The number of psychiatrists being trained has increased over time. While about a decade ago, only about 450 psychiatry seats were available per year, presently it is about 1500. Based on that, there are about 0.7-0.9 psychiatrists per 100,000 population. We must acknowledge that a significant number also leave the country for better prospects abroad. Thus, the ratio is way below the recommended median of 3/100,000. We have about 6000 PG seats in general medicine per year. So certainly, there is scope to increase the number of seats in psychiatry to match these numbers. Less than 50 per cent of the medical colleges presently offer post-graduation in psychiatry. Thus, while there is scope to increase post-graduates, it is critical that we maintain the quality of teaching and ensure employability of those who are trained. There are doctors, for example, who are specialised in child psychiatry, geriatric psychiatry and addiction, and it is important to use their skills effectively not just for services, but for training of doctors and other health care providers in these areas as well. This means creating job opportunities in different settings, so that their skills are appropriately utilised.
At NIMHANS, we have demonstrated that a multi-disciplinary approach is particularly important for the treatment of mental disorders, especially for those that tend to be chronic and relapsing and those that require psychosocial support. This means that in addition to psychiatrists, we also need more clinical psychologists, psychiatric social workers and psychiatrically trained nurses. The ratio of such professionals is much lower than even psychiatrists. While we endeavour to increase the specialist mental health providers, we need to focus on integrating training in mental health along with physical health in the undergraduate curriculum, so that all doctors and health care providers can offer basic mental health care, just as they provide physical care. Many task-sharing models have shown promise, but the challenge is in the scaling up, so that care is available to all, and services can be properly networked and tasks truly shared. This would include all credible care resources including government care, private care, and the NGO space. The focus needs to be on providing basic mental health care as well as specialised care.