A Focus Group Study of Indian Psychiatrists' Views on Electroconvulsive Therapy under India's Mental Healthcare Act 2017: 'The Ground Reality is Different'

Richard M Duffy; Gautam Gulati; Vasudeo Paralikar; Niket Kasar; Nishant Goyal; Avinash Desousa; Brendan D Kelly

doi:10.4103/IJPSYM.IJPSYM_247_19

A Focus Group Study of Indian Psychiatrists' Views on Electroconvulsive Therapy under India's Mental Healthcare Act 2017: 'The Ground Reality is Different'

Indian J Psychol Med. 2019 Nov 11;41(6):507-515. doi: 10.4103/IJPSYM.IJPSYM_247_19. eCollection 2019 Nov-Dec.

Authors

Richard M Duffy¹, Gautam Gulati², Vasudeo Paralikar³, Niket Kasar³, Nishant Goyal⁴, Avinash Desousa⁵, Brendan D Kelly¹

Affiliations

¹ Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland.
² Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland.
³ Department of Psychiatry, KEM Hospital Research Centre, Pune, India.
⁴ Department of Psychiatry, Academic Section, Central Institute of Psychiatry, Ranchi, Jharkhand, India.
⁵ Department of Psychiatry, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, India.

Abstract

Background: India's Mental Healthcare Act, 2017 (MHCA) greatly restricts the use of electroconvulsive therapy (ECT) in minors and bans unmodified ECT. Indian psychiatrists have raised concerns that these measures may deprive certain patients of life-saving treatment. This study describes the perspectives of Indian psychiatrists on how ECT is dealt with in the legislation.

Methods: We conducted nine focus groups in three Indian states. We explored the positive and negative implications of the MHCA and discussed its implementation, especially in relation to ECT.

Results: Many of the themes and concerns commonly discussed in relation to ECT in other jurisdictions are readily apparent among Indian psychiatrists, although perspectives on specific issues remain heterogeneous. The one area of near-universal agreement is Indian psychiatrists' affirmation of the effectiveness of ECT. We identified three main areas of current concern: the MHCA's ban on unmodified ECT, ECT in minors, and ECT in the acute phase. Two broad additional themes also emerged: resource limitations and the impact of nonmedical models of mental health. We identified a need for greater education about the MHCA among all stakeholders.

Conclusion: Core concerns about ECT in India's new legislation relate, in part, to medical decisions apparently being taken out of the hands of psychiatrists and change being driven by theoretical perspectives that do not reflect "ground realities." Although the MHCA offers significant opportunities, failure to resource its ambitious changes will greatly limit the use of ECT in India.

Keywords: Electroconvulsive therapy; India; a) Indian psychiatrists have grave concerns about legislative restrictions on ECT and mental health resource limitations. b) There is a need for greater education about the Mental Healthcare Act, 2017 among all stakeholders, not least because failure to resource its ambitious changes will greatly limit ECT in India.; human rights; jurisprudence; mental health legislation.