Kerala Journal of Psychiatry 28(1) January – June 2015 www.kjponline.com ISSN: 2395-1486 1 Letter to Editor COMMENT ON: “MENTAL HEALTH CARE: CAN WE CREATE A NEW KERALA MODEL?” Harish M Tharayil Professor of Psychiatry, Government medical College, Kozhikode. Correspondence: 11/1339, Blessing, Iringadan Palli Road, Kovoor PO, Calicut - 673 008. Email: drharishmt@gmail.com Dear Sir, I read the article titled “Mental Health Care in Kerala: Can we Create a new Kerala Model?” in KJP 28 (1) 2015 with interest. The author has to be commended for his effort and interest in improving the mental health of the people of Kerala, especially the poor and vulnerable sections. My comments on this are given below: PRINCIPLE 1 Kerala has a significant proportion of middle class who are concerned about quality of care and the time taken to access them. They are willing to pay for better services or for services available closer to their homes. The consultation fees charged by most private psychiatrists in Kerala (except those in huge corporate hospitals, which are a few and in bigger cities only) ranges from Rs 150 to Rs 300 per visit. This is affordable to majority of the working class of Kerala who earn around Rs 600 to 800 per day as wages. The actual burden is the cost of medications. Psychotropic medications are not procured adequately by government hospitals, either at state level or locally, for various reasons. Except for DMHP, the availability of drugs is poor in government sector. Insurance generally pays only for inpatient expenses and not for purchase of drugs by outpatients. The government scheme called Rashtriya Swasthya Bima Yojna (RSBY) does not even reimburse the expenses incurred for psychiatric treatment as inpatient, despite orders from the Honorable High Court of Kerala. PRINCIPLE 2 There are no standard treatment guidelines or protocols for treating even physical illnesses or emergencies in Kerala. Very few specialized psychiatric services are available at present in the state. What is generally available is service of a general psychiatrist without any backing of specialist training, qualifications or supporting staff. There are few special clinics on child mental health, suicide prevention and substance use in government medical colleges. But even these are not offering full range of needed psychosocial services due to lack of manpower and time. PRINCIPLE 3 The services available in the Government Mental Health Centers (GMHCs) will have to be brought in line with recommendations on human rights. Appointment of additional staff will be the most needed step for this. PRINCIPLE 4 There is a rapid increase in the number of psychiatrists in Kerala as the number of Please cite this article as: Tharayil HM. Comment on: “Mental health care: can we create a new Kerala model?” (Letter) Kerala Journal of Psychiatry 2015;28(1). Available at http://kjponline.com/index.php/kjp/article/view/20/html