August 24th: CMC Psychiatric Department

The walkway to CMC's Psychiatric Department

Today we went to the psychiatric department of CMC Hospital where there the focus is on family-centered care. Alison is a BSN/MSN Psychiatric Mental Health Nurse student and this was one of the main reasons she wanted to participate in this program. The department is actually completely physically separate from the main hospital and on the same quiet, relaxing campus as our dorm. Family centered care in this case means that a patient needs to have one (preferably two) relatives stay with him/her while at the hospital. The family helps support the patient during his stay and when he is rehabilitated back into the community. At CMC, the family helps deliver the care, learns about medication, and even helps inform the staff/physicians about the patient's personal symptoms and level of functioning. For example, if a person were to come to the hospital and was not performing at optimum functioning, but improved and the physicians were discussing discharge, then, the family would give their input and say that it is not the optimum functioning and the person needed continued support.

The Psychiatric Department is located in a picturesque area

On admission, the patient (and family) are informed and commit to generally a minimum of a four week stay at the hospital. Still, no wards in the hospital are locked, the patients discuss being discharged when they feel ready (and physicians and family discuss the possibility of
continued support if necessary) and if the patient feels it is necessary, he may leave the hospital grounds, and the hospital will call the home to check that the patient got home safely.




Apparently, this hospital is one of the only ones in India that follows the family centered model. The family even stays overnight with the patient, and helps with everyday activities. In the morning, there is occupational therapy as well as group therapy and all patients are encouraged to participate. Mid-day is relaxed, and the patients are encouraged to participate in afternoon activities.

This morning, we observed daily rounds in which the medical doctors, nurses and occupational therapists make rounds on the patients. Medical residents also participate and we listened to a very thorough and comprehensive case study of one patient who was diagnosed with bipolar disorder. The  hospital is very interdisciplinary. We were pleased that we knew answers to some of the questions that the lead physician posed to the group.

Unlike the main CMC hospital (where physical ailments are addressed), insurance does not cover mental health. So, people pay out of pocket, even the patient of the lower socioeconomic classes will pay some amount. The nurse said that it is good that the patients pay, even if it is a small fraction, so that patients understand the severity and importance of the care and she corsrelated payment with good
compliance.

Earings made by
patients at the rehababilitative center

In the afternoon, we went to the rehabilitative services, where people do not stay overnight at the hospital and instead participate in day care activities (like making earrings, candles, and paper bags out of newspapers that are then used in the college store) and then sell their products. The clients create relationships and take anger management classes and learn to identify stressors.

Coconut bowls made at the rehab center

There are four phases and by the end of the fourth phase, the client is encouraged to reenter society and hold a job. The therapists work with merchants (like grocery store owners) to help the clients get jobs, and follow
up with the clients. There is even a half way house for the clients to live in while their life is stabilizing. One downside is that a lot of the clients have chronic mental illnesses, and many of the families desert them and discontinue support, so it takes long time to create a relationship and support the client to reach the fourth phase. The program even addresses stigma of mental illness and how to approach the stigma in society in an adaptive manner.

Nurses station at the Acute Care Unit
where patients are monitored for 48hrs

As we may have mentioned before, the nursing faculty have to teach theory courses as well as clinical courses and manage their hospital jobs. Many also conduct research and are pursuing their own advanced degrees. It seems very time consuming and difficult. As students do not stay long at their clinical sites, and psychology is often not a favorite of students, it seems difficult to integrate students, and meet the patients' needs at the psychiatric hospital. Still, it seems like there is one student for a patient (we learned about some government hospitals where there are 10 students per patient) and not every patient has a student. The role for nurses at this hospital seems to be overseeing things and administering medication, not as much counseling as there is in (ideal settings) in the US.

Dinner at Dean Rosaline's House

That night we were graciously invited to Dean Rosaline's house for dinner. She, with the help of her husband, made a delicious meal of gobi (cauliflower), two types of chicken (one dry and one with gravy), chappathi, vegetable rice and the most refreshing ginger lime juice. For dessert we had fresh mangos, bananas and apples. Everything was very delicious! After eating we all gathered together to take pictures. It was a very pleasant evening.