By Sudarshan Kottai
Edited by Namitha Sadanand, Senior Editor, The Indian Economist
I have, by now, spent 7 years for my education to become a Clinical psychologist. After finishing my two-year M. Phil. in Clinical Psychology in a government-run institution- weathering extreme climatic conditions and problems with food and language- I was finally paid a fixed salary of Rs. 20,000 for the post of a clinical psychologist at a Central Government run mental health institute in Assam whereas my psychiatrist friends were drawing around Rs.80,000. I was not allowed to stay on campus, and had to take care of accommodation, food and all other needs with this meagre amount. Now, this being the case at a central institute, you can very well imagine the state of affairs in state government institutions and privately run hospitals/teaching institutes. The same situation applies for all psychiatric social workers.
I sat on the chair of a clinical psychologist for 6 months, all of which were eventful. I would start my day by around 9 a.m. and attend the rounds in the in-patient wards. My colleagues, except a very few, who are mostly from the same state where the institute is located, would be discussing at length, presenting complaints, family history, medications, et all in their native language. Keep in mind that this is a teaching hospital, fully funded by the Ministry of Health and Family Welfare, Government of India where students/professionals come from all parts of India to study/teach MD Psychiatry, M.Sc Psychiatric Nursing and M. Phil Psychiatric Social Work and Clinical Psychology courses. All outsiders, including me, were in a fix. Why are there no guidelines to make sure that the professionals speak in English while discussing the cases in central institutions where students and teachers come from every nook and corner of our country? Is it not my right to be well-informed about the patient’s treatment by all means at least from my colleagues who comprise the so called ‘mental health team’? Is this not discrimination meted out to me on account of language/region?
Medical hegemony: Role of the state
Mental health team in our country consists of the clinical psychologists, psychiatric social workers, psychiatric nurses and psychiatrists as per the provisions laid down by the National Human Rights Commission and the Honourable Supreme Court of India. The clinical psychologists are trained in terms of the psychological basis of mental disorders and its treatment by psychological means, viz., by assessments and psychotherapy services. The psychiatric social workers are trained to look for social aspects of mental illness and address them accordingly, whereas the psychiatrists are trained in the biological basis of mental illness and its medical treatment.
To be called a multidisciplinary team, all the team members of said team are to be treated equally. But in practice, in sharp contrast to what is on paper, the Government of India has been discriminating and side-lining the clinical psychologists and psychiatric social workers- who look at the psychiatric patient from the psychological and social points of view respectively, fulfilling the bio-psycho-social model in the care and treatment of the mentally ill as envisaged by the W.H.O. and mandated by the National Human Rights Commission and the Honourable Supreme Court of India.
Brain drain of qualified clinical psychologists and psychiatric social workers is now the main issue, as these professionals are demotivated by the discrimination by the government in terms of pay and perks. There exists a strong tendency amongst these professionals to change their career path as they are unable to grow and enhance their potential in the existing scenario.
In a nutshell, it can be rightly said that the Government of India practices discrimination against the psycho-social models in mental health, which are equally important in the care of the mentally ill. When a student who is initially passionate about working in the field of mental health joins an M. Phil course in Clinical Psychology or Psychiatric Social Work, the motivation to stay back in the field declines progressively from the day he/she enters the training programme due to this very cause. The first and foremost aspect of this discrimination is the monetary benefit, which is an explicit metric to assess the status of a person. While an MD student of Psychiatry is paid around Rs.50000 per month as stipend, M. Phil students of Clinical Psychology and Psychiatric Social Work, who are supposed to be part of the interdisciplinary team contributing to the psychosocial treatment, are paid a meagre amount of Rs.12000 by the Government of India. This huge disparity itself puts the psychiatry or medical profession on the top, creating hierarchies amongst the professionals who are contributing equally to the care and treatment of mental illness and promoting mental health.
It is a well-known fact that medicine is not the panacea for psychiatric problems. Mental health is intertwined with bio-power, stigma, culture, exploitation, social death, human rights and a lot more. Poverty, disasters like war, and social marginalisation are important factors that affect mental health. But medicine cannot cure poverty, war or any other socio-political disadvantage. Social science perspectives, by employing a contextual approach, are imperative and also equally vital in the field of mental health. ‘Medicalising’ every socio-politico-economic problem in terms of mental illness and addressing it with psychotropic drugs can neither lift patients out of mental illness nor from their compromised social situation. The government needs to broaden its thinking and build upon realities rather than promoting biomedical hegemony in the field of mental health. It is not to be forgotten that biomedical psychiatry is an ethno-medical system of western culture rooted in principles of biological reductionism, mind-body dualism, objectivism, individualism and impersonalism. In this context, the Clinical Psychology and Psychiatric Social Work disciplines cannot be complemented by any other profession, and are entitled to enjoy equal status with Psychiatry in order to keep them on the field with dignity, vitality and vigour for better mental health care delivery. This can revitalise team work and motivate the best of non-medical professionals to stay back in the field of mental health.
Practically speaking, on the ground, the psychosocial aspects of mental health care are hardly given importance; it is well-known that India lags behind western countries in the quality of mental health care delivery and research. The step-motherly treatment of these two important non-medical disciplines is one of the reasons behind this downfall. Clinical psychologists and psychiatric social workers have important roles to play in terms of development of indigenous systems of healing, with cultural understanding of the local knowledge for the benefit of local people in a post-colonial world.
On one hand, there is the trend of already qualified clinical psychologists and psychiatric social workers opting out of the profession. On the other hand, the government is aggressively increasing Clinical Psychology and Psychiatric Social Work seats in the name of increasing manpower. Is mental health care getting reduced to treating the brain by the psychiatrists? Is the discrimination of non-medical clinical psychologists and psychiatric social workers in terms of pay and perks justifiable? Is the policy well-planned? Does it require second thoughts? Are there new possibilities to be pursued? I leave it at that for now.
A recent RCI registered clinical psychologist, Sudarshan R. Kottai obtained his M.Sc in Applied Psychology from Pondicherry University and his M.Phil in Clinical Psychology from LGBRIMH, Assam. He is currently pursuing his PhD in Psychology at Indian Institute of Technology, Hyderabad.
Passionately involved in bringing to the fore sensitive issues related to human mental life, he also follows issues related to public administration that have direct consequences to human life in general and human mentation in particular. Solitary activities like travelling, listening to music, reading literature and spending time with animals are sources of immense contemplation for him.