An exclusive interview with Dr R.K. Chadda

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An exclusive interview with Dr R.K. Chadda

Educational Qualifications:

  • MBBS (Dec 1980) – Medical College, Rohtak
  • M.D. (May 1985) - Post Graduate Institute of Medical Education and Research, Chandigarh          
  • MAMS (1998) - National Academy of Medical Sciences (India)
  • Diplomat (2007) - International Academy of Behavioral Medicine, Counseling & Psychotherapy
  • MRC Psych (2004) -Royal College of Psychiatrists (UK)
  • FAMS (2008) - National Academy of Medical Sciences (India) 
  • FRCPsych (2013) - Royal College of Psychiatrists (UK)

Present Position:

  • Professor and Head of Department of Psychiatry
  • Chief of National Drug Dependence Treatment Centre All India Institute of Medical Sciences.

Teaching and administrative experience:

32 years’ experience after MD at various reputed hospitals in India and abroad (AIIMS, IHBAS, Sir Ganga Ram Hospital, Brandon Mental Health Unit- Leicester General Hospital (UK), College of Medical Sciences & GTB Hospital, PGIMER- Chandigarh, Lady Hardinge Medical College)

International experience:

Visiting Faculty at P. B. Koirala Institute of Health Sciences, Dharan, Nepal

Publications:

More than 225 publications to his credit including (Books/Monograph: 04, Chapters: 36, Research Papers: International: 58 and National: 101)

Achievements:

Received 14 awards for his remarkable work in the field of Psychiatry including Gen Amir Chand Oration award of the National Academy of Medical Sciences, Tilak Venkoba Rao Award of the Indian Council of Medical Research, DLN Murthy Rao Oration of the Indian Psychiatric Society and NN De Oration of the Indian Association for Social Psychiatry

Current research project:

Proteomics of CSF for the identification of protein signatures in the dopamine dictated states of schizophrenia and Parkinson's disease. Funded by Department of Science and Technology 2014

 Memberships:

  • 8 memberships in different government bodies and 9 in memberships of Scientific Societies bodies including:
  • Fellow, the Royal College of Psychiatrists of UK
  • International Distinguished Fellow, the American Psychiatric Association;
  • Honorary Fellow, World Association for Social Psychiatry
  • Fellow, National Academy of Medical Sciences of India
  • Member, Editorial Board of the BJPsych international
  • Past President, Indian Association for Social Psychiatry
  • Chair, Organising Committee, XXII Meeting of the International Society of Addiction Medicine, ISAM 2019, New Delhi
  • Chair, Organising Committee, XXII World Congress of Social Psychiatry (WASP 2016)

25 offices held in various international and national

1. What are your current responsibilities and position at The National Drug Dependence Treatment Centre?

Primarily, I have two responsibilities, being Head of The Department of Psychiatry and Chief of The National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi. My work is divided into outpatient services, inpatient, teaching, administrative and research. At the National Drug Dependence Treatment Centre, my role is more of administration. 

2. Can you please enlighten the readers by telling them about the different places you have worked at?

I had the privilege of working in many places in India and abroad. I have worked at 6 places in India and in addition in the UK for about 15 months and in Nepal as visiting professor for about 5 weeks. In India, I had the privilege of working at the PGIMER, Chandigarh, where I also received my training in psychiatry. In Delhi, besides AIIMS, I have worked at Lady Hardinge Medical College, University College of Medical Sciences, Institute of Human Behaviour & Allied Sciences (IHBAS), and also at Sir Ganga Ram Hospital (for about 3 months). Thus I got the opportunity to be familiar with clinical services at multiple settings.

3. Apart from the work you do; what are your interest areas or leisure activities you enjoy?

I am an avid fan of Bollywood movies and Hindi film’s music. I also like to listen to Jagjit Singh and to enjoy my morning walk, which I try to follow even when I am out of Delhi.

4. Mental health care, specifically psychological disorders are still a taboo for people to talk about. Any comments on this?

a) It is primarily ‘the lack of awareness’ that makes the psychological disorders or mental illnesses a taboo. Generally, mental illnesses have an early age of onset and tend to run a chronic and relapsing course, if not properly treated. Another important characteristic is that even severe mental illnesses don’t affect longevity as a severe physical illness like cardiac illness or malignancy affects. Thus, an individual with mental illness continues to be visible to society with all the disabilities and abnormalities of behaviour, which is not the case with severe physical illnesses. Very frequently, the media also portrays the person with mental illnesses as odd, eccentric, unpredictable and violent to create sensational news. Even the movies depict the person with mental illness in a stigmatising way.

b) All the above factors mentioned above leads to an impression that the person with mental illness is odd, unpredictable and to be feared upon. Some of the mental illnesses like depression and anxiety disorders are not even considered illnesses, but a part of nature or the personality profile.

c) Often, it is perceived that there are no effective treatments available, or treatment of mental illnesses is costly. But in reality, most of the mental illnesses can be treated effectively and cost of treatment for most of the illnesses is not high. Yes, there are issues of availability of psychiatrists, especially in rural and remote areas. But now most of the districts in our country have psychiatrists available.

5. Who is your real-life role model?

In my professional life, I have been influenced by Dr Vidya Sagar, who gave family psychiatry to the world and Dr Parmanand Kulhara, who was my teacher at PGIMER, Chandigarh.

6. There are very less voluntary admissions in rehabilitation and de-addiction centres. What can be the possible reasons behind this?

Forceful and involuntary treatment for drug dependence is very unlikely to succeed. It is very important to first build up the motivation in the individual with drug dependence. At NDDTC, all admissions are voluntary. Motivational enhancement therapy is an essential component of the treatment of drug dependence.

7. Cases related to Substance Abuse & Alcohol/ Drug dependence are increasing at a considerable pace in India, especially among Indian youth. What different factors are contributing to it according to you?

It is not only Indian youth but all around the world that substance use is increasingly affecting the young population.  Media, surrogate advertisements, breaking family ties, an absence of role models. Sensation seeking and peer pressure are two important reasons for the initiation of drug use in the youth.

8. Do you have any suggestion or message for the families of the patients facing a Psychological Disorder?

Mental illness is also an illness; not much different from physical illnesses like diabetes or hypertension. There are effective treatments available for all mental illnesses. The patient needs support and care from the family. Treatment often needs to be given for a long period as happens with many physical illnesses (Diabetes, hypertension, hypothyroidism, heart ailments). One should not stop treatment in between and should follow the advice of the treating doctor.

9. While working in the National Drug Dependence Treatment Centre or even in other Rehabilitation Centres and Psychiatry Wards you must have encountered several difficulties can you please tell us about those problems and how did you overcome/tackled the challenges?

Patients, as well as the families, need a lot of support. Since the mental and substance use disorders are often chronic and the patients, as well as their families, are often ignorant about their nature, both need to be educated about the nature of the illness, treatments available, need to continue treatment for the long period. The families need to be educated that the behavioural problems in the patient are a part of the illness and not deliberate. The families also need to be taught stress coping skills.

10. After completing your M.B.B.S was there any particular reason behind pursuing a career in Psychiatry?

My medical college did not have post-graduation in psychiatry but had one of the biggest departments of psychiatry in the country with a faculty of 5 teachers and 75 beds in a general hospital, established by Dr Vidya Sagar. I did not get an opportunity to be taught by him since he had passed away by the time, I reached my final professional. We had 3 weeks posting in psychiatry during MBBS, which generated interest in the subject.  I purchased two books on psychiatry in my MBBS, which was unusual for an MBBS student, since psychiatry was not a full-time subject, and most of the students would read just lecture notes. 

11. What are the obstacles faced by Mental Health Care services while reaching to everyone and creating awareness among the masses?

The biggest obstacle is the lack of awareness, and also the denial by the patient as well as the family, that their family member has a mental illness. The absence of adequate treatment facilities creates a big hurdle. The recent National Mental Health Survey of 2016 has reported a mental health gap varying from 70-90% for different mental illnesses.

12. Can you please elaborate on the idea behind the paper titled “Suicide in Indian women” which was published in the British Journal of Psychiatry (1991) and the findings of the paper?

This was not a paper but a letter to the editor responding to two papers on suicide in women in the Journal. We commented on Sati not being a suicide but a ritual being followed by women in the past especially in the state of Rajasthan following the death of their husbands.

13. You are working for more than 3 decades in the field of teaching and psychiatry. What appeals you more as a career in terms of your personal interest as well as working conditions?

I have found the discipline as very satisfying professionally when the patient improves and resumes functioning. We have effective treatments available for most of the mental illnesses. Fortunately, the treatment is not costly in our country and the cost of medications for most of the illnesses is between 5-10 rupees per day. However, a large mental health gap remains a big challenge. Even in cities like Delhi, a majority of patients with mental disorders don’t seek treatment.

14. What is the biggest challenge that you faced in your student life?

Spending long times in studies and clinical duties with very limited time for leisure remains a challenge with most of the doctors and was with me too.

15. What are several changes you have observed since you started your career in Psychiatry in 1983 till now?

There have been a number of changes in the mental health scene in India since the 1980s. The most important is the growth in manpower associated with increased availability of postgraduate training facilities. In the early 1980s, there were only about 25 postgraduate teaching departments in the country and most of them had an annual intake of one or two students per year. We were producing about100 psychiatrists per year. As on now, we have more than 200 postgraduate training centres in psychiatry with an annual intake of about 550 students per year. Similarly, there has been a marked increase in training centres in clinical psychology, psychiatric social work and psychiatric nursing. In 1987, we got the new Mental Health Act which has been replaced by the Mental Healthcare Act in 2017. There has been a marked growth in psychiatry in the private sector, which was in a preliminary state in 1983. On the treatment side, we have got a large number of medications for various mental disorders with most of the latest introductions available for use. But still, we have a large mental health gap, as I have pointed out earlier.

16. Comparing Western and Indian education; what are the major differences you have observed in terms of study environment, resources and living conditions for the students in both the continents (Asia and UK)?

Here, I would like to clarify that my training in psychiatry has been only in India, though I have worked in the UK for about 15 months in 2004-05. However, I will be able to give a comparison based on my experience in the UK. Postgraduate students in India get much wider clinical exposure as compared to the West since we have a much larger clinical load. But our students have very limited exposure to the subspecialties of psychiatry like the child and adolescent psychiatry, old age psychiatry, addiction psychiatry, consultation-liaison psychiatry. We are also lacking in training opportunities in specialised psychotherapies like cognitive behaviour therapy, interpersonal therapy and others. I would like to add that India has been a pioneer in general hospital psychiatry. It is only in India and South Asia that family members are allowed to stay with the patient in the wards.

17. There are many students who want to go abroad for pursuing higher studies in this field. Any particular suggestions for them?

As far as training in general adult psychiatry is concerned, we are no less than anywhere else in the world. However, for specialised psychological treatments and subspecialties in psychiatry, one can look to the West. But here, I would like to clarify that the health system in every country is planned as per local needs. That’s why the Western methods can’t be blindly applied to the East. Our families are a big institution of support for the patients.

18. How can Mental Health Care and Physical Health Care bodies work together to improve the overall health status in India?

Integration of mental health care in general medical care is crucial as was also stated in the objectives of the National Mental Health Programme of India in 1982. It is not necessary that all patients with mental disorders especially those with depression and anxiety disorders be seen by the psychiatrists. Most of these patients can be seen in primary care and also by the general physicians. There have been regular ongoing attempts at sensitising the primary care and non-psychiatric clinicians to the psychiatric problems in their clinical practice. I would like to add that in India, we have limited exposure to psychiatry in undergraduate medical training unlike the West. This has not been strengthened despite persistent attempts by psychiatrists and the professional organisations. Psychiatry gets just 2-3% of the training time in the full MBBS course, though any doctor’s clinical load has 15-20% of patients with psychosocial problems.

19. Any advice for the aspiring/budding psychiatrist/psychologists?

Professionally, it is a very satisfying discipline, but one needs to spend a lot of time in understanding the patient. There are no shortcuts to it. Empathy remains an important component in understanding the patient.

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