Emergence of General Hospital Psychiatry

Psychiatry services are being initiated and delivered in the general hospitals. Though this is being achieved at a slow pace, nevertheless, the trend is being set. Community programmes lor the delivery of psychiatric services are also being planned. The delivery of mental health care services at the primary health centres and the peripheral areas would perhaps be strengthened it the role of General Hospital Psychiatry was increased. It would be beneficial to promote setting up psychiatric units in the general hospitals. General hospitals are ideally suited for such units. Most districts have general hospitals-small or large. Many such general hospitals even have medical colleges attached to them. Such teaching centres also have a role in the delivery of mental health services. Though general hospitals are well suited for having psychiatric units, not much significance has yet been given to this aspect. The general hospital psychiatry units can have certain specific roles. Firstly, many psychiatric disorders ot milder severity and those with somatic presentations invariably present in such centres. Also, the psychological and emotional problems associated with many physical illnesses, acute or chronic can be better managed in such units. Many such psychiatric units should have in-patient facilities to deal with acute problems or emergency situations. The need ot psychiatric services for patients suffering from cancer, chronic debilitating illness , or those kept in intensive care or coronary care units are well acknowledged. Besides imparting important services, general hospital units can have another important role to play. Training ot undergraduates has been highly neglected especially with respect to the subject of psychiatry. Psychiatry training for medical undergraduates should consist of a specific programme and should orient the undergraduates to common psychiatric problems-their identification and management. Also, general hospital units can take up the role of training nurses and other paraprofcssionals. This aspect of training needs immediate attention of all mental health professionals. The general hospital units could organise orientation programmes for other medical and surgical professionals. Such a need has been identified by the medical specialists also. Perhaps much more can be achieved through general hospital psychiatry units than is usually expected. Other roles of such units would be identified once such units are set up in larger numbers and their feasibility examined. Patients also may feel more free to attend such units where social factors like the stigma attached to the mental hospitals are not cxistimg.