Organization of Services

Although India has well-established adult psychiatric services for individuals with major psychiatric illnesses, some disparity exists in terms of the availability and delivery of services in rural versus urban areas. Pediatric psychiatry, however, is still a developing specialty in India. Very few established programs are dedicated exclusively to the psychiatric treatment of children and adolescents or their families. India has no private hospitals dedicated exclusively to the provision of inpatient care for children and adolescents with psychiatric issues and no medical-psychiatric units. However, a few university hospitals have established departments of child and adolescent psychiatry that provide both inpatient and outpatient services as well as traditional inpatient-based consultation-liaison services. These hospitals play an important role in resident education. Because specialized accredited training programs in child and adolescent psychiatry do not exist, the major teaching hospitals provide electives in child and adolescent psychiatry for adult psychiatry residents.

In general, pediatricians, general practitioners, and adult psychiatrists are the primary care providers for children and adolescents with psychiatric issues. However, referrals of children and adolescents for psychiatric treatment tend to be limited as a result of stigma attached to psychiatric illness and poor training at the graduate level of education. Families are more inclined to seek help for a child's academic difficulties and are more willing to pursue treatment options, including medication use, in the context of academic progress. In recent years, especially in metropolitan cities like Bangalore, practitioners have been receiving increasing referrals regarding learning disabilities, attention-deficit/hyperactivity disorder, and developmental disorders such as autism. Nonetheless, behavioral issues and psychosomatic illnesses are quite common presentations in the urban areas and are well documented in the Indian literature. Psychosomatic presentations commonly encountered in children and adolescents include psue-doseizures, headaches, stomachaches, difficulty in breathing, and limb pain. Alternative traditional modes of treatment, such as yoga, meditation, homeopathy, and Ayurveda (an ancient form of medical practice, primarily using herbs and extracts of various medicinal plants), are often pursued.

In rural areas, pediatric services are provided by medical officers, traditional healers, and medical trainees in the primary health centers, as well as by outreach programs run by either governmental or nongovernmental organizations. Psychosomatic presentations in rural settings can take the form of illness related to religious customs (such as being possessed by demons or a god) and are most often treated with traditional forms of therapy, as earlier mentioned, based on beliefs in the community. Patients in urban and metropolitan areas have greater access to psychiatric services, in particular in the outpatient setting. Significant growth has occurred in office-based practices in the past decade. Rates of psychiatric hospitalization and medication use in children and adolescents are low compared with those in Western countries.

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