Emerging Leadership Role of Psychiatry Teachers in Enhancing Medical Training and Mental Health Services in India

To the Editor,

There is a huge mental health service gap in India (with <1 Psychiatrist/1,00,000 population in several states). ¹ Adequate training of Indian medical undergraduates in mental health can be instrumental in bridging this gap. The young doctors who will work in primary healthcare centers, if trained adequately, could contribute substantially in this regard, particularly when access to a mental health specialist is low. ² They can not only identify persons with mental illness (PwMI) and provide initial treatment but also promptly refer individuals requiring more intensive psychiatric interventions to higher centres.

The National Medical Commission of India (NMC) understands the importance of training undergraduates in mental health. It has increased the duration of psychiatry teaching from 20 hours of theory lectures and two weeks of clinical posting to 40 hours of theory lectures and four weeks of clinical posting. ³

Also, two autonomous institutes, All India Institute of Medical Sciences (AIIMS) Rishikesh and AIIMS Deoghar, have made psychiatry a mandatory subject during MBBS, and students must appear for a hundred marks exams in psychiatry.^2,4

These are steps in the right direction, but psychiatry teachers need to advocate for policy change at the level of the NMC so that training in psychiatry becomes mandatory for the undergraduate curriculum.

Psychiatry teachers can play a crucial role, particularly in enhancing the quality of psychiatry training in medical colleges, especially when the stigma attached to mental illnesses is enormous. Apart from teaching the students, a psychiatry teacher can get involved in various leadership positions at a medical college. For instance, one could be an academic in charge of the institution or a member of the Medical Education Unit of the college, thereby helping enhance psychiatry training (through foundation courses, early clinical exposure in psychiatry, integrated teaching, etc.) among undergraduates. They could also be a member of the Medical Research Unit, the Ethics committee, the Cultural & Literary Committee, and the student-welfare committee. Other key positions include administrative roles like Registrar, Medical Superintendent, Dean, or Vice-Chancellor. Leadership positions increase the department’s visibility, importance, and reach within the college. For example, Dr BN Gangadhar, a senior psychiatrist, is heading an important Institution like NMC and contributing to the cause. ⁵

There are four essential qualities of a leader: self-confidence (in the path one chooses), determination (in following one’s goal), willingness to undertake personal sacrifices to perform leadership roles effectively, and endurance and energy. ⁶ Leadership in psychiatry encompasses several domains: patient care, education, mentoring, research, and administration and management. ⁷

Successful leaders can take up more pragmatic issues for research. They can also motivate students and faculty, ensure adequate funding, and work to enhance interdepartmental collaborations for research. Psychiatric leaders need to have excellent interpersonal and communication skills. They should collaborate with researchers from other departments, get peer support for grant applications, and find new colleagues to grow. ⁶ They need to work hard to increase their visibility in the media, conferences, and medical societies and sensitize people about the importance of mental health. Finally, they should strive hard for promotional and preventive activities related to mental health, apart from providing quality care to patients.

Technical expertise is an essential quality of leadership. Psychiatrist leaders can think of different and innovative methods to disseminate knowledge about psychiatry to undergraduate and postgraduate students, faculty, and staff from other departments. Research suggests that decent quality psychiatry training at medical school and having psychiatry teachers as role models positively influence students’ attitudes toward psychiatry and pursuing it as a career. ⁸

Likewise, training in administration (including psychiatry’s relationship to local bureaucratic systems and regulatory agencies) and personnel management (classroom and staff management) are paramount. Such managerial skills could be incorporated into the Psychiatry training curriculum of the young trainees, ⁹ or psychiatry teachers themselves can undertake such courses as a part of continuous professional development.

Intuitively, all psychiatry teachers will not become leaders. But those with leadership potential can lead and achieve their goals better. Moreover, their leadership skills will help them judge whom to follow even if they do not become leaders. ⁶

In summary, psychiatrist leaders must express leadership in implementing competency-based medical education, reducing mental health stigma, providing quality services to the PwMI, and promoting the development of a conducive environment (for students/staff) by incorporating principles of psychological well-being.

Many platforms are available within the country for interested psychiatry teachers to enhance their leadership skills. These include the early carrier professionals national fellowship by Dr Ramachandra N. Moorthy foundation at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru; the National Teachers Training Center (NTTC) at Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry; the Foundation for Advancement of International Medical Education and Research (FAIMER); the Indian Teachers of Psychiatry’s scholarship for Teachers towards enrichment in psychiatry teaching skills (IToP STEPS), and so on.

More discussions need to be held at various levels about devising strategies for optimizing the leadership role of psychiatry teachers. It will have lasting implications for improving public mental health services in the country.