Number of psychiatrists in India: Baby steps forward, but a long way to go

Sir,

The recently conducted National Mental Health Survey (NMHS) of India pegs the prevalence of mental disorders at 10.6 weighted percent.[1] To deal with this high burden, there is a need for a proportionate number of Psychiatrists.

For proper planning of services, there is a need to have accurate data regarding the number of psychiatrists. As per the National Survey of Mental Health Resources carried out by the Directorate General of Health Services, between May and July 2002, against the required 11,500 psychiatrists in the country, only 3800 existed.[2] The World Mental Health Atlas 2014 mentions the number of psychiatrists as 0.30 per 100,000 population.[3]

In this background, we decided to try and collate the current number through the following sources: The membership directory of the Indian Psychiatric Society (IPS), the report (on mental health) of the technical committee of the National Human Rights Commission (NHRC), and the recently concluded National Mental Health Survey.[1] We also calculated the number of Postgraduate seats from the Medical Council of India (MCI) website. While not completely reliable, data from personal sources and records from pharmaceutical companies were also used to help with the estimation.

The current number based on these sources are as follows: membership directory of the IPS shows about 8600 registered members;[4] however, this figure includes many expatriates, who are not providing services in India currently. The NHRC report puts the number of psychiatrists at 2052 (as per the affidavits submitted by the states and union territories to the supreme court of India).[5] The report also calculated the number of psychiatrists using the data on training seats of psychiatry and put the number of psychiatrists in 2015 to about 6220. Data from a Pharmaceutical company source (collected from registration and attendance at the recent CMEs and conferences) put the number of psychiatrists at approximately 4500. Finally, data from the recently concluded NMHS addresses this issue in the following manner: “The availability of psychiatrists in the NMHS states varied from 0.05 per lakh population in Madhya Pradesh to 1.2 per 100,000 population in Kerala. Data available for some of the high-income countries indicate this number to be between 1 and 2 per 100,000 populations. Except for Kerala, all the other states fell short of this requirement.”[1]

As is clear from the above sources, the number of psychiatrists in India currently is about 9000 and counting. Added to this, about 700 psychiatrists graduate every year. Going by this figure, India has 0.75 Psychiatrists per 100,000 populations, while the desirable number is anything above 3 Psychiatrists per 100,000. This is a very conservative estimate going by the figures of 6 Psychiatrists per 100,000 population in the high-income countries.[3] Taking three Psychiatrists (per 100,000 population) as the desirable number, 36,000 is the number of psychiatrists required to reach that goal. India is currently short of 27,000 doctors based on the current population of country.

There is no reliable source of getting the exact number of doctors in any specialty in India, not just psychiatrists, as the Medical Council of India does not have this information on their websites.

The 3800 number is often quoted but we had reasons to believe that the data were not exact and that there were many more psychiatrists.

Even if we keep the population growth rates and attrition rates of Psychiatrists at 0%, we require 2700 new psychiatrists annually to fill in the gap in the next 10 years. However, every year only 700 psychiatrists are trained in PG seats.

From the public health point of view, this leads to a couple of searching issues: (a) absence of a reliable and unified system of monitoring of numbers of psychiatrists (b) addressing the shortage of psychiatrists (c) related to the above, addressing the huge variability of their availability.

Regarding shortage of psychiatrists and addressing the variability of their availability – while there is no doubt that the situation and the number of psychiatrists is improving, it needs to be acknowledged that this is not happening uniformly throughout the country. A 2010 article on the issue identifies surplus in only four states, with Chandigarh having 244% while all other states had a deficit, only two with <50% and nine states having a deficit of more than 90%.[6] This is also indicated in the NHRC report which identifies certain states with increase of up to 600% in psychiatric facilities as compared to 2002, while others have shown stagnation or even decline.[5]

Increasing the number of PG seats is one way forward. Achieving such numbers anytime soon is not only impossible but improbable too (going by the total number of other specialty PG seats and the popularity of psychiatry among medical students). In this connection, the recent initiative of NIMHANS to reserve certain number of MD seats to those states with grossly deficient human resources in psychiatry (Northeastern states, Uttarakhand and Chhattisgarh) is noteworthy.[7] Similarly, the Union Ministry for Health and Family Welfare has initiated a survey to take account of the mental health human resources available in the country.

Maintaining and updating details of practicing psychiatrists – a unified and fool proof method of regularly updating the number of psychiatrists needs to come in place. This can be easily done by the MCI, which is the nodal agency for registering medical degrees.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.