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Britis h In dian Ps ych iatric A s s oc iation

From the Editors Desk
It is our pleasure to bring to you this latest version of the BIPA newsletter. We hope it is able to convey to you a avour of some of the excitement and dynamism which currently surrounds BIPA, harnessed under the expert stewardship of the Executive Committee and the President Prof. Sab Bhaumik. There are an increasing number of initiatives being undertaken or planned currently either in the UK or in India. All of these have the twin goals of improving the quality of life for the service users we treat as psychiatrists of Indian origin as well as to equip us with the tools which will enable us to serve them best, whether they are in the UK, India or anywhere else in the world. The article from the President helps to sets the tone for the newsletter. It provides an excellent summary of the issues currently facing psychiatrists of Indian origin in the UK. We live in economically difcult times, which has a huge effect on our working lives. We are all being asked to do more for less. In parallel, opportunities for training are more limited to meet the new challenges, with the pressure on study leave budgets. There is also more pressure from outside bodies like the GMC, magnied by the publication of the Francis Report on the lessons from Mid-Staffordshire, which puts the responsibility for reporting poor performance squarely on clinicians. Doctors from Black and Minority Ethnic (BME) backgrounds continue to be overrepresented in the GMC complaints procedure, a reection of these continuing pressures. The Presidents article acknowledges some of these issues and tries to provide a road-map through the difculties to provide greater support for BIPA members in such difcult times. At the same time, a number of us want to give something back to our mother country which started us off in the journey to be where we are today. It is heartening to note that diaspora organisations consisting of psychiatrists of Indian origin are increasingly coming together and are organising joint meetings in India. There are also an increasing number of psychiatrists who are taking up initiatives in their respective states to improve the well-being of populations there, thus putting their training in the UK to good use. The newsletter highlights some examples of this, and is keen to hear from others who are doing the same, so that we can all learn from each other. Training and development is never to be forgotten, as it opens up new vistas for professionals. The high proportion of Indian subcontinental graduates in MRCPsych CASC failure numbers is a slur on all psychiatrists of Indian origin in the UK, including the trainers. A number of quality initiatives to improve this are being undertaken, and more to follow. BIPA is starting to provide important leadership in this eld, not only for South Asian psychiatrists, but potentially for all psychiatrists who have trained outside the UK. Lastly, we all need to nd a way to relax and unwind, bearing in mind the stresses of our daily lives, and smile a bit! We are very grateful to the contributors who have sent us their poems, which serve as useful reminders of the world beyond psychiatry. We are keen for this section to grow further in future, and look forward to contributions. We have also included lots of photographs, like last time, as one picture is often worth a thousand words!

BIPA CHAIR REPORT Professor Sab Bhaumik



REFLECTION Dr Vinod Kumar Lunawat




POEMS Dr Kavita Das Dr Nilamadhab Kar Dr Pradeep K Chadha

BIPA NEWSLETTER ! One word of caution. This was the rst newsletter for which we decided not to approach specic people to write on specic topics. We took the view that the newsletter was now mature enough for people to voluntarily send in their contributions. However, even though this process was started quite early and a number of requests were sent out to the membership by the Executive seeking articles for publication, the response has not been particularly enthusiastic, to say the least! While this is in part a reection of the pressures we are under, it is still worth reminding ourselves that in exactly such times, organizations like BIPA can be of assistance to us and the newsletter provides a mouth-piece for us to publicize your achievements as well as to highlight your specic difculties. It goes out to all the membership and thus generates a fair degree of publicity for the issues you wish to bring to the attention of colleagues. We hope you bear this in mind when the request for articles reaches you

2013 from the Executive and consider taking a couple of hours off your busy day to pen a few words about an issue or project which concerns you. The response and interest you generate might be a pleasant surprise! Finally, we wish to thank the BIPA executive for their continued help and support in producing this newsletter and for their patience and forbearing with us. Please provide us with your honest feedback which is always immensely helpful to improve the quality of this newsletter, and also to ensure that it remains relevant to the needs of the membership. For those of you attending the annual conference, hope you have a great meeting. From the editorial team Piyal,Ranjit and Sridevi

BIPA Chairs Report

Dear all, It has been a while since we met. BIPA has been quite active in the meantime in addressing some of the key issues our organisation, members and health communities are facing. As you would recall, one of my key priorities was to develop a support structure for our members through mentoring process. Dr Subodh Dave has taken on that mantle and is driving it forward. Very soon, you will all receive correspondence or email regarding joining the mentoring scheme. We wish to gather a list of senior members connected with BIPA who are willing to provide mentoring in specic areas i.e. workplace, research, management and education/ training. We have also met at the initiative of the Royal College of Psychiatrists with all other Diaspora organisations and have now got a clear mechanism of meeting at the College coinciding with the days we attend the International Affairs Committee of the College. The meeting is very well attended and is supported by the President of the Royal College of Psychiatrists amongst others. The group has elected a Chair and I have been requested to take on this role, I am very ably supported by Dr Mateen Durrani currently Chair of British Pakistani Psychiatric Association. We have now got an agreed terms of reference and have set our priorities for the coming year. The priorities are as follows: 1. Medical Training Initiative College is in dialogue with the GMC about this and plans to start a pilot project in Leicester/Derbyshire and Bradford. 2. Access to Mental Health Services for BME communities I am meeting Professor Bailey to move this forward and support the programme. 3. Research Support for Diaspora Members The Diaspora group is going to try and establish a support mechanism with clear mentoring processes regarding this. 4. Representation of Diaspora groups at College committees For international advisory committee there is a rotational arrangement that has been agreed between the Diaspora groups. However further discussion is going on about representation in other relevant committees. 5. CASC Examinations Performance by Diaspora trainee members at CASC examinations is a priority and I am holding further discussions with the Dean of the College regarding this. 6. National Psychiatric Diaspora Conference A conference is being planned in conjunction with The Great Partnership which will showcase achievements and contributions of different Diaspora members and groups. The group has met on two occasions and the meetings have been very well attended with evidence of plenty of enthusiasm and willingness to work collectively. I have also been meeting Professor Sue Bailey on a regular basis on several issues including that of information sharing with Diaspora organisations and commissioning Mental Health services for black and minority ethnic communities. Besides the above, there have been other initiatives with other organisations including BAPIO especially in the areas of MRCPsych examination and Educational training. BIPA itself has now agreed to hold a regular development training programme for its members and the rst of such programmes was held at De Montfort University on 23rd March 2013. The topic of the programme included Clinical Leadership and Consultant job interviews. I am pleased to say that the programme was very well received and following this we have agreed to have an annual plan to hold 3 such meetings on different topics related to development needs for trainees and consultants. These meetings will be held at 3 different geographical locations if possible. Our next such programme will be held on 12th October in the North East. I am grateful to Dr Subodh Dave, Abrar and Venkatesh for supporting me in moving this forward.

BIPA NEWSLETTER ! We also had a successful CPD event at NIMHANS, Bangalore in January 2013. The event was very well attended and extremely well received and with the focus of the talks on Psychotherapy, Dementia care and Rehabilitation Psychiatry. Our MoU with IPS has been signed during the ANCIPS conference and our relationship with Indian Subcontinent has been signicantly strengthened through this process. Many of you will be well aware of our forthcoming Annual Conference which will be held at Daventry Court Hotel on 8th 9th June 2013. The programme is very attractive with a clear theme on current issues in Psychiatry and the speakers include Professors Sue Bailey, Dinesh Bhugra, Indira Sharma, Simon Wessely and Lawrence Mynor-Wallis, amongst others. I sincerely hope that most of you will be able to join us in this meeting and I wish to take the opportunity to create a members forum to identify the key issues in clinical practice that BIPA members are facing at present. BIPAs support is there for you and we plan to strengthen this further with establishment of a hotline and members feedback forum. With the changing economic and nancial climate, life has not been easy for many of us and I am aware that many of you are facing enormous pressure at workplace and are required to do much more for much less. The morale of NHS Trust staff particularly has been rather low and it has affected more vulnerable groups including the BME staff group. BIPA is keen to address the issue of discrimination to our members, create opportunities for our members to progress in their careers and to support our members through difcult times. BIPA belongs to

2013 you and it is expected that you will spend a little bit more time in making BIPA better as an organisation with transparency and accountability. I am very keen that our members make signicant effort in improving access and quality of service for BME communities suffering from mental health problems and we will endeavour to support you in making this happen at your workplace. Our international links work in India should be based on clear objectives, strategic direction and local population needs and BIPA is willing to provide nancial support and resources for worthwhile projects abroad. Very soon you will be asked to provide submissions for projects that you think is going to improve quality of care for patients in other countries and also in improving standards of teaching and training in other countries. Please keep your eyes on the website for this purpose. Finally, I request you all to consider sharing good and innovative practices that some of you have developed and are using in your services. It is important that our organisational reputation is built on a quality focus, innovative practices and transcultural research. Embracing leadership in all these areas is essential for personal and organisational growth. I wish you all the best and look forward to meeting you at Daventry on the 8th 9th June 2013. Professor Sab Bhaumik President British Indian Psychiatric Association

CRHT service is a relatively new addition to mental health resources. This service is unique as it helps individuals stay in their natural abode who will otherwise be admitted and treated in an inpatient unit to contain the risk and resolve their crises. I started with a CRHT service in 2009 with no prior experience of it although the service was introduced to this area in 2005. I was initially amazed that the team was working to contain the risks in the community as this was never tried before. The team included members with varying degrees of experience and knowledge and hence their own anxiety level varied in trying to help individuals in the community. Some of the members would often quip We are in crisis in response to difcult situations related to these individuals. I eye-witnessed varying reactions from panicky feelings to sense of hopelessness. My initial excitement of working with the new service was turning into dismay. Our team was dealing with a full range of complex and difcult patients and many of them were presenting to us repeatedly. We found that such patients invariably resulted in frustration and sense of hopelessness among team members. Some of the team members even felt unable to help the developing crises. However members were encouraged to be honest about how they felt about crises as without this, engagement with patients would become more difcult. With support, their condence and self esteem improved which reected well on their self awareness. As a senior psychiatrist, I was leading a multidisciplinary team of a variety of professionals: Nurses, Social Workers, Psychologists, Psychosocial intervention therapist, Social and Time Recovery Worker, Support Workers, Trainee Psychiatrists Introspection about the past made us feel that most of the frustration was generated by complex need patients who were presenting to the service repeatedly which often led to less experienced members feeling useless and incompetent. These complex need patients included: Severe mental illness with frequent crisis, Personality disorders, Dual diagnosis and substance misuse, Self harm, Victims of domestic violence, Eating disorders, Young people, Culturally diverse groups. It was therefore important to look deeper into this group to get to know these individuals so that we could identify them early and reduce their repeated presentations. My brief study on the subject provided us with important information about the nature of this patient group. But this was not the end of the crisis for us

BIPA NEWSLETTER ! as it was important to act to reduce their repeated visits, otherwise challenges would continue and it would continue to generate sense of desperation and panic amongst team members. Managerially, we ran the risk of being regarded as inefcient. Our further evaluation revealed that the team was focusing more on the here & now approach. We were doing well in containing the risk. However, learning from one crisis to reduce their repeated presentations was not done effectively. Therefore it was decided to encourage patients and their carer to reect on what should be done to reduce their repeated visits to CRHT service. Many of the patients and carers would argue that they felt unsupported when they needed it most as either they did not have a designated care co-ordinator or he/she was not available, or did not have a team to contact at the beginning of their difcult situation. Some were even of the opinion that they did not know what to do and therefore difculties simply got worse and slipped into a full blown crisis thus resulting in another visit to the service. Therefore, they were unable to see the light at the end of the tunnel. There was a strong sense of realisation among patients and their carers that they should have greater involvement in the management of crises and their future progression. Teams which had responsibility for continuity of care were involved and meetings involving the teams and the service users and their carers were encouraged so that unanimous care plans could be drawn up.

2013 The service users were encouraged to contact their care coordinator or their respective community teams early in their crisis and not employ maladaptive coping strategies. After using these interventions over a period of time, the team felt that these interventions apparently went well with the patients, as we could see crisis boards, which show the number of service users with the team at any given time, appearing less congested. We have also seen crisis workers coping well and their frustration appearing less. On the other hand, managers and service planners appeared less pressured. The team as a whole received more appreciation from not just service users and their cares but also from the management. One of the service directors even commented, We are doing well. This certainly augurs well for achieving the goals of the organisation in the current environment of results orientated service planning. Overall, our effort has resulted in greater satisfaction among all concerned. We therefore feel that we should be more proactive in dealing with future crises and not just at the point of presentation. We should also have regular meetings of the

members of the team to discuss difcult emotions about not just service users but also about themselves so that selfawareness of the difculties is encouraged and then dealt with effectively to produce better results.

CASC Practice Course

Background CASC is the nal clinical examination to become eligible for the membership of The Royal College of Psychiatrists. It is designed to assess trainees clinical and communication skills in a wide range of scenarios ranging from simple to highly complex situations. The passing rate of CASC has dwindled to between 30 to 40%. The passing rate has been historically low for overseas graduates and is particularly low for candidates from South Asia. It is an expensive examination and is a signicant cause of hardship to psychiatry trainees. Apart from the nancial burden, the trainees are at risk of not being able to complete training that can have signicant repercussions on their career progression. Due to consistently low passing rates of overseas graduates, this can potentially lead to underrepresentation of consultants from an overseas background in the long term. MRCPsych is a popular membership amongst Egyptian trainees. They also have similar difculties in passing CASC as faced by candidates from a South Asian background. Moreover, they have limited awareness of British psychiatric systems making it even more difcult to pass the examination. They have to resort to attending private preparation courses, which are very expensive. BIPA has a long history of collaboration with other international organizations. In keeping with this, BIPA collaborated with the Egyptian Psychiatric Associations Early Career Psychiatrists Section to conduct an in-house CASC preparation course in Cairo. 4 Course Structure The team consisted of four examiners and 4 actors (two of these were locally recruited as volunteers). All examiners and actors participated as volunteers with only reimbursement of expenses incurred. The course was conducted over three days. The rst day consisted of a number of talks, ranging from orientation to CASC and British psychiatry to communication skills, and single station circuits to assess levels of trainees. The next two days consisted of a mixture of small group workshops to develop advanced communication skills and dealing with complex scenarios as well as several circuits of single and linked stations with individual feedback. 9 trainees attended the course. The Team Dr. Subodh Dave- Organizer and link person, Dr. Hussein El Kholy- Link Person (Egypt), Dr. Lena Palaniyappan- Logistical support and examiner, Dr. Sita Ratna- Examiner, Dr. Ashok PatelExaminer, Dr. Abhinav Rastogi- Coordinator and examiner, Ms. Liz Hughes- Actor, Mr. Ed Kennedy- Actor, Ms. Nefertiti- Actor, Ms. Aya- Actor Feedback The feedback from the attendees was overwhelmingly positive. All but one trainee rated the course from very good to excellent on all the domains of feedback including course organization, relevance, meeting learning needs etc.

BIPA NEWSLETTER ! The one trainee that rated the course differently from other marked all domains as satisfactory. None of the attendee mentioned any concern about any of the aspects of the course. All attendees remarked that they will recommend the course to their friends. Three of the attendees had attended a popular private course; during informal feedback they reported the BIPA course to be as good as or even better than the private course. Follow up emails from our Egyptian collaborators have suggested a high degree of satisfaction amongst the attendees. Future Directions BIPAs initial foray into examination preparation for overseas graduates has been successful. This course has provided BIPA with a foundation based on which BIPA can further built on and pursue its aim to extend support to overseas graduates training in Psychiatry in the United Kingdom. Similar courses can be

2013 conducted here in the UK. BIPA already has a lot of expertise between its members and has access to experienced examiners. It may be relatively inexpensive to set up the course but we may still need minimal nancial contribution from the attendees. Setting the course will need signicant preparation and pre-course workup by organizing members. Conducting such a course will consolidate BIPAs position in providing educational support to its trainee members. It will offer trainees the opportunity to have high quality training at a fraction of the cost that they would incur in going to a private course. For BIPA, this may also result in an increase in its membership enrolments by trainees. British Indian Psychiatric Association in collaboration with Egyptian Psychiatric Association, Early Career Psychiatrists Section, 1517th August 2012, Cairo, Egypt

Report On Link Work At CSM Medical University 2012-13

I have been carrying out link work at CSM Medical University, Lucknow, India (CSMMU) since 2007. The rst two workshops delivered the introduction to CBT, the third focussed on behavioural experiments in CBT and the fourth focussed on case discussions, formulation, assessing suitability and developing a local interest group at Department of Psychiatry, CSMMU. The fth focussed on empowering local faculty, developing research projects and role plays of patients being treated by trainees. The outcome of the rst two was presented in the form of posters at the annual conferences of BABCP (British Association of Behaviour and Cognitive Psychotherapy). After the three workshops, the outcome of all three was compiled into a paper presented at the Annual Conference of Indian Psychiatry Society East Zone, awarded as the best paper and presented at the 2012 Annual Conference of Indian Psychiatry Society at Cochin as a competitive entry for the Pune Psychiatry Association Silver Jubilee Award. It has been accepted for publication by the Journal of the Indian Association for Social Psychiatry. The experience of all these workshops and the results of the fourth workshop were compiled into a paper and has been published in International Psychiatrist in the August 2012 issue. An informal agreement was achieved with Department of Psychiatry, CSMMU (lead contacts Prof P K Dalal and Prof J K Trivedi) to start working on the possibility of doing research in CBT at Lucknow. Rating scales in Hindi that are available for use were identied. A research and educational project was developed and submitted to THET, UK (Tropical Health Education Trust) in November 2012 for a grant but it did not gain support unfortunately because most of the grants were awarded to projects in Africa. The sixth workshop was delivered by me over three days in December 2012 again with the support of the NTW NHS foundation Trust. This time, again the local faculty had already delivered foundation workshops to new trainees. Twenty eight participants attended the workshop including post graduate students of psychiatry and students of masters in psychiatric nursing. Many of them were attempting to deliver CBT to their patients under supervision from local faculty as well as occasional supervision from me via email and telephone. The workshop used role plays to focus on patients undergoing treatment by these trainees and faculty members. Feedback was collected from participants at the end of each day which demonstrated the learning being achieved. Unfortunately, due to poor quality of video recording of treatment sessions, we could not use the video recordings either for training or quality control. A decision was made that CSMMU will procure better quality equipment for video recording of CBT sessions so that we can use them for quality improvement and training purpose. This will allow us to use CTSR for rating of therapist/trainee. The CSMMU faculty also resolved to develop a research project grant for application within Indian funding agencies. There is a possibility that one of the post graduate trainees might take it up as his topic for an MD thesis. It was also agreed that the local faculty members will regularly take up cases for CBT themselves. In the mean time I intend to continue to support the development of CBT training at CSMMU, Lucknow, India. I have been contacted via telephone and emails for supervision of cases undergoing CBT. I shall attend again to conduct more workshops and encourage development of a good training programme and research project. Dr A K Gupta Consultant Psychiatrist (NTW NHS Foundation Trust) Associate Clinical Lecturer, Wear base unit, University of Newcastle upon Tyne, GMC Associate (medical member, Fitness to Practice Panel), Cherry Knowle Hospital, Ryhope, Sunderland SR2 0NB, UK



British Indian Psychiatric Educational Link Project

DR. SUBODH DAVE & DR. SRIDEVI SIRA MAHALINGAPPA Background Psychiatric morbidity in India is comparable to the global rates; however, mortality is 10-times higher. As per Ministry of Health in India, patients are under diagnosed, inappropriately investigated and treated leading to a signicant impact morbidity. Western countries have 14 psychiatrists/100,000 population as compared to 0.4/100,000 population in India. Primary care doctors are unable to bridge the decit, as undergraduate psychiatry training is inadequate. Systematic reviews show that training doctors (not merely psychiatrists) to recognise psychiatric illness is an evidence-based intervention to improve patient care. Decits in skills and attitudes rather than of knowledge are associated with poor recognition of psychiatric illness. Aims of the project To improve the recognition and management of psychiatric illnesses by medical undergraduates in medical colleges in India. So far we have made links with two medical colleges in India, Seth GS Medical College (GSMC) in Mumbai and Mysore Medical College, Mysore. To train faculty members in improving the quality of undergraduate medical education through better design and delivery of psychiatric curriculum. Link details: Indo-UK link projects are vital for two reasons. Psychiatrists of Indian origin are the largest group of non-UK trained psychiatrists in the country (>5000). At the same time, India struggles with a manpower shortage in psychiatry in the face of increasing psychiatric morbidity and mortality. This link project will play a key role in utilising volunteer psychiatrists from the UK to improve mental health training and service delivery in India. UK link details Undergraduate Psychiatric Teaching Unit (UPTU), Department of Psychiatry, Derbyshire Healthcare Foundation Trust (DHFT) offers 120 placements per year to medical students of University of Nottingham. DHFT has supported the link project from the outset. Mysore Medical College, Mysore, India (MMC) is well known institute in Karnataka. Currently about 150 Medical students are posted in Department of Psychiatry each year, usually in their 3rdand 4th year medical school. They have around 10-12 hours of didactic teaching. They also attend ward rounds and are allowed to present psychiatric history to the ward consultant. Dr Raveesh Head Of Department Of Psychiatry, Mysore sought link with BIPA to improve psychiatric education in MMC to make their curriculum more focussed towards experiential learning. Why now? The National Mental Health Programme and the Five Year plan in India have identied enhancing the psychiatry content of the medical curriculum at the undergraduate level and eradication of stigma towards psychiatry as key priorities. These objectives are being hindered by the lack of capacity of trained psychiatric educators. The Indian Medical Association convened a Global Health Summit in 2010 with local stakeholders in mental health (MoH, Medical Council of India and Indian Psychiatric Society) to discuss ways of improving psychiatric care in India. MCI has made it mandatory to have medical education cells but data indicates that psychiatric morbidity is being missed and that therefore education is lacking in creating an impact on patient care. BIPA was invited to offer expertise from the UK. What have we done so far? In January 2012 a four day train the trainer programme was delivered by 5 experienced UK faculty members. We covered key topics like delivering teaching more efciently using problembased learning, self-directed learning and e-learning. We also covered assessment methods including extended matching items (EMIs) and Observed Structured Clinical Examination (OSCEs). The faculty was provided with resource materials and they have also continued to receive regular and consistent on-line support from the UK faculty through the year. What are the intended benets of the link project? Short-term goals: 1. Introduction of a common curriculum with shared teaching resources across 5 medical schools in Mumbai 2. Introduction of feedback and formative assessments 3. Introduction of a locally owned curriculum identifying key curricular priorities with linked assessment methods. 4. Development of interactive teaching material for key topics in psychiatry 5. Introduction of e-MCQs and OSCEs for summative assessments 6. Increased involvement of senior clinicians in psychiatric education planning.

India link details We have established links with two medical colleges in India. GSMC and King Edward Memorial Hospital, Mumbai is a municipal hospital catering to the inner-city poor. Up to 1.8 million outpatients and 78,000 inpatients are treated at KEMH annually, vast majority of them being signicantly underprivileged, are treated totally free of cost. Despite such large numbers, referral patterns and epidemiological data indicate that psychiatric morbidity is being missed. Professor Parkar, the lead link in Mumbai, sought a link with UPTU to improve psychiatric education at GSMC.

BIPA NEWSLETTER ! Long-term goal: Improved patient care for patients at KEM Hospital and at Mysore Medical College Hospital with better psychiatric skills in medical students is the ultimate goal of the project. Dr. Ramanathan Ganapathy, Consultant Psychiatrist. Dr. Kavita Das, Consultant Old age Psychiatrist Dr. Somshekara Shivashankar , Consultant Psychiatrist Dr. Rehan Siddique, Consultant Psychiatrist


What can be done in future? The links aim is to initiate a sustainable and scalable project to improve the teaching of knowledge, skills and attitudes in medical schools across India. Currently there are more than 313 recognised medical colleges in India with about 35,000 students joining the medical colleges every year1.The State of Maharashtra where we conducted this project has a decit of psychiatrists by 40.74%2.There is also a signicant shortage of medical teachers, especially in psychiatry in most medical colleges. This project is our rst step towards developing capacity of medical teachers. This year, the programme has been extended to other medical colleges in Karnataka. A two-day interactive train the trainer programme has been organised at Mysore Medical College for the professionals with the role or interest in Medical Education in Psychiatry. This course will emphasize on experiential learning and will help them to improve skills and condence as Trainers and Educators. Projects like this will produce tangible results but we will need more volunteers with an interest and experience in medical education to make this a successful enterprise. If you are interested in becoming a volunteer with this educational link project then please contact project lead at

Acknowledgements: Prof. Shubha Parkar,; Prof. Ajita Nayak, A/Prof. Jahanvi Kedare and other staff + residents of GSMC, Prof. Reg Dennick,University of Nottingham and Derbyshire Healthcare NHS Foundation Trust Dr Raveesh, Dr Sindhura Mohan Teaching is only meaningful if it improves patient experience and outcomes References: 1.Shridhar Sharma( 2010). Postgraduate training in psychiatry in India J Psychiatry. January; 52(Suppl 1): S89S94. 2.M. Thirunavukarasu and P. Thirunavukarasu(2010). Training and National decit of psychiatrists in India A critical analysis . Indian J Psychiatry. January; 52(Suppl 1): S83S88.

Link participants: Dr. Subodh Dave, Clinical Teaching Fellow and Consultant Psychiatrist. Dr. Mary Wheatcroft, Consultant Child & Adolescent Psychiatrist and Clinical Teaching Fellow. Dr. Sridevi Sira Mahalingappa, Consultant in Liaison Psychiatry Dr. Vijender Balain , Locum Consultant Psychiatrist.

Picture from train the trainer workshop at KEM hospital January 2012

Prof Sab Bhaumik at - Leadership and Consultant InterviewTraining

An excellent workshop on Leadership and Consultant Interview Training was conducted by Prof Sab Bhaumik & Prof Dinesh Bhugra on 16 March 2013 at Leicester. This workshop was well attended and received very good feedback from the delegates. BIPA will be conducting more workshops on this topic in future ,planned for one in London in October 2013 and Cardiff in February 2014. Please watch out for the future dates at http://



Project Summary - Old Age Health

The complete life, the perfect pattern, includes old age as well as youth and maturity. The beauty of the morning and the radiance of noon are good, but it would be a very silly person who drew the curtains and turned on the light in order to shut out the tranquillity of the evening. Old age has its pleasures, which, though different, are not less than the pleasures of youth.-William Somerset Maugham

Global Population Aging The worlds population is undergoing a dramatic shift in age structure, with rapid population aging among its most notable characteristics. The worlds population aged 60 and older is currently 760 million people, representing 11% of total population.By2050, it is expected that 22% of total population, or 2.0 billion people, will be aged 60 and older. Population Aging in India With 1.21 billion inhabitants counted in its 2011 census, India is the second most populous country in the world. Currently, the 60+ population accounts for 8% of Indias national population, translating into roughly 93 million people. By 2050, its 60+ population share is projected to climb to 19%, or approximately 323 million people. Trends and Challenges Population aging has substantial capacity to diminish the productive capacities of national economies. Regardless of the effect on the economy as a whole, population aging will lead to increased need for elder care and support, at a time when, in developing societies like India, traditional family-based care is becoming less the norm than in the past. In addition, a higher share of older people will affect budget expenditures (less for education, but more for health care) and may affect tax rates. The elderly dependency ratio (the number of persons aged 60 or older per person aged 15 to 59) will rise dramatically from 0.12 to 0.31, largely as a result of fertility decline and increasing life expectancy. At the same time, Indias older population will be subject to a higher rate of non-communicable diseases (like dementia , heart disease, hypertension, diabetes, cancer, problem of joints ), a higher share of women in the workforce (and thus less able to care for the elderly), children who are less likely to live near their parents, and a lack of policies to deal these issues. In response to increasing elderly number, a joint report by United Nations Population Fund (UNFPA) and Help Age International said, "in order to realize their right to enjoy the highest attainable standard of physical and mental health, elderly persons must have access to age-friendly and affordable information and services that meet their demands,". The population trend in Assam Population of Assam is 31 million. The size of elderly population is given below. Size of elderly population (aged 60+) and their share in total population in States and Union Territories (Source: Population Census 2001 ) Number (in thousand) of persons aged 60 & above for different State/ sub-population in the state UT % of elderly India Assam Kerala 7.4 5.9 10.5 Persons 76622 1560 3336 Females 38854 760 1851 Males 37768 801 1484 Rural 57445 1361 2479 Urban 19178 199 857

Among major states the overall old-age dependency ratio varied from 8.4% in Delhi and 10% in Assam to more than 15% in Himachal Pradesh & Punjab and 16.5% in Kerala. The National Policy on Older Persons (NPOP), India was announced in January 1999 to reafrm the commitment to ensure the wellbeing of the older persons. The Policy envisaged State support to ensure nancial and food security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of their lives. I did my primary medical qualication from Assam, and visit regularly. My research suggests that the work around the issues of older people varies a great deal between states, on the one hand signicant developments have happened in the south of India and comparatively in Assam, the work has been bitty and dismal. Older peoples mental health is a neglected subject and stigma is a major issue. What did we do? Two charitable organizations,Cascade, founder and president, Prof Dipesh Bhagabati, Head of Dept, Psychiatry, Guwahati Medical College, Assam and Nevida Healthcare, founder and chair, Dr Kavita Das, Consultant Old Age Psychiatrist, UK, collaborated and held a 8



symposia, titled OLD AGE HEALTH-DEMENTIA REVISITED, on 30th March 3013 , Guwahati, Assam, with the view to increase awareness and talk of issues in relation to dementia. Both organizations, registered in Assam, India, are passionate about working on mental and physical health and well-being issues of older people. Key outcomes The main goals of the symposia were to: Offer learning opportunities about dementia to health professionals working in the eld of older people mental health. Promote the exchange of ideas and experiences in relation to dementia and develop learning projects. To bring the groups, working with older people, together to focus on problems and solutions, sharing information and networking. The talks on the subject were contributed by, Dr. Kavita Das, (DEMENTIA CARE PATHWAY and CARING FOR CARERS: What do they need?), Prof. Dipesh Bhagabati, Psychiatrist, Guwahati Medical College, Assam (Old Age Psychiatry-beyond today and Old age Psychiatry in Hospital setup), Associate Prof. Nilakshi Mahanta, Clinician, Guwahati Medical College, Assam (Old Age Psychiatric services in the Indian context) and Dr Chandana Sarma, Social Anthropologist, Guwahati University, Assam (Aging In An Urban Context). The symposia was attended by more than 150 delegates, comprising of Psychiatrists, Psychologists, Nursing staff, local NGOs working in the eld of health and social care, staff from old age homes, service users and carers. In the Panel Discussion: Ask the experts session, the audience was interactive and participated very well and provided food for thought for further anticipated work. We received good feedback. The event also received very good press and media coverage. The future. The two organizations, Nevida Healthcare and Cascade, will continue to collaborate and work in the eld of Old Age Health, in Assam. We hope to conduct further Awareness Programmes and activities for older people, care-givers and those who work with older people eg community health workers, staff in old age homes and nursing staff in hospital setting. Furthermore we would concentrate on Skill Development Programmes eg. Train the Trainer programme, for key stakeholders working in Old Age Health. We would also encourage formation of Senior Citizen Association or Support Groups. We also envisage research

The Indian Global Psychiatric Initiative (IGPI)

The IGPI is the over arching organisation of all overseas psychiatrists from India who are settled in various countries all over the world. The latest addition is the Indo Irish Psychiatric Association. The IGPI was formed after the historic Jaipur accord of 15th January 2010 of all the Indian psychiatric associations of the world. The fourth IGPI conference was held at Bangalore, at St. Marks hotel on 13th and 14th of January 2013. The highlight of this conference was the pre-congress international scientic symposium on 12th of January 2013 at the Meditation Hall of the Art of Living International Centre, Bangalore. The inaugural keynote address was delivered by H.H. Sri Sri Ravi Shankar. Distinguished speakers from Australia, Canada, India, Indonesia, Norway and US A made presentations on scientic time honoured practices derived from Eastern wisdom and cutting edge Western Science to achieve optimum results in mental health care. On the 13th after the inauguration, there was a moderated dialogue between the two spiritual leaders H.H. Sri Sri Ravi Shankar and H.E. the Most. Rev. Bernard Blasius Moras , Archbishop of Bengaluru on the topic of The place of spirituality, religion and mental health in the age of globalisation and societies in transition. This was followed by lectures by Prof.Matcheri Keshavan (USA) , Prof Shiv Gautam(India), Prof Fahri Saatcioglu (Norway), Dr Sandeep Grover and Prof SD Sharma (India), Dr Igusti Gunadi (Indonesia), Prof Ajit Avasthi and Prof BN Gangadhar (India). There was a conference dinner in the evening where Shri. Vinay Hegde, Chancellor of N I TTE University, Karnataka was the chief guest. Four IGPI members were felicitated and awarded accolades for their meritorious service. The recipients were Prof Rajeev Tandon (USA), Dr. Anand Ramakrishnan (UK), Dr. Rohan Ganguly ( Canada) and Prof E Mohandas (India). On the 14th there was a symposium on Nosology of psychiatric disorders DSM-5, I CD- 11 and the future by Prof. Rajiv Tandon and Prof. William Carpenter ,USA, Prof. Wolfgang Gaebel from Germany and Prof. Sanjeev Jain from India. The next IGPI meeting will be held at Pune on 14th and 15th of January 2014. Dr. A.Ramakrishnan Treasurer, IGPI



The ANCIPS 2013 was held in Bangalore from 1013th of January 2013. BIPA had a session on the 11th and that was well attended by more than 70 delegates. The rst topic was Psychotherapy and its relevance to practicing psychiatrists by Dr Graeme Whiteld, Consultant Medical Psychotherapist (in CBT), Leicestershire Partnership NHS Trust, UK, the second talk was on Schizophrenia by Dr Hemant Bagalkote, consultant psychiatrist, Nottinghamshire Healthcare NHS trust and 3rd topic was Management of dementia patients with BP SD, UK perspective by Dr Hari Subramaniam, Consultant Psychiatrist, Leicester and Indian perspective by Prof Shaji, from Medical College, Trichur, Kerala. Dr. Anand Ramakrishnan, Honry Secretary, BIPA. IGPI Award for leadership 2013 The Indo Global Psychiatric Initiative appreciates and honours the excellent leadership and vision of Prof. Anand Ramakrishnan, an executive of British Indian Psychiatric Association for the genesis and growth of IGPI.

BIPA Annual Conference 2012

BIPA Trainee Awards 2012

1. 2. 3. 10 Dr Sridevi Sira Mahalingappa Dr Kavita Das Dr Himanshu Tyagi



You Know I Am A Psychiatrist
( To be taken with a pinch of salt) I know nothing about the soul Or how emotions extract their toll. ( Emotions have no role in psychiatric assessment) I could well be called a drug dealer, (We are trained to prescribe mainly drugs) But I am called a soul healer. (psyche= soul, iatreia = healing) You know I am a psychiatrist I have trained for many years To talk mental sense to my peers. (To discuss in psychiatric language) I can now decide who is mentally ill, Who needs therapy and who needs the pill. You know I am a psychiatrist. I am well versed in ICD 10, That Depression occurs less in men. ( Depression occurs more in women) Have little clue of my own stress, (Psychiatrists are under stress-Dr Bhaumick) Or if I am myself in a mess. (Psychiatrists have Highest rate of suicide among doctors) You know I am a psychiatrist. I do not know if anyone can be mad, (Madnessin laymans language) But I can diagnose SAD and BAD. (SAD= Seasonal Affective Disorder) (BAD= Bipolar Affective Disorder) I do not know what anger or grief can do, (Only predisposing, perpetuating and precipitating factors). How soul can treat the mind, I have no clue. (Psychiatrist= soul healer) I am a psychiatrist you know. I believe I am the best, (Western Psychiatry is the only one we have) Because I am trained in the West. Now I learn I can be ill with Grief, ( Reference: DSM V) And only medication can give me relief. You know I am a psychiatrist. !By$Dr$Pradeep$K$Chadha,$BIPA$Member.,$26,$Lu:ellstown$Avenue,,$Castleknock,,$Dublin$15,$Ireland.

The Wait
Kavita Das

There is a beautiful story, Sans the meaning. Know not why I feel lonely, Even in a crowding. There are many words spoken, Sans the voice, Am I waiting for you in vain? Dare I make the choice. There is an intense emotion, Sans the feeling.

Life is a confused potion, Why I see the sadness owing? There are wishes I keep all day, the reality. O Time! Lend a hand to lay, I wait for you tirelessly. There is the morning sun, its sooth. O Beloved! Please take the turn, And come to your...forgotten lover.




Nilamadhab Kar

Here is how I would live After you Its a practice Preparation Rehearsal Its not that You are old and inrm No more needed, or You are living beyond Your sale by date, or You are expendable, or People can live without you Nor that you are living A borrowed life It is not for you It is for me That I plead, for you To leave your home Our home Me And live in an old age home For me Yes, it sounds horrible But, it has come to this, my dear I am not growing younger With shaking hands, Dwindling condence Muddled mind Before I realize I have become old and invalid Its for me To take a gasp of air Before I lose sight Of the shoreline Of an island That we always wished to visit In life, in our life Its for me To stretch my legs Take an afternoon nap To sleep a while more In unhurried early mornings To take my tea on the bed, With the pajamas on and Idle newspapers 12

There are carers Who can take better care of you Than me, And when my time comes When I can no more manage Tying my shoelaces or making a tea May be I will join you there too I wish you could be around me Taking care When I would have forgotten everything For dementia or for whatever But its not like that Its my opportunity, I am the one destined To look after But I am sure; you would have done the same Taken my care, in the best way possible I know, after you Our nest is empty, I am all alone Children have left long back Exploring distant skies Honing their skills ying, and Building their own niche Teaching their little ones to y Its not easy Living a life In our home, without you I am preparing for the role Getting used to now, to silences And its not easy The poem is for all the elderly as they prepare to cope sending their spouses to old-age homes and start living a life all alone. Correspondence: Nilamadhab Kar, Consultant Psychiatrist, Black Country Partnership NHS Foundation Trust, Steps to Health, Showell Circus, Low Hill, Wolverhampton, WV10 9TH, UK, Email: