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Since 1st March, 1999
 
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Wanted: A fight against stigma

When he first voiced his desire to take up psychiatry as a profession, S. Haque Nizami was greeted by howls of protests from professors who believed that the bright student was meant for greater things. Nizami stuck to his stand and has had no reason to regret the decision in his 26-year-old career. The director of Central Institute of Psychiatry (CIP) joined the institute as a junior resident in 1981 and became a faculty member in 1987. He took over as director in May, 2000.

Nizami's efforts have ensured that the budget allocation to the institute has gone up substantially. In an interview with S. Shekhar, Nizami talks about his stint as director.

lThe CIP has been recognised by the Union government as a centre of excellence. What has your contribution been in the four years that you have been its director'

You do not need be the head of an institution to make a contribution. I have been here for 26 years and contributed in whatever I could. I have worked at the most basic level and, therefore, understand its problems. Since I took over as director, my work has been to ensure that the institution has the best technology at its disposal. Right now, we have the most modern machines required for analysing psychiatric cases and research.

lIn terms of infrastructure, where does the CIP need to improve'

The CIP is spread over 400 acres and has a bed capacity of 673. There are 16 wards, nine for men and six for women. One unit is for families. There is adequate space between the wards considering privacy plays an important role in mental treatment. The mode of treatment is based on the premise that adequate space needs to be given to a patient to heal. It may be worth noting that unlike other mental hospitals, CIP, Ranchi has never adopted a custodial attitude towards its patients. We plan to build a new library building. We have reserved Rs 8 crore for construction of new buildings and Rs 10 crore for purchase of new machines.

lFrom your long experience, can you tell us something about social attitudes to mental illness' How different is it from attitudes in the West'

It saddens me that mental illness is still considered disgraceful. The basic problem is that people tend to hide illness. We recently conducted a survey in Namkum block and found that 94 per cent of patients of mental ailments, primarily epilepsy and psychosis, did not turn up for treatment. This figure is around 40 per cent in Europe, which is no good either. Social stigma continues to cost psychiatric science dear.

The situation has improved in urban localities. Earlier, if we would get 10 cases in a month, all of them had to be admitted to the hospital. Now, if we get a hundred cases in a month, only three have to be admitted, which suggests that families are responding faster to mentally ill members.

lWhat should be the ideal atmosphere in a mental hospital' Should patients be confined to a dormitory or should they be allowed to move freely' What do you do when patients who are cured are not accepted by their families'

CIP has always been an open hospital and patients are never confined to rooms. They are free to roam within the boundary wall of the hospital. Apart from drug therapy, various psychotherapies like behaviour therapy, group therapy, and family therapy are routinely used.

We also have the concept of a milieu therapy where patients help in running the ward and help in looking after other patients. Patients can take part in regular physical exercise, outdoor, indoor games or yoga. Our inpatient psychiatry unit provides services for acutely ill psychiatric patients including those who require extensive care for concurrent medical disorders.

Our staff has been trained to recognise the vulnerability of patients during an inpatient stay. We focus on stabilising the patient and planning short and long-term treatments.

The hospital keeps track of patients even after they are discharged. Before a patient is discharged, we make every effort to coordinate with the patient's family. We consider this contact and coordination crucial to the success of the treatment. As for ensuring that family members take a person home, a caution fee is charged at the time of admission. The guardian is also required to sign a bond. We call a patient who is not accepted by his family members a long-stay patient. The percentage of long-stay patients in CIP was once 80 per cent. Now it has come down to 20 per cent, which is a good sign.

lWhat facilities does CIP provide to psychiatrists' There are reports that many senior residents from the institution migrate to foreign countries each year. Will that not create a dearth of expert hands here'

Budding psychiatrists at CIP have access to all the resources of the department of psychiatry and the hospitals. They actively consult with specialists in many fields of medicine, imaging, psychology, and laboratory evaluation. They carry out research on major psychiatric disorders.

The department also runs trials of new pharmacological treatments. Patients may volunteer to participate in research or clinical trials, after going through appropriate consent procedures.

But yes, it is a fact that residents do shift to the West. Last year five went to Australia. I do not object to migration but that will create problems here.

A country like India with a population of over 100 crore has only 3,000 psychiatrists.

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