Indian Express
17 February 2011
By Pritha Chatterjee
New Delhi, India

Quality Concern Guidelines set by qci Meant for General Hospitals; Need to be Adapted for Mental Healthcare Units, Say Doctors
FOR the first time in the country, quality control guidelines for mental health institutions across the country are being compiled by the Institute of Human Behaviour and Allied Sciences (IHBAS), under the aegis of the Quality Council of India (QCI).

Being the first hospital to seek the prestigious QCI accreditation under the National Accreditation Board of Hospitals (NABH), the hospital is identifying quality as surance factors that are unique to a specialised mental health facility.

Dr Nimesh Desai, Director of the autonomous institute under the Delhi government, said: "The current QCI guidelines are meant for general hospitals. Since we are the first such hospital to apply for their stamp, we are involved in developing a framework for specific quality requirements of mental health patients."

FIRST IN LINE The hospital has been working for the last three months to finalise these guidelines, and hopes to complete its own accreditation process by this year. QCI Secretary Dr Girdhar Gyani said, "IHBAS is doing an excellent job, and may obtain the certification much before other hospitals that applied long ago."

The latest among a host of new facilities introduced at the IHBAS is a six–bedded mother–andchild care ward, the first such at a mental health institution in the country. Dr Rupali Shivalkar, Associate Professor of Psychiatry at the hospital, said: "About 25–30 per cent women suffer from a condition known as post–partum depression, which is chronic depression post–delivery, during which they feel a sense of aversion towards the infant. The treatment protocol for such problems usually involves separation of the mother and the child. At IHBAS, we are now trying to treat these conditions by keeping the mother with the infant in our new ward."

Special paediatric beds have been procured for the ward, and two attendants have been put on duty for every mother–child pair. The unit has also been equipped to handle deliveries for pregnant patients as well. Till now, as many such mothers were sent to the hospital by court orders for medical care, the newborns were sent to NGOs or orphanages for the duration of the treatment. TWEAKING OF GUIDELINES This is one of the many aspects the institute is including in its guidelines, which is being compiled by a team of six nodal officers, comprising faculty members from different disciplines.

Dr Shivalkar said: "NABH guidelines gives a patient the right to refuse treatment and sign the consent forms for treatment modalities. In cases of mental health patients, hospitalisation and treatment are often involuntary as they are not in the state to make the right decision." Existing guidelines also state that patients and their immediate relatives have the right to access treatment records. "Often what patients reveal in the course of treatment is confidential, and it would be a breach of trust to reveal such details to the family," said Dr Shivalkar.

Other important points of difference lie in critical and emer gency care at psychiatric hospitals.
"While ICUs at general hospitals strictly require infection control and equipment for monitoring a patient's vitals, we do not have any ventilators in our ICUs," she added. Meant for suicidal and homicidal patients, the ICU's focus is on providing intensive personal care to stabilise patients.

Security guidelines also need to be more strict in psychiatric hospitals. "Symptomatic patients need to be kept away from sharp objects and electric wires lest they harm themselves," Dr Shivalkar said.