Bipa Newletter 2011

British Indian Psychiatric Association Newsletter

BIPA Newsletter - June 2011

BIPA managed to persuade the College to re-examine the issue of the withdrawal of exemption from Part I exams for those who had passed the old style MRCPsych written exam. This was a significant victory as it involved the College doing a U-turn on its policy. We have also asked the College to share with us data on trainees’ MRCPsych examination results.

In March this year BIPA organized a conference in Birmingham on “Improving Mental Health Outcomes in BME Communities”. BIPA is now contributing to a national consultation on this issue. Later this year BIPA will carry out a pilot project aimed at improving mental health access in primary care for BME communities.

BIPA contributed to the consultation by GMC on fitness to practice procedures. BIPA was invited by the GMC for further discussions following this consultation. BIPA is aware of the challenges facing its members once revalidation is introduced next year and I am glad to report that Dr. J S Bamrah who authored BIPA’s response to the GMC will also be leading BIPA’s strategy on revalidation.

BIPA’s members have been very keen to participate in link projects in India. Last year, BIPA participated in the Global Association of Physicians of Indian Origin (GAPIO) conference in Delhi, which was a meeting aimed at improving health outcomes in India. BIPA’s role in the mental health stream was appreciated and our project aimed at enhancing the teaching of psychiatric skills and attitudes to medical undergraduates was endorsed as a demonstration project. This project is being done as a randomized study with some batches of students receiving the new curriculum. The study has received ethics approval and a batch of BIPA members will be going to India later in the year to conduct a Train the Trainers program.

It is obvious that all of the above could not have been achieved without the support of a large number of active BIPA members. In fact, I do not recall such a large number of members working actively at any stage of my membership in BIPA, which is very good news. Another good news, is the close working relationship we have developed with key organizations including the RCPsych, BAPIO, Indian Psychiatric Society and other diaspora psychiatry organizations in the UK. However, it’s not all good news. I feel that misconceptions about BIPA remain. I still get asked (sometimes even by BIPA members) – “what is BIPA; what does it do?”

Let me answer this question in very clear terms. BIPA above all is a professional organization. We are an association of psychiatrists first and foremost. This then raises the question- why BIPA when we have RCPsych? There are two reasons for this. 1) There is strength in numbers – we are better able to represent and solve issues specific to us if we deal with them as a cohesive group rather than alone. There are key areas (outlined above) that concern our members, which I feel, are not adequately dealt with by the College. BIPA’s role, I believe, is vital to deliver on these objectives. 2) There are obvious cultural and social factors that tie us and I do not feel any reason for us as a professional organization to be embarrassed about it. I hope that BIPA members are able to talk about their BIPA membership with pride. Indeed, I have found that Trust Boards are very positive about the diverse sets of skills that BIPA members are likely to offer.

Another misconception, I have come across is that BIPA is an old boys’ network. In fact, the number of members actively engaged in BIPA projects has doubled over the past year. However, I do think that we are not always able to clearly answer the question that many have “What’s in it for me”.

The clear answer to this question is that BIPA offers its members opportunities to develop their leadership role whether through its association with the College, GMC or through its international links or indeed through its patient-care orientated projects. There are various projects that have commenced and many more that remain unexplored and are crying out for input of dynamism and enthusiasm. BIPA is a happy inclusive family. Come join us on www.bipa.org.uk

Dear Friends, It has been a busy year as the Chair of BIPA. We have made significant progress on many issues that we had identified as key challenges. Broadly, I had identified 4 key areas in my inaugural message “Fairness and Responsibility” 1) trainees issues including poor pass rates in MRCPsych exams 2) poor mental health outcomes for BME communities in the UK 3) overrepresentation of non-UK trained doctors in fitness proceedings and suspensions 4) Link projects in India. As we know, suicide rates in India are 10 times higher than in the UK while the duration of undergraduate psychiatric training (currently only 2 weeks) is being threatened with further reduction.

In the past year, BIPA has been able to make steady progress in all those areas.

BIPA Organizing Committee Members : Subodh Dave, Giri Nimmagadda, A.N.Ramakrishnan, Bhavana Chawda, Sridevi M, Jp Rajendran

Editorial : Dr Piyal Sen & Ranjith Baruah As BIPA moves from strength to strength under the able guidance of its leadership, we hope to use the newsletter to convey some of the themes that are currently relevant for the community of Indian psychiatrists in the UK, whose voice is represented by BIPA . The article from the chair reflects the current priorities for BIPA and a road-map for the way forward. There is also an article from the vice-president reflecting on his involvement with the activities of The Royal College of Psychiatrists and how best BIPA can work with the College. It needs to be remembered that in terms of membership strength, BIPA is second only to The Royal College of Psychiatrists as an organization speaking up for psychiatrists in the UK. We have also tried to cover some other themes in this newsletter that are of importance to psychiatrists from India. To reflect some of the difficulties around passing the MRCPsych, we have included an article written by someone who has run a very successful MRCPsych examination revision course for many years in Cambridge, elucidating some of the possible reasons for the failings of overseas graduates and also suggesting ways to rectify this. An increasing number of Indian doctors are also choosing the Certificate for Equivalence of Specialist Registration pathway, also known as the Article 14 route, to work as a Consultant in their chosen speciality. We have included an article from such a doctor, who is currently going through this process, sharing her experience and offering guidance. There is also an article providing information on the activities of the BIPA Trainees’ Forum. In keeping with a trend started from the last newsletter, we have included an interview of Dr. Ajit Avasthi, President of Indian Psychiatric Society(IPS), who visited the last BIPA annual conference and kindly consented to be interviewed for the newsletter. There is also an account of some inspiring voluntary work carried out by a BIPA member in the Solomon Islands. We have also included lots of photographs, like last time! Please tell us what you think about it. Your honest feedback helps us to improve the quality of this newsletter, and also to ensure that it meets the needs of the membership. We wish to thank the BIPA executive for their continued help and support in producing it. A very special word of thanks to J P Rajendran, whose considerable IT skills ensured that it was formatted properly. For those of you attending the annual conference, hope you have a great meeting.

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However, the latter did not progress as much as I had hoped and I realized that it was mainly because of the differences in the priorities of the two groups. There was a degree of lack of awareness of each others’ functioning and I still wonder whether this model of having Faculties and Divisions existing separately is ever going to work effectively for the College machinery. Over the years, I also became aware that it was about individual leaders’ personalities rather than the system that makes it work. During my involvement with the College, I learnt two key things: the first one being “we are the College” and that “we need to consistently put in extra effort to become involved in the College matters to bring about the necessary changes”. In the past ten years, I have worked with three different Presidents, with three different styles, each having their own vision and priorities. I believe that a tenure of three years as College President is too short to effectively bring their vision to reality and a total shift of vision every three years does not bode well for the longer term objectives. In the context of organizations like ours (BIPA), the only close relationship that exists with the College machinery is through the International Advisory Committee (IAC), and despite our best possible efforts, a real partnership model between the Royal College and the Diaspora Organizations has not yet evolved. This is one area I wish to spend some time on when I take up the role as the Chair of BIPA. A joined up approach to influence policies and decision making of the Department of Health on mental health issues is only possible through such a forum. The partnership model can extend to different parts of the College machinery including Research and Training and CRTU. In conclusion, I intend to persuade the College machinery to have a MoU with the Diaspora Organisations with a clear platform to influence the policies and drivers that shape the mental health services. I also think that a section should be created within the College to look at the ongoing issues faced by the BME workforce including the challenges they face at work and other related areas, in addition to the professional support mechanisms that can be arranged jointly with the College.

My experience of being involved with the Royal College of Psychiatrists Dr Sab Bhaumik , Vice president BIPA

When I was approached by the BIPA news letter editor to gather some thoughts around my experience on the workings of the Royal College, I did not realize that it would be so difficult to do justice to the task of describing the relevant areas in a few paragraphs succinctly. As a trainee and then as a junior consultant, the College appeared large and distant. At that time, I had no inkling that I would have to spend so many years in the latter part of my career with the College affairs. My first sojourn came when I became an executive committee member of the Trent Division of the College in the year 1999. Gradually, I became aware of the issues that the College deals with, although I was directly not yet directly connected to it at the time. I became the Chair of the Trent Division in 2003 and that was the first time that I started attending the College Council meetings. At the same time, I became involved with the Learning Disability Faculty, having already been elected to the Executive Committee in the year 2002. I was appointed as the Academic Secretary of the LD Faculty in 2003 and subsequently elected as the Chair of the Faculty in 2006. As I grew familiar with the College machinery, I also became aware of the apparent divide that existed between the Division and Faculty Chairs and this did surprise me. Through Mike Shooter’s initiative, I saw how power was devolved to the Divisions and this worked much better than the previous model of central control. Through my initiative, I organised regular meetings between the Division Chairs and another set of meetings between the Faculty Chairs at the College. I also arranged occasional joint meetings between Divisional and Faculty Chairs.


How to pass the MRCPsych CASC Exams The pass rates in the MRCPsych CASC exam for those who had their Primary Medical Qualification (PMQ) Outside the Western Europe is disappointingly low compared to those who qualified in the Western Europe. A significant proportion of the failing candidates have had their PMQ from Asia, especially, the Indian subcontinent. Hence, this is a matter of grave concern for BIPA. Let us look at the possible reasons. Racial discrimination: This is the first reason that springs to most people’s minds. However, Asian doctors who have Western PMQ attain high CASC pass rates. Those who had their PMQ from Asia have poor skills and knowledge: This is unlikely because the pass rates in theory exams are much more similar in the two groups. Doctor-patient relationship: In Asian countries the doctor-patient relationship is more paternalistic. However, in the UK patients like to be treated as equals. This could cause difficulties in clinical relationship especially for those who have had long medical careers in their country before coming to the UK. Communication skills: This is an essential component of every station in the exam. From the very beginning of the station, many Asian candidates communicate in a very ‘formal’ and stilted manner. This would give the role player an impression that the candidate would be difficult to communicate with. The examiner may conclude that this candidate is neither an effective clinician nor a good team player. Preparation for the CASC exams In the CASC exam one of the skills tested is the way the candidates interact with patients in clinical situations. However, the way many candidates prepare for examinations in fact reduce their chances of passing the exams. Let us review some common strategies they adopt with suggestions for improvement

Group study: Most hospitals have a number of trainees who have failed the CASC exam on numerous occasions and are preparing together for future exams. Many of them seem to have entrenched opinions about reasons for their failures. The also have notions about the best ways to pass the exam and what to do and what not to do in particular examination scenarios. They share horror stories and tend perpetuate learned helplessness. Spoken English: For many failing candidates English is their 2nd or 3rd language. The patients as well as the role players speak colloquial English. Improving familiarity with the local population would improve their communication skills. Trainees use many techniques to achieve this e.g. going out socially to restaurants and pubs with colleagues as well as watching soap operas. CASC Courses: Attending one or few courses should give them some idea about the courses and exams. However, some candidates believe that attending courses is the only thing they need to do in order to pass the exams. Most candidates pass the CASC exam without attending any courses. Courses are never a substitute for clinical experience. CASC Books: Many books are good sources of information on the types of scenarios that might come up in the exams. Many give useful information for developing Strategies and Schedules, but seeing patients and learning from them is more important than reading books. Routine clinical work: The trainees should see as many patients as they can, assess them including doing physical examinations, answer their questions and explain things to them. They should do these occasionally in front of colleagues and ask them for feedback. It may be difficult in the beginning and especially if they are not used to honest feedback. The trainees should see as many patients as they can, assess them including doing physical examinations, answer their questions and explain things to them.

Work place based assessments are a helpful way of doing this and are more useful when made by Consultants.

Observe others

Make a long list of possible scenarios

Develop Strategies

Develop Schedules

Practice

Physical examination stations

Improve Strategies and

Schedule

Plan and Organize In the weeks before the exams

At the exam: Carefully read

the Problem and identify the Issue.

All the Best V Sunil Babu Director of Medical Education Surrey and Borders Partnership NHS Foundation Trust Sadgun Bhandari Clinical Tutor and Clinical Tutors for SAS Doctors Hertfordshire Partnership NHS Trust Albert Michael Director of Medical Education Suffolk Mental Health Partnership NHS Trust [ For a fuller Version of the same please Visit www.bipa.org.uk ]


“Psychiatry in the Solomon Islands” Dr Ashok N Singh, Consultant Psychiatrist in Boston, Lincolnshire spent three months from 15 February 2010 to 14 May 2010 in the Solomon Islands as a Royal College Volunteer and WHO external consultant. Country Background : The Solomon Islands is situated in the South Pacific Ocean and is a low income country. It comprises nearly one thousand islands with the land area of 304,000 kilometres spread over a sea area of about 1.5 million kilometres making communications, travel, and service delivery difficult and creating inequities in access. The population of Solomon Islands was estimated at about 581,318 in 2008, is young, with 42% aged less than 15 years (SIMOH 2006). The majority of the people are Melanesian (93%), and 98% of the population belongs to a Christian church. The population is extremely diverse with some 91 indigenous languages and dialects being spoken in addition to Solomon’s Islands pijin (the most common language) and English (the official national language). Over 83% of the population live in rural areas where subsistence agriculture, fishing, and food gathering are the main income source (statistics of the Solomon’s Island Government 1999), there is not a tourist industry and the gross domestic product (PPP) of $1.5 billion and per capita income $2.800 approximately (international monetary fund 2009). Total expenditure on health represented 5.6% of GDP and only one percent of total health budget represented mental health budget expenditure. (WHO Mental Health Atlas 2005). Dr Singh’s main role was to improve clinical skills of the local psychiatrist and senior nurses in terms of diagnosis, prescribing, psychosocial rehabilitation and psychoeducation with patients and families. Also to improve their management skills by holding and chairing regular meetings, to develop WHO model for CMHT and to establish individual care plans, to reduce relapse and re-admission rate and to improve mental health services to local prison.

During the three month period he also performed direct clinical work at out patient clinic, ward rounds, liaison psychiatry consultations and family visits. Finally, the Community Mental Health Team (CMHT) was inaugurated on 6 May 2010 by a service user in the presence of more than 50 invited guests from Ministry of Health, Solomon Islands, INGOs, NGOs, Department of Police and the local media. The ceremony was addressed by the WHO country director for the Solomon Islands.

Dr A N Singh Consultant Psychiatrist in Recovery, Rehabilitation & In-Patient Lincolnshire Partnership NHS Foundation Trust United Kingdom Tel: 01205 446863


Most of you must be aware of the success we achieved in resolving the problems faced by trainees following the retrospective withdrawal of the life-time validity of a pass in the old-style part I exams imposed by the College. BIPA made a robust response to the College Council and also to the College Ethics Committee, which led to the College re-examining its stand.

However, there is another very important issue facing our international trainees.- their pass rate in MRCPsych examinations is significantly poorer compared to UK trained graduates. BIPA had requested the Examination Department of the Royal College of Psychiatrists to provide some data that might illuminate the reasons for this disparity. This data has not yet been made available to us. We have also tried to get more information about the poor ARCP reviews for International Medical Graduates. We seem to face a lot of obstacles in getting the information needed but BIPA will continue to endeavour to get to the bottom of the reason for these disparities.

Youth Scientific Forum (YSF) is yet another initiative by BIPA in a long list of concerted efforts to help trainees and academics who have to come to work in the UK. BIPA will use the excellent resources at its disposal to support the Young Trainees and Scientists in all aspects of their Professional career.

The Youth forum is a scientific platform which helps provide answers to issues relating to Professional exams, Career development, Research pathways in the form of lectures, question and answer sessions, plenary discussions, and workshops! The YSF conference places young scientists at the forefront to encourage them to excel in their chosen field(s) as clinician and/or researcher. Highlights: Lectures from Eminent Professors In Psychiatry || Separate Workshop on Research for SHOs and SpRs||“Crack the CASC” by well known CASC organizer DR SPM Murthy || “Ask the Panel”- chance to interact with successful professionals ||Social Networking || Ongoing and Continuous support to attendees through BIPA network . [ BIPA's YSF committee: Venkatesh Muthukrishnan, Vijaya Murali, Nora S Vyas ]

BIPA Newsletter – June 2011

BIPA Trainee and Core Group Members 2010

Diaspora psychiatrists and British psychiatry: Travails and Triumphs If you are attending the International Conference of the RCPsych in Brighton please attend a symposium on Diaspora psychiatrists organized by BIPA. . Why do overseas trainees fare poorly in MRCPsych? Why do overseas doctors get referred to GMC more often? BIPA Chair Dr. Subodh Dave will be leading a symposium on "Diaspora Psychiatrists: Travails and Triumphs" at the the International Conference of RCPsych in Brighton on 29th June at 11: 30 am, which will answer these questions. Speakers include: Prof. Femi Oyebode and Prof. Dinesh Bhugra. Please attend.

BIPA For Trainees : [ Vijaya Murali ] BIPA has been vigorously trying to sort out some of the training issues that our International Medical graduates face in the UK.

BIPA Youth Scientific Forum ( YSF) : Welcome to the Youth Scientific Forum for all Psychiatry trainees, Young scientists and academicians organized by the British Indian Psychiatry Association.

How to apply for a Certificate of Eligibility for Specialist Registration (CESR) under Article 14 of the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003: Dr Suneetha Kovvuri [[email protected] ] At the start of the process, having looked at pros and cons and alternatives, to take the important decision that the CESR is ‘the route’ you want to take to attain your specialist status. Gain a thorough understanding of the Royal College Curriculum in your chosen speciality.Write down all the relevant experience you have acquired and compare it with the Royal College Curriculum. Speak to an SpR (CT4-6 trainee) and get hold of their training timetable. Focus on the training ‘post MRCPsych’. This is if you already have MRCPsych. If not, it would be a lot more work, though the College says possession of MRCPsych is not a must. Identify the deficiencies in your experience compared with the mandatory SpR training. If possible, speak to an SpR and tailor your work and training to the requirements. Job Plan: Come to an agreement with your management to allow you to have protected time for training in the areas of your identified deficiencies. Time Span: Have a realistic dead line as to when you want to submit your first application. Validation: start collecting your evidence as you go along and get it signed off. Do not leave it to the end. I divided my application into separate sections and started collecting evidence under different sections. Having separate sections definitely made me reflect and focus on collecting the evidence. Choose your referees: One has to be your current medical/clinical director. My personal advice is to choose referees from the medical profession and from your own specialty, i.e. from consultant psychiatrists who are on the specialist register. Do not stop collecting your evidence after the application is sent off! Stay in touch with your certification officer in the GMC. In my experience, they are extremely helpful

BIPA Newsletter – June 2011

Cultural wing of BIPA - Bhavana Chawda

disappeared swiftly. At the evening social dinner I experienced pangs of joy very similar to those at any social or family gathering back in India. Since then I have never failed to attend any of our BIPA annual general meetings. As an executive member my interest lies in organizing social and cultural events. BIPA is incomplete without the participation of the spouses and children. BIPA families make our social evenings a complete, enjoyable success in their bright colorful sarees, lehangas, kurtas, chudhidhars and jewelleries; along with the tasty Desi food. At the last annual general meeting and also at the greater partnership the children were entertained by a professional entertainer with non competitive participative games, magic show, balloon displays and musical disco while the families enjoyed henna painting by professional Mehndi artists. At BIPA we aim to keep the spirit of our Indian culture and customs alive and welcome any suggestions to enhance this idea. This chance offers us to remain in contact with our culture and gives us the sense of Indian-ness at our home in England. BIPA would also like to offer its platform to the families to display their skills in art, poetry, music, writing, singing, dancing etc. These talents can be captured and show cased through active participation in future and we can even consider competitive shows. I am proud to be a BIPA member and am thankful to the committee for offering me the responsibility of organizing our cultural program. I look forward to working with your ideas.

More than 10 years ago at my first BIPA annual general meeting, I was in the midst of a hundred other Indian psychiatrists. My feelings of loneliness, along with lowering

INTERVIEW OF PROFESSOR AJIT AVASTHI, LAST PRESIDENT OF IPS

Tell us a bit about your early life. I was born in the city of Srinagar, Jammu and Kashmir, and thereafter I had my initial schooling, as well as my education in the city of Jammu, in Jammu and Kashmir. I completed my graduation in medicine from the Government Medical College, Jammu, and thereafter I got my placement in PGI, Chandigarh, Post Graduate Institute of Mental Education and Research, followed by Post Graduation in Psychiatry, and after doing my Post Graduation MD in Psychiatry by the end of 1981, I joined there as a Senior Resident, and after completing three years of my training as a Senior Resident I left for Libya, and there I joined as a lecturer in the Anab Medical University in Benghazi, Libya. There for two years and thereafter I returned back to PGI and joined the Faculty, and continue there now as Professor of Psychiatry. If I can ask you, how did you end up choosing Medicine and later psychiatry as a profession? The interests are many, one was that the doctors, physicians and surgeons, were really looked up to as something unique at that time, so they were the role models, and those were the careers at the time, medicine as a career at the time was a very prized career. I have a family tradition of physicians, although they were AyurVedic practitioners, but that was the tradition that my father in fact influenced me to continue. He felt that one of us as children should take up medicine and continue with the family legacy.

I was also interested in a way because it appealed to me that looking after patients and kind of helping them in this hour of need, and when they are suffering, would be a good idea to have a meaningful life, and I chose medicine. Psychiatry is interesting because I always thought that it is not only the science which would interest me, but also the art of the practice of science. I had my interest in literature, I was a good communicator, that is how I believed myself to be at that time. I felt that this will be one of the specialties where I will be able to pursue, not only just the pure science, but also the humanity view, and therefore this combination of science and humanity which psychiatry offered as a good opportunity. So it attracted me toward it, so I joined. At that time it was a difficult choice of a career. Psychiatry hadn’t really come up at that time, and when I said that I wanted to pick up psychiatry many people raised their eyebrows, including my teachers. Eventually, I persevered, and I said no, this is what I want to do. I was encouraged by my family, and actually my father was very supportive. He said whatever you want to do, do it, and my principal of the medical college, he was also very supportive of my choice, Do you want to just share with us a bit of your career highlights. First of all the opportunity to have a very unique kind of job in India, and that was the PGI Chandigarh, had a lot of reputation as an institution, and the department also had a very good reputation with Professor Wig, Professor Verma there, Professor R. Srinivas Murthy was working there, and we had a psychiatrist as the Head of the Institute at that time, Professor S Negi. There was also for some period Professor Morris Carstairs, who was with us as a Visiting Faculty for nearly one year. I think the highlights have been that I got a good opportunity to pursue my interest in teaching, which is a passion with me. I have been very passionate regarding this, interacting with my students, shaping their careers, kind of contributing to their

growth in the profession and otherwise too. Apart from that, the service is a very high quality service that we provide, and there are quite a lot of challenges. Research was the third highlight. It gave me all the three exposure: research, teaching, patient care, all three were put into one, that is why I had multiple hats, you know many hats which I could choose from at the time, and it carried on. As it happens, and you are there for a long time, you start getting a number of awards. Practically all the awards which Indian psychiatry could offer me, I have already won. Do you want to share that with us, I know you are very modest about it? A number of times I have won the Best Paper Award, which is called BP Award, at least four times I have won it, and the Marfatia Award, the PPA2 Award, and now I have also been awarded the D.L.N. Murthy Rao Oration, which is in fact the highest award which Indian psychiatry can award to anybody, and it was almost given as a lifetime achievement award. Apart from that, I had a lot of exposure in setting up a few things, I am very proud of having set up the very first clinic in India which deals with the psychosexual disorder, like marital problems, psychosexual disorders, way back in 1982. We have a host of publications, a lot of the manuals that we had developed, very proud of it, and then with Dr Kulhara, my senior, and others, the schizophrenia research which we have continuously done for say about 27-28 years. That is something and it has been recognized the world over. Our schizophrenia research from PGI is largely clinical research, has given quite a lot of insight into the illness of schizophrenia and the various dimensions associated with it. I have been the convener of the taskforce set up by the Indian Psychiatric Society, which has come out with clinical practice guidelines for psychiatrists in India, and we came out with five volumes actually. Constantly for five years, one after the other, with various disorders, we have come out with clinical practice guidelines for Indian psychiatrists [ Contd..]


Do you just want to tell us a bit about the history of your involvement and your key achievements in IPS ? I have been involved in various ways. I started with leading the state Chapter, then I had headed the zonal branch of Indian Psychiatric Society, that is the North zone branch, and I have already contributed quite a lot to the educational programs of the Indian Psychiatric Society. There were quite a lot of initiatives, which I have told you about, like the clinical practice guidelines, very proud of that achievement. Apart from that we have come up with a publication division of the Indian Psychiatric Society, and we have come out with some good publications. Last year we released two books, which were distributed free to all the members of the Indian Psychiatric Society, about the physical health of the mentally ill, and neuro biology of psychiatric disorders, and this year again, we are actually coming out with some kind of a compilation of these psychological instruments, which are locally relevant, which have been adapted in India, which have been developed in India so that people can have access to those and instead of using instruments which have been developed outside and there could be methodological issues, they have the local instruments and they can use those for research. The other thing ,that I am very passionate about, and which partly have succeeded is to start a research division in the Indian Psychiatric Society. We are now conceiving some of the multi-centric research in India, which is funded by the Indian Psychiatric Society. So, apart from just the continuing medical education and the professional development, the social aspects of the Society, we are also now very heavily into the intellectual inputs and some of the organizational, and even now we are flexing some kind of influence with the Government of India. The President of the Indian Psychiatric Society is now a special invitee to the Central Mental Health Authority of the Government of India. They tend to have some kind of inputs into the National Mental Health Program, and into the policy

decisions that are taken. We have developed a very good international network, as part of it, right from the time we had associates like the British Indian Psychiatric Association, Indo-American, Indo-Australian, Indo-Canadian, so we have been part of it. This culminated into another very good initiative, that is the Indian Global Psychiatric Initiative what is called the IGPI. We had its launch in this year only, at Jaipur, and this is just to bring all together, the resources, the talent of the psychiatrists of Indian origin, who are either practicing in India or abroad, under one umbrella. So, that is another thing. I have been associated with the launch of the Asian Journal of Psychiatry. It is again very good. This gives quite a lot of profile to the research that originates from parts of Asia, including south-East Asia. Those are the kind of initiates which have been done. I think I see that the Indian Psychiatric Society will continue to grow and add various kinds of activities. In that context, what do you think are the challenges and opportunities facing Indian Psychiatry currently? Well, I think the greatest challenge that now faces us is that we have to evolve with some kind of strategy, we are still very acutely short. We have just about 4,000 psychiatrists, and you know that India is a very large country with quite a lot of population, which is absolutely untouched. There are no facilities. There is no kind of way that these 4,000 people can reach to more than 1 billion population. So we had to think of various strategies, and I think one of the strategies which we are already working on very seriously, is to strengthen the under graduate psychiatry training, and teaching and training, and we have already submitted this last month only, our own recommendations for strengthening the psychiatric syllabus in the MBBS curriculum, and also to suggest then the teaching method, the course curriculum, the evaluation, so that some basic knowledge of not only psychiatry but health and behaviour is imparted to the graduate courses, medicine and surgery, so that we have

every doctor who even gets the basic education can have some capacity to deal with some of the morbidity in the field. . At least, if we can have some rational referrals from them, that will be a great achievement. We also want that through the District Mental Health Program, which has already covered now over 120 districts in India, we wish to increase more and more, so through those District Mental Health Programs we can at least start having some semblance of a community psychiatric program in India, so that the people don’t have to really travel long distances, and they can get reasonably optimal treatment closer to their homes. So, those are the various kinds of challenges. Just to move on to a slightly lighter topic, to you as a person outside work, what does Professor Ajit Avasthi do to relax? I do quite a lot of things. Other than the medicine, literature is my passion. It interests me quite a lot and I read quite a lot of history, contemporary, in India, as well as history of mankind that it does interest me. Music is something else, I sing myself. I sometimes lock myself in my room and even if the rest of the family like it or not, I continue singing for hours together. I am a very outdoor person, I visit places, I see quite a lot of things. I have a very good and supportive family, my wife, my children, my brothers, their children. I have a large family with whom I keep in regular contact, talking to them, contributing, doing things together. I’m a very social person, large number of friends. I take holidays, I go in the hills and spend some time out there. I like travelling and I enjoy nature quite a lot. These things I do in my free time. Just coming back to the business of psychiatry and Indian and British psychiatry, what is your view about the challenges and opportunities for Indian psychiatrists in the UK? Oh well, there are challenges of course but opportunities are many. I think you have a lot of racial mix, ethnic minorities in Britain. [Contd..]


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Newsletter Editors : Piyal Sen / Ranjith Baruah

It is becoming a more multi-cultural society, and in order to understand the nuances of the cultures that people carry with them, I think Indian psychiatrists can be very good at that. It gives them a great opportunity to learn quite a lot of things. What I would say, is that it is not that I am thinking that the psychiatrists from India come straight from there after graduation, they come and they get placed in the system and then they just practice what is being done here. But, I would love to see that there is quite a lot of exchange, what we are doing, what they are doing out there, and I think that Indian psychiatrists can contribute quite a lot to the development of psychiatric services, as well as the expertise, manpower development, in India. At the same time they can learn quite a lot from us, and the insight that we have there, some of those insights would be very helpful to shape the practice of psychiatry here. That is why I spoke on the family, and its importance, in mental healthcare, that was my idea. It appears to me as if we had become just individual-centric, whereas we need to have to have the individual family together if we want to have a really meaningful and worthwhile intervention. And that brings me very nicely on to my next question, which is what do you think are the ways that the Indian Psychiatric Society can work more closely with an organization like BIPA? That is very good. I think what I see is that first of all there should be more interaction between BIPA and IPS, not only just sometimes, somebody from the Indian Psychiatric Society coming here and attending your conference, and people going there and attending other conferences. That is alright, but more than that, what we need to have is some kind of a joint project here. We should be working together on the field. We should have some joint project so that we can see how you have your experiences and your expertise and we have our experiences, and how we can get together and contribute something good. The other thing is that we are aware that there are a lot of areas which still need to be developed, and you have certain kind of abilities in there, and probably you can

help us out in establishing those specializations of various fields in psychiatry, like learning disabilities, forensic psychiatry. You see care of the elderly, even community programs where you have conceded may not be directly applicable there. But you have a wealth of experience there, the organizational structures, that is something very important, and it is interesting how to make it more organized, how to make it more accountable, those are the kind of things that I think BIPA and IPS should sit together, more interaction, not only with attending conferences, and giving a few talks here and there, but also sitting together and doing things together. That is what I feel what BIPA and IPS should aim at doing. Leading on from there, this is the last question, what would be your key message to the members of BIPA who will be reading this newsletter where your interview will appear? Well I think the key message is that we feel BIPA needs to not look at India as just a place where they can go and visit their families and go for pilgrimages You know you get a sabbatical, if you can take time off, spend a few weeks’ schedule there, IPS is one particular body through which you can develop and create a strategy for having a greater say in mental health policy discussions globally. Across the field, this is a good way to influence global health policies. [ Interview by Dr Piyal Sen ] CURRENT BIPA EC Members

OTHER NEWS : Dr. Subodh Dave, Chair, BIPA raised £5000 + for a small charity providing foster care to orphans in India (http://www.helpchildrenofindia.org.uk/index.html). He completed 2 marathons in the process (26.2 miles each) finishing 6th in Mumbai with a time of 3 hrs 28 min and a personal best time of 3h 23 min in New York. +++++++++++++++++++++++++++++ IGPI has recently launched its new website http://indianglobalpsychiatricinitiative.org The Indian Global Psychiatric Initiative The Scientific Congress of the Federation of Global Indo-Psychiatry Associations Objectives of IGPI: To promote mental health care in India. To facilitate networking between psychiatrists of Indian origin. To promote the interests of psychiatrists of Indian origin. It was inaugurated at Jaipur in January 2010, had its second meeting in New Delhi in January 2011. IGPI President: Prof. Russell D’Souza (Aus) Secretary: Prof. D.Natarajan (Can) IGPI COUNCIL: Prof. Ajit Awasti (India), Prof. E. Mohandas (India), Prof. M. Thirunavukarasu (India) Dr. Anand Ramakrishnan (UK), Dr. Subodh Dave (UK), Dr. Seshagiri Rao Nimmagadda (UK), Prof. Dinesh Bhugra (UK), Prof. Uma Rao (USA), Prof. Rohan Ganguli (Canada) Prof. Mohan Isaac (Australia), Prof. Shekar Saxena (Geneva), Prof. Shiv Hatti (USA) Prof. Rudra Prakash (USA), Prof. Ananda Pandurangi (USA), Dr. Shailesh Kumar (New Zealand), Dr. George Mathew (New Zealand), Prof. Suresh Sundram (Australia) Prof. Dilip Jeste (USA), Prof. Lakshmi Yatham (Canada), Prof. M.P. Deva (Malaysia) Prof. B.N. Gangadhar (India), Prof. Dinesh Arya (Australia), Prof. Mohan Gilhotra (Australia), Dr. Carlyle Perera (Australia), Prof. Mathew Yalto (Canada), Dr. Savalai Manohar (Canada) Member organizations: British Indian Psychiatric Association Indo American Psychiatric association Indo-Canadian Psychiatric Association Indo Australian Psychiatric association Indian Psychiatric Society Indian Association of Private Psychiatrists

Chair: Subodh Dave Vice Chair: S Bhaumik Gen Secretary: S R Nimmagadda Joint Secretary: Pradeep Arya Treasurer : Anand Ramakrishnan Public relations : Sivaswami Nagraj Executive committee members Ashok Jainer / Balaraju / Bhavna Chawda / Ipsita Mitra / JP Rajendran / Karthik Thangavelu / Mallikarjun Rapuri / Niruj Agrawal /Nora Vyas / Rajnish Attavar /Shobana George /Shrikant Srivastava /Srikanth Nimmagadda / Thomas V /Venkatesh M / Piyal Sen & Ranjith Baruah [ Newsletter Editors]

Documents

Bipa Newletter 2011