Psychotherapy belongs to whom?

Sir,

Medical Council of India (MCI) guideline for the MD psychiatry curriculum recommends training in domains such as personality, memory, learning theories, neuropsychology, psychodiagnostics, psychodynamics, and psychotherapy.[1] Moreover, every psychiatry trainee undergoes extensive training to evaluate and manage all kinds of mental disorders. Further, supervised psychotherapy tutorials with postings in clinical psychology (CP) add to the competence of a psychiatry trainee. MCI guidelines also mention that the psychiatry trainee must independently provide psychotherapy at the end of the course.[1]

Psychiatrists have been delivering mental health intervention, including psychotherapies, either in-person or through teleconsultations. However, the relevance of teleconsultation has increased in the context of the recent COVID-19 pandemic. In this regard, on April 14, 2020, the Department of CP, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, released new tele-psychotherapy guidelines.[2] It was a welcome move considering the potential benefit to many patients in the context of a pandemic. However, profoundly concerning issue in the above-cited guideline was the answer to the question “who can offer these services?” The answer was, “…who are recognized to practice as clinical psychologists in India, according to the RCI.”

Although the guideline mentions its applicability to CP only, the intervention in question does not belong solely to CP. Further, there is a severe shortage of psychologists, who consist of a mere 0.07/1 lakh population in our country.[3]

It is of immense concern for another reason because NIMHANS is the leading mental health institution in the country. Health professionals, public health experts, and policymakers across the country look forward to NIMHANS for guidance, especially during stressful circumstances such as a pandemic. Therefore, such guidelines will be used by many across the country, albeit, with every possibility of being misinterpreted.

In the future, this can potentially lead to a similar situation where psychiatrists were excluded from the specific learning disability certification panel. Further, it is possible that, through a policy or notifications or amendments in the Mental Health Care Act, a psychiatrist's role may be restricted to a narrow spectrum of interventions in the field of mental health.

The exclusion of psychiatrists from offering tele-psychotherapy services raises a few concerns in our minds, namely, Is it that the relative severe shortage of clinical psychologists being ignored, especially in the context of the potential rise of pandemic related mental health issues? Are clinical psychologists assuming that psychiatrists cannot offer psychotherapy? Are we fostering the notion among other medical health professionals and the public that psychiatrist just prescribes psychotropic drugs? Does it make nonmedical mental health professionals view that psychiatrists lack the training in psychosocial interventions?

CONCLUSION

Psychiatrists have made significant contributions to the field of psychotherapy and are qualified to practice psychotherapy. Eligibility to practice psychotherapy or tele-psychotherapy interventions must be based on techniques, skills, and training. Recognizing all mental health professionals' expertise and making it accessible is the need of the hour, especially in difficult times such as a pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.