from now on, I will be able to write about what's happening between trips.