Open J Psychiatry Allied Sci. 2022;13:3-9. doi: 10.5958/2394-2061.2022.00007.6. Epub 2022 Jan 31.

Conceptual framework of psychiatric care in India: moving from community psychiatry to public psychiatry.

Malathesh BC, Manjunatha N, Kumar CN, Math SB, Thirthalli J.

Abstract

The psychiatric care across western countries has evolved from mental hospitals to community psychiatry as a by-product of deinstitutionalisation. The psychiatric care in India traditionally followed the homecare then shifted to mental asylums, then to various forms of community care such as co-community care within mental hospitals, camps, rural mental health clinics, District Mental Health Programmes (DMHPs), and general hospital units/ private clinics.

With these evolutions, the psychiatric care in India can be divided into mental hospital psychiatry and community psychiatry. This division hinders the growth of many other sub-specialties of psychiatry such as primary care psychiatry, disaster psychiatry, public psychiatry, etc.

The authors propose to abandon the concept of community psychiatry and classifying psychiatric care into two broader divisions: clinical psychiatry and public psychiatry. Clinical psychiatry is divided into hierarchy-based primary, secondary, tertiary, and quaternary care psychiatry.

In contrast, public psychiatry is to be divided into non-hierarchy-based community/ local level (micro), district level (meso), state/ country (macro), and global level (mega). The proposed public psychiatry cannot function in isolation or standalone field. It shall begin to synchronise with an Indianised Jacob’s concept of public health to achieve its targets. The divisions proposed above should be kept in mind for framing the future policies on psychiatric care in India.

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