Treatment should involve the alliance of patient, family and clinician
Going to therapy is already a difficult decision in a society where mental health is so stigmatised. And with the number of quacks that have crept into the profession, it becomes even more confusing to know if you’re getting the right treatment.
How do you identify whether the person you’re going to is qualified or not to treat you?
Zahra Ali, a clinical psychologist, explained what you need to look out for.
“If you’re seeing a psychiatrist they will have an MBBS degree, followed by a residency in psychiatry and now they’re a consultant psychiatrist. If you’re going to a psychologist make sure that they at least have an MPhil in clinical psychology,” Ali told participants during a workshop at The Recovery House on Saturday.
These qualifications are important because they show that the therapist has relevant clinical experience dealing with patients as compared to someone who has only studied the discipline, she said.
However, even if you’re going to someone with the necessary qualifications, it doesn’t always mean you’ll be getting the treatment you need. Sometimes patients see the same doctor for years without an improvement in their condition. Can you then question your doctor?
“Patients have rights just like consumers do. If you’re going to a doctor and don’t find any change, you should question it. Ask them their long-term plan and if you’re not satisfied ask them to refer you to someone else,” said Dr Nazila Khalid, a consultant psychiatrist and certified psychiatric rehabilitation practitioner.
But a lot of people in our society don’t question their doctors because in their opinion they’re at the top of the hierarchy, she said.
Treatment isn’t just management of acute symptoms, the speakers said. It should involve making the person a productive member of society—what is known as rehabilitation. This can only be achieved when there is an alliance of medical professionals and caregivers.
The three tenets of that alliance are the patient, the family and the clinician, which can be the psychiatrist, psychologist, or rehab practitioner, Dr Khalid elaborated.
And with that alliance, comes the role of the broader community.
“In an educated society, the family, teachers, general physicians, madrassa teachers, the whole community needs to work together and identify changes in a person,” said Ali.
In other countries, it is usually the general physician who refers a patient to a psychiatrist or psychologist. But for that the GP needs to have training in psychiatry, too.
This isn’t the case in Pakistan, the psychologist added, lamenting how even in MBBS programmes psychiatry isn’t included in professional examinations. Medical graduates don’t choose a residency in psychiatry, she said, because to them the field is reserved for those who don’t score high in their professional exams.
Thus, we end up with GPs untrained in psychiatry, further complicating the treatment of mental illness. Added to this is the lack of integration in mental health services themselves, Dr Nazila stated.
“Here medical practitioners have the habit of working in silos. They don’t believe in sharing. Patients should be informed of their rights.
“They should ask their psychiatrist or psychologist to refer them to someone who they are in communication with,” she said, emphasising how crucial it was for each clinician to update all other practitioners involved on the progress of treatment.