Healthcare Delivery

Introduction to Psychiatric Conditions

By Dr Kiran Manduva

Mental health is an often ignored aspect of overall health. It is a truism that there is no health without mental health. In fact, mental health is so crucial to one’s overall well being that a physically disabled or otherwise afflicted person can still be a happy and productive member of society if his mental health is taken care of. There are many examples of such people who ‘ve beaten tremendous odds in life to come up and make their mark on society. That is simply not possible without a robust psychological state of being. Thus, despite health being a holistic entity, if I had to choose, I will place psychological health a notch above physical health.

Instead of going into technical details and statistics, I will try to present a bird’s eye view of the problem at hand. At the risk of sounding simplistic, I will divide the psychological disorders into six groups, for the purposes of the present article. These are

  1. Major psychiatric disorders including schizophrenia, bipolar disorder, severe depression etc.
  2.  Minor psychological conditions including anxiety, minor depressions, stress-related conditions,
  3. Personality disorders, marital discord.
  4. Substance abuse including tobacco chewing and smoking, alcohol addiction, cannabis abuse etc.
  5. Neuro-developmental disorders like Mental retardation, autism, ADHD, SLD
  6. Dementias especially Alzheimer’s disease.

The above is an informal classification presented here for the sole purpose of simplifying the subject matter for the laypeople so that a better understanding of the issue can be achieved. This is not meant to an exhaustive list and some of the rarer conditions are not covered in the classification. These categories are not watertight and many conditions span the different groups based on their severity and other variables. Often, a person can suffer from multiple conditions from different groups because psychological disorders are not discrete entities, as categorised below. Rather, psychological disturbance can manifest itself in multiple ways and quite often in more than one form, simultaneously, in the same person.

Below, I shall dwell upon each of these groups of disorders in brief- how they arise, how they impact the person and how they can be treated.

The disorders in the first category, the major psychiatric disorders, like schizophrenia, bipolar disorder, severe depression etc can loosely be termed ’psychoses’, in which, the person develops delusions and hallucinations, which cause him to lose touch with reality. These disorders usually have a heavy genetic component and also depend on the maternal health (especially fevers etc) when the patient was ‘in utero’. These can normally be treated only with medication with adequate psychological, social and occupational support for reintegration into the society. In many cases, the patient may need to be on the medications for a fairly long period of time.

The second category, the minor psychological conditions like anxiety, depression and stress related conditions arise mainly due to two reasons. One – as a genetic accompaniment to major psychiatric disorders that someone else is suffering from in the larger family. Two – due to various interpersonal issues, family disharmony and social conditions like school and work related stresses, poverty, unemployment etc. Many of these patients need a variable period of treatment with psychological medicines that ameliorate the neurotic symptoms. These conditions can also be treated with better coping skills, self empowerment, breathing exercises, Yoga etc. Once the person is better, the medicines can be slowly tapered off and allow the natural defences of the person to deal with the issue.

The third category is that of personality disorders and its consequences. These are people who have a particular pattern of seeing themselves or relating to others, and many times, these might result in interpersonal disharmony and suffering to either the patient himself or to the others. A frequent cause of marital discord is the existence of some traits of any personality disorder in one or both the partners. Many violent crimes, including domestic violence, child sexual abuse and other criminal violence can also be due to personality disorders in the perpetrator. This often needs a comprehensive approach including medication, counselling and the intervention of other agencies like child care services and law enforcement services including the police

The fourth category is that of substance abuse. There is a steep hike in the number of people addicted to various substances like nicotine (smoking tobacco), alcohol and cannabis. The youth of the society are more prone to it due to their innate impulsive and rebellious nature of their behaviour. This can result in significant damage to ones long term health and productivity, apart from causing family disharmony. This needs treatment with medication, counselling and in many cases a relatively long period of treatment in a rehab centre.

The fifth category is that of neurodevelopmental disorders that afflict children right from their very early age. This is due to the altered brain structure and includes conditions like mental retardation, autism, attention deficit hyperactivity disorder, specific learning disability. These children have a different trajectory of development of milestones, behavioural and academic problems. They need lot of intensive psychological intervention.

The sixth category is that of dementias, the most common being Alzheimers dementia. This is a disorder of the elderly brain degenerating and is more prevalent in the community as the proportion of the elderly increases in the society. It is a problem that is only going to increase in the country and needs lot of family support, medication and institutional old age care.

It is imperative that any person suffering from any kind of emotional or behavioral problem approach a mental health professional without delay or stopping oneself due to the stigma normally attached to psychological conditions. With proper treatment, many are able to lead a near-normal and productive social and occupational life. The public health strategies for different conditions need to be tailored to the particular subgroup of disorders and is an uphill task for the country to ensure the availability and effective delivery of health care services to all the needy.

About the author

Dr Kiran Manduva did his MBBS in 2001 and studied Psychiatry from NIMHANS in 2005. He is interested in deaddiction, psychotherapy for victims of sexual abuse and neuroscience. He is especially interested in novel public health approaches to make psychiatric care accessible to all.


The curious rise of mental illness in India

Rahul (name changed) was having a tough time at office. He had worked his way to the top of the finance industry in Mumbai India. He was now a Sr VP at a financial institution and looking forward to a great time steering the entry of a new financial institution in India. But somehow his work load was increasing. What started as a stretch project spanning a few weekends, had consumed him for months. Soon he started dreading the thought of going to office. Even at work his ability to cope with work was reducing, affecting his effectiveness. Soon he was in a cycle, where stress was eating away at his ability to get things done, which contributes to further delays and more stress. Soon panic attacks started hitting him in the office. He would sweat profusely and remain tense throughout the day.

Rahul was lucky that he recognised some of the symptoms and sought medical help. He reached out to a counsellor and started treatment immedicably. He also took a break from work and focused entirely on his wellbeing. Slowly over a period with counselling and medication, Rahul felt better as the incidents of panic attack and their severity started reducing. Before long he was back at a new job, this time with the knowledge that he would have to handle his work better and avoid triggers that might set off the attacks again.

Rahul’s case is not an isolated case. I remember when I joined the technology world, my first job was with this healthcare network. A middle level manager who was my mentor at that time used to warn me about not taking projects with pressure. He said it was just not worth it. Coming from the medical world, we know all about pressure and its physiology that helps us a humans trigger the flight or fight reflex.

According to a report published by the World Economic Forum in 2014 on the impact of non-communicable diseases on Indian economy it is projected that the loss due to lack of mental health would run into trillions.

“The evidence is compelling. India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions. Cardiovascular diseases, accounting for $2.17 trillion, and mental health conditions ($1.03 trillion), will lead the way in economic loss.”

So today we stand at the crossroads of healthcare highway, where mental well being is going to cost us more than Diabetes and Cancer put together by 2030. India it seems is one of the most depressed country in the world. We have close to 6.7 % of the population that is suffering from some mental illness. And just like Diabetes there is no specific urban/rural divide on this. So, the common feeling that people in the villages are not affecting by depression is not true. On the other hand, I feel they are worse off as there is limited awareness and facilities available in the rural areas. According to a WHO report done by National Care of Mental Health, suicide rates in India are around 10.7 per lakh of population and they are mostly below 44 years.

What should one do if you felt tings were not ok mentally?

Well for starters contact your physician immediately. Best not to self diagnose. I myself had consulted my physician after the death of my mother and visited a counsellor.

The secondly seek support from family and friends. I had taken my wife into confidence during that time. She had accompanied me to the session.

Finally, no matter how bad it may seem there is no justification for self-harm. If such thoughts to occur, best to take help from one of the many depression helplines. I have a list that I found at a website, not sure if this is current but still a good list to use.

In conclusion, mental health is a clear and present danger for us in India. Rising expectations and the collapse of work life balance has brought us to this situation. I still feel digital can help in specially providing immediate, anonymous counselling. Work is important but not at the cost of life. Do take care and keep smiling.

Healthcare Delivery

Dealing with depression in the digital world

A few days ago a young man committed suicide in India. The reason was a internet game called the “Blue Whale Challenge” that sends the players a set of 50 tasks as the end of which they are asked to commit suicide.

A very obnoxious way to structure a game, nut what struck me was that most of the players were young, loners and odd. They did not have social circles and very quiet. In other words they were displaying some form of sub-clinical or even clinical depression. It is not uncommon to read newspaper reports of students committing suicide during the exams. But while one can understand the affect, no one has really put light on the cause. Indians today are suffering from mental illness like never before.

According to WHO almost 90 million citizens in India suffer from either depression or anxiety disorders. That makes it almost 7.5% of the population. There is still a belief that conditions like depression and anxiety disorders are mostly western in origin. But that is not true. Ayurvedic doctors like Charaka have written in details on the signs and symptoms of mental illnesses and have also given the cure.

In most cases anxiety attacks can be managed with some common sense. Easiest way is to breathe deeply and might provide feelings that are better in no time. Sometimes just walking out of situations or walking out of the door is the key step ti manage the anxiety attack. One out of 3 people has experienced a feeling of loneliness and depression, and a few of them can’t even say what’s which makes them feel this way.


The other key factor in the management of mental illnesses is that we need to increase social interactions. There are many ways to chase melancholy and the loneliness away, What matters is removing impulses making them feel low or sad. Feeling lonely could be as simple as not having anyone about them to socialize with on a daily basis. One feel lonely and still can be about people, and so to not feel this way, attempt to learn why.

Depression can happen to anyone, and causes it to be varied from one individual to another. Being lonely might lead to becoming depressed, but they don’t always go hand at hand. Feeling anxious and despondent occurs whenever we can’t deal with things in life at that moment, and we feel that there’s no hope to getting past that. They could begin to find ways to create they feel, when someone has identified a number of reasons why he or she are feeling the way they do. Among the ways people can manage the situation is by taking medication under consult with a physician or Psychiatrist to determine if it’s right, prior to taking any medication.

Using remedies may be an acceptable replacement to using medication. Going to a health shop can offer many excellent choices for currently taking a natural approach to your depressed mind-set. The individuals who work there may be extremely helpful in finding the legal remedies which will work best. Another excellent way of getting rid of the blues is to create an appointment with a few mental wellness specialist in your area. Occasionally talking things out with someone completely distanced from one’s life, can give a chance to work out some of what’s bothering an individual.

So to conclude, it is unwise to deal with depression alone. Always consult a physician or doctor if you feel symptoms of depression. Social Interactions help us manage the condition better. Always avoid stress, look for pleasant interactions to avoid the anxiety attacks. Health is a state of physical and mental well being. Live long and prosper.

(Photo by Kyle Broad on Unsplash)

Healthcare Delivery

Indian govt passes the Mental Healthcare Bill 2016, but a lot more needs to be done

According to a study conducted by World Health Organization (WHO) over five crore Indians suffered from depression and over three crore others suffered from anxiety disorders in the year 2015. India accounted for the highest number of suicides in the world in 2012, as per a report published by WHO in 2014. The report said that every 40 seconds one person commits suicide, globally.

But still mental health remains a taboo topic. Many prefer to suffer in silence rather than expose their condition to friends and family. Recently celebrities came out with accounts fight with depression, of late many movies in hindi as well as other regional languages give account of how individuals have learnt to cope with mental conditions like depression and anxiety.

But a lot more needs to be done. The traditional Indian system of medicine looked at holistic health that involved mental and physical well being. Somehow once that was dismantled, we never could manage to ensure that those who needed help received it.

“Many patients would request not to mention their names in the record or would ask to give normal subscription as they do not want anybody to know that they are consulting a psychiatrist. Also, there are times when psychiatrists or psychologists would be asked to remove name boards from their clinics so that the patients visiting are unaware that he/she is visiting a psychiatrist,” said Dr. Pallavi Arvind Joshi.

Depression is the leading cause of suicide not only among females but also in males. It is important to remove the social stigma attached with mental health and get external help when required. We live in a technology advanced world where the challenges of everyday life are difficult to overcome. Not being able to handle work related stress, meet family expectations or unable to cope up with everyday pressure leads to people taking extreme steps.

Some of the symptoms of depression include change in appetite, prolonged sadness, trouble concentrating, changes in sleeping pattern, lack of activity, loneliness, worthlessness – all symptoms lasting for minimum period of 2 weeks.These are some of the leading causes of suicides among people:

  • Extreme form of depression: Extreme form of depression along with social isolation is one of the major causes of suicide. When people are not able to handle stress, they isolate themselves, think nihilistically which many a times may lead to committing suicide
  • Auditory hallucinations: People suffer auditory hallucinations where they hear false perceptions of sound, voices repeatedly which command them to do self-harm. In such cases a lot of patients make up their mind to commit suicide and it’s important that they get help on time
  • Impulsive behaviour: People with terrible anger and impulsive behaviour are not able to vent their frustration which in many cases may lead to them taking extreme steps
  • Unexpected outcomes: When people with poor coping mechanism are faced with unexpected situations like bad exam results, job insecurity or relationship troubles, they hold on to suicide as the only option
  • Hopelessness: When people turn completely hopeless about their future they think of attempting suicide
  • Heredity: Some people are genetically vulnerable to depression with a family member suffering with depression. There are cases where people suffer from regular episodes of depression because of family history where a family member has attempted suicide in the past

Are Indians happy

The government of India has been working on this aspect of health very closely as well. The Ministry of Health and Family Welfare had created a policy called the National Mental Health Policy 2016, which was recently passed by the parliament. Now the the Mental Healthcare Bill, 2016, aims to provide provide for mental healthcare and services for persons with mental illness and ensure these persons have the right to live a life with dignity by not being discriminated against or harassed. One of the other key features of this bill is that suicides have been decriminalized. This would help those with these conditions and previous attempts to seek help from qualified professionals, doctors and Councillors. Also the bill stipulates the creation of a mental health board. Finally persons with mental illness now could stipulate how they want their treatment to be conducted and have the right now to nominate representatives for themselves while they undergo treatment. So in many ways this is a positive step in the right direction from a policy perspective. But implementation would be the key to its success.For a quick summary on the bill read this article here. 

“Majority of depressed people attempt a pre-planned suicide where they isolate themselves from people and undertake measures that nobody gets to know about it. Some people would give initial hints where they would distribute their priced possessions to people, complete unfinished tasks or will hint in their conversations with near and dear ones. It is important that we talk about it and provide support to people facing mental trouble. Depression if identified early, can treated and steps can be taken to prevent suicidal tendencies,” said Dr. Pallavi.

These are some ways in which individuals can take measures to prevent depression and anxiety:

  • Regular exercise: Exercising regularly can help people cope with pressure, stress and anxiety. Exercise helps in improved blood circulation in the body, release stress and pressure of day-to-day life. Moreover, regular exercise helps in secretion of positive hormones and boosts the feel-good factor
  • Healthy diet: A balanced diet including two fruit servings and milk is important to be healthy. In some cases, people who suffer from depression tend to eat more. Controlling of eating habits can help them relieve pressure. Try to include plenty of green vegetables like spinach and fruits as it helps ease depression
  • Set goals: When a person is depressed he/she might not feel like doing anything. The feeling of hopelessness can lead the person to take drastic steps. Therefore, it is important that people set small goals and accomplish them to boost a sense of self-confidence.
  • Get in a routine: When you feel, distressed try structuring a routine for yourself. Focus on your routine and follow it regularly. This will help you achieve positive results for yourself and you will feel happy
  • Get enough sleep: Sleep is an important part of our lives. While depressed or worried, people might find it hard to get sound sleep. Therefore, it is important to make some changes in your daily routine like exercising, brisk walking, attending dance classes or pursuing long awaited hobby. Take all distractions out of your bedroom and make sure there is no TV or computer in your bedroom. Try to keep your phone away and go to sleep early

But most importantly get help. Talk to those you trust or visit a professional. Digital is another medium that is helping reduce some of the barriers in the mental health space. Some time ago we covered this startup in Delhi that was working on the digital platform for online consultation with mental health experts. Maybe more initiatives like this can help.

Also Indian Express, gave a list of helplines to help individuals combat depression, here is a list that can come in handy.

On the occasion of World Health Day today, the WHO has gone with the apt theme, “Depression: Lets Talk”. In a sense that is the key to preventing loss of life from a condition that has treatment modalities. Its just a question of spreading awareness and ensuring that treatment in reaching the right people at the right time. In our drive for progress, we see that many have been left behind, crushed by the heavy wheels of unending ambition and desires.

Only time shall tell if this relentless pursuit of progress was worth it, I am sure we shall soon find out for ourselves. Do let me know your thoughts and comments. If there is anyone who needs help and you dont know how to proceed do contact us and we should be able to get them the help required.


Fighting depression with

Imagine you are a student studying in a remote campus with no access to quality healthcare close by. What is the best way to get quality medical care? This was the question that four young graduates from BITS Pilani were trying to answer during their education there.

The answer was: use Digital. So the four young men, incubated this idea and out of this was born ‘Get Visit’ that brings the doctors and patients together. Now you might be wondering that there are so many startups in this space and what would be so unique about this particular one? Well I was thinking similarly, having spoken to a few others in this space and I found some very unique differentiation.