Year : 2018  |  Volume : 60  |  Issue : 6  |  Page : 224--226

A journey from custodial to community-based care: Psychiatric Centre, Jodhpur


DR Purohit1, Ankit Awasthi2, GD Koolwal1, Sanjay Gehlot1, Surender Kumar1,  
1 Department of Psychiatry, Dr. S. N. Medical College/Psychiatric Centre, Jodhpur, Rajasthan, India
2 Department of Psychiatry, Government Medical College, Pali, Rajasthan, India

Correspondence Address:
Dr. G D Koolwal
Adarsh Society, Light Industrial Area, Shastri Nagar, Jodhpur, rajasthan
India

Abstract

Since 1979, consistent and untiring efforts of Dr. D.R. Purohit, Dr. Mahaveer Chand Jain and Dr. G. D. Koolwal against the odds have brought remarkable changes in the Psychiatric centre, Jodhpur.



How to cite this article:
Purohit D R, Awasthi A, Koolwal G D, Gehlot S, Kumar S. A journey from custodial to community-based care: Psychiatric Centre, Jodhpur.Indian J Psychiatry 2018;60:224-226


How to cite this URL:
Purohit D R, Awasthi A, Koolwal G D, Gehlot S, Kumar S. A journey from custodial to community-based care: Psychiatric Centre, Jodhpur. Indian J Psychiatry [serial online] 2018 [cited 2021 May 16 ];60:224-226
Available from: https://www.indianjpsychiatry.org/text.asp?2018/60/6/224/224671


Full Text



 Introduction



Jodhpur, the “Sun-city,” a gateway to The Thar Desert, was built on Marwar soil by Rao Jodha of Rathore clan of Rajputs in 1459 A. D. The “lunatic asylum” which happens to be the first in the state of Rajasthan, was established in April 1940 in a secluded place It was situated at a distance of 8 kilometers north-east from the city of Jodhpur. It was located in an antiquated “Haveli” of a former prince and was popularly known among laity as the “Jeevan Singh Ji-ka Bagh.” There was an artificial lake behind the building, and in front, there was a vast open land. The campus was picturesque and its beauty was enhanced by a lush green garden. Dr. Brij Mohan Lal was the first Medical officer in-charge of the asylum. The first patient of the asylum was referred from the “prison” of Jodhpur. As is the usual case in the asylums; the patient's name was “unknown.” However, she was christened as “Gopi.”

 Transformation of the Lunatic Asylum



Since its inception, a medical officer used to pay a part-time visit to the “lunatic asylum” on a weekly basis. In due course of time, it turned into a daily visit. Dr. M. L. Baheti was the first qualified psychiatrist to head the Mental Hospital, Jodhpur, since February 1958. In 1964, under the adroit stewardship of Dr. Baheti and with the generous help of philanthropists and pious citizens of Jodhpur, a 25-bedded ward was added to the hospital, raising its bed strength to 85. In 1965, a premier Medical College, the “Dr. S. N. Medical College” started in Jodhpur. The lunatic asylum was also attached to it for teaching purposes and became referred to as the “Mental Hospital.” At its commencement, the medical college had two attached hospitals, Umaid Hospital, accommodating Gynaecology and Paediatric Departments and Mahatma Gandhi Hospital, housing most other departments. Psychiatric outpatient services were started to cater to the patients daily for a couple of hours at the Mahatma Gandhi hospital. Medical undergraduate students began getting training in psychiatry at the “Mental Hospital.”

Initially, the “lunatic asylum” or “mental hospital” provided only custodial services. Later on, with the advent of antipsychotic drugs in the fifties, the treatment of psychiatric patients was revolutionized. The combination of electroconvulsive therapy and pharmacotherapy vastly improved the prognosis of mental illnesses. Insulin shock therapy was also offered to some patients. There was less emphasis on psychotherapy and rehabilitation services were at a nascent stage.

In 1979, Dr. V. K. Razdan (Former Head of Psychiatry Department and Medical officer In-charge, Mental Hospital, Jodhpur) organized the first conference of the Rajasthan Psychiatric Society with diligent participation from psychiatrists from the Mental Hospital, Jodhpur. In 1983, he invited 8th Annual conference of Indian Psychiatric Society- North Zone and 4th conference of the Rajasthan Psychiatric Society, in which legendary psychiatrist from Jodhpur Dr. B. K. Vyas was felicitated. In 1991, he again invited Annual conference of Indian Psychiatric Society- North Zone and in 2001, he organised 2nd Annual Conference of Indian Association of Private Psychiatry. In all these conferences, he received whole hearted support from all psychiatrists of Psychiatric centre/ Department of Psychiatry, Dr. S. N. Medical College, Jodhpur.

 The Psychiatric Centre



In due course of time, on account of certain managerial problems, the premises of the Mental hospital was sold, and it was shifted to the newly constructed Medical College Hospital, which was designated as a New Teaching Hospital (it was later renamed the Mathura Das Mathur Hospital) on July 29, 1981. With its shifting to a new place, the mental hospital subsequently came to be called the “Psychiatric Centre, Jodhpur.” The new building was inaugurated by the then Hon'ble Health Minister of Rajasthan on July 2, 1983. The unique experience and change of the environment of the Psychiatric Centre from one of the isolation to an open general hospital setting was unprecedented. It had a tremendous effect on the number of patients attending the psychiatric outpatient department (OPD) as well as on the duration of inpatient stay. Bhargava et al.,[1] in their landmark study, compared the duration of stay of patients admitted to mental hospital, Jodhpur, with that for patients admitted to the Psychiatric Centre, Jodhpur, and found that it was shorter for the Psychiatric Centre. They also found that there was an augmentation in the number of admissions by 42% in the Psychiatric Centre. They ascribed this increase to the fact that there was a simultaneous increase in the number of the patients attending the OPD, increased acceptability on account of shifting to a general hospital setting with a comparatively uncomplicated process of admission of patients to the psychiatry ward. At the Psychiatric Centre, relatives were allowed to stay with the patients. In addition, the visit by other relatives was also more frequent. This was perhaps the most important factor contributing to the quicker discharge of patients from the Psychiatric Centre.

 Further Expansion



In 1983, Dr. D R Purohit (Associate professor and Head, Department of Psychiatry and Medical officer In-charge of the Psychiatric Centre) established newer clinics at the Psychiatric Centre:

Headache clinic Epilepsy clinic De-addiction clinic Child guidance clinic; started in 1980 at Umaid Hospital and shifted to the Psychiatric Centre.

In 1983 and 1984, Dr. D. R. Purohit was nominated by the Government of India to the WHO group advisory meetings on “Role of primary health care worker in drug and Alcohol Related Problems” held at SEARO, New Delhi, where he represented the country along with Dr. D Mohan from the All India Institute of Medical Sciences, New Delhi. In January 1985, Dr. D. R. Purohit sent a proposal to the State Government for the establishment of a 30-bedded de-addiction center, which was eventually sanctioned in March 1985. This center is credited as the first such center in the country. Dr. D. R. Purohit organized community-based camps for opium addiction, which is widely prevalent in western Rajasthan and he is known for pioneering work in the camp approach for management of opium-detoxification.[2],[3],[4],[5]

In 1985, electroencephalogram machine, behavior (aversion) therapy machine, brief pulse electroconvulsive therapy machine, and psychological tests for assessment of intelligence, memory, and personality were added to the department. In the same year, the Psychiatry department was inspected for initiating postgraduation. Although the Medical Council of India (MCI) inspector recommended the proposal with some suggestions, the MCI, however, turned down these recommendations on flimsy grounds.

In 1987, the Indian Council of Medical Research (ICMR), Delhi initiated a multi-centered Task Force Project on “Monitoring of Drug Abuse in the Community” which had three components:

Monitoring of drug abuse in the community Area sample survey Treatment evaluation.

The ICMR project was simultaneously conducted at AIIMS, Delhi; SGPGI, Lucknow and Dr. S. N. Medical College, Jodhpur.

 Golden Jubilee



In 1990, the golden jubilee of Mental hospital was celebrated through organizing two training workshops in drug de-addiction and the National Mental Health programme for paramedics. The proceedings of these workshops were subsequently published by Dr. Purohit in the form of a booklet. A training program was conducted for medical officers in 1994, for which funding was provided by UNDCP through the Ministry of Health and Family Welfare. In the same year, a separate de-addiction ward was constructed with financial aid from the Ministry of Health and Family Welfare, Government of India.

 Postgraduate Training



In 2006, the Psychiatric Centre made great strides under the dynamic leadership of Dr. Mahaveer Chand Jain (then Head of Department and medical officer in-charge, Psychiatric Centre, Jodhpur). The postgraduate course in psychiatry eventually started with an intake of one student per year. The Psychiatric Centre remained active by incessant participation in community services throughout these years. Dr. G. D. Koolwal (current Head of Psychiatry department and Medical officer In-charge, Psychiatric Centre, is rendering consistent camp services free of cost at a nearby town named Balotra. He had been awarded for his excellent services by various authorities, including District administrations of Jodhpur and Barmer. Similarly Dr. Sanjay Gehlot (Professor of Psychiatry) had also been awarded by District administration, Nagour for providing camp services at Nagour. In 2011, the Department of Psychiatry organized the 7th annual national conference of Biological Psychiatry which was a true academic feast for all delegates who attended it.

 Future Endeavor



A proposal for an institution of neuropsychiatric research and rehabilitation centre in Jodhpur has been sent to Government of India to further excel the psychiatric services toward the needy population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 COMMENTARY



Set up in the twilight years of the Raj, the history of psychiatric services in the northern state of Rajasthan is an interesting one. An institutional history provides a narrative of the important milestones, events, and people who have contributed to where the institution is today. Such histories do not have related just successes, but disappointments, as well as even failures, at times. Every transformation of a health institution in general and mental health institutions in particular, follows this general thread. The story of mental health institutions, as in the case of other "stigmatising conditions" like leprosy and tuberculosis, is invariably nested in the social constructs of the malady and its consequences, myths, and shared beliefs, as well as larger political vagaries which determine funding and programme development. Such institutional histories are important, not just for the institution in particular, but to tell the story of health care in the country and region.

References

1Bhargava SC, Bohra SP, Purohit DR. General hospital psychiatric clinic versus mental hospital setting: A study of socio-demographic variables in a novel experience. Indian J Psychiatry, 1981;23:330-2.
2Purohit DR, Vyas BR. Opium addiction treatment camp: A follow-up study. J Clin Psychiatry 1982;6:55.
3Purohit DR, Vyas BR, Limba PR. Opium deaddiction camp II. J Clin Psychiatry, 1982;6: 98.
4Purohit DR, Razdan VK. Evaluation and appraisal of community camp approach to opium detoxification in North India. Indian J Soc Psychiatry 1988;4:15–21.
5Purohit DR. Progress of psychiatry in Jodhpur and some of my experiences. In Souvenir: 2nd Annual conference of Indian Association of Private Psychiatry; 2001.