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THREAD on patient confidentiality bcoz I am asked questions repeatedly. Read this & please stop tagging me on your tweets. My mentions can't cope! These are my opinions so please feel free to ignore!
1. Does confidentiality apply to counsellors/psychologists?
Ans: Yes ...1/n
2. Does confidentiality apply after death?
Ans: I am not aware of any precedent in Indian case law, but see box below. MPS is a malpractice insurance provider to Drs. Last point in Box suggests it does apply after death too. See this link for details ..2/n
medicalprotection.org/southafrica/ad…
3. What about "public interest" in the box above? That can be grounds for breaking confidentiality?
Ans: Yes. Even the Mental Healthcare Act makes this an exception to break confidentiality. However what is public interest is open to interpretation...3/n
4. What about the clause of protecting others from harm?
Ans: Yes, law allows breaking confidentiality to protect others from harm. However in the past, this has always meant protecting a 3rd party from harm by the patient concerned. In SSR case, the patient is dead...4/n
& we are talking abt harm to a person from public due to a lynch mob whipped up by mainstream & social media, Bollywood & politicians. Unsure if it is sufficient grounds to break confidentiality. This is a law enforcement issue & lady in Q needs protection from the public...5/n
Not sure if that is sufficient grounds for breaking confidentiality.
5. Can legal action be taken against the counsellor under India's Mental Healthcare Act?
Ans: Not sure. Counsellor seems to be a foreign national with foreign qualifications & not sure if she is registered..6/n
here in India.
6.Did she have licence to practice in India?
Ans: Highlights how poorly we regulate counsellors psychologists etc. Anyone can set up shop calling themselves counsellor/therapist/coach with no regulation/licensing.
END. Will add to this thread if more Q's come up
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Dr Soumitra Pathare
@netshrink
THREAD on Medical Students #suicides
There are 78333 medical seats across India. Considering a 6 yr course & accounting for recent seat increases, there are ~450,000 students in medical schools at any given time. Dandona et al using GBD data estimated suicide rate...1/n
for Indian 20-24 & 25-29 yr olds btwn 27-33 per 100k. For ease of calculation let's take a middle rate of 30/100k. Most medical students in this age group. Assuming med students suicide rate is same as general population, India has ~ 135 medical students dying by suicide/yr..2/n
Remember India has 78,333 medical seats in 549 med schools which is an average of 142 seats/med school. So each year, we lose approximately 1 medical school's yearly intake to #Suicides
The human cost & suffering is unmeasurable. The financial cost we can estimate..3/n
Read 6 tweets
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Dr Soumitra Pathare
@netshrink
THREAD: Troubled by many media reports & SM conversations where depression + mental health issues are assumed to be only causes of #suicide
Of course, we need conversations on #Mentalhealth & depression is associated with suicide. Why am I then bothered by this? Read on..1/n
In the West, studies show that ~ 80% of suicides have depression as a predisposing cause. Also in West, suicides peak is mostly older ppl (>60 yrs) + male:ratio is ~ 4: 1.
However India's suicide epidemology is different. In India, only ~50% have some mental illness...2/n
Also our peak suicides are in age group of 18-39 yrs + male:female ratio is ~ 1.5:1. So a lot of young Indian women dying of suicides.1 out of 3 women dying of suicide 🌍 are Indian. For women in this age group, suicides is No 1 cause of death, ahead of maternal mortality..3/n
Read 11 tweets
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Dr Soumitra Pathare
@netshrink
THREAD: Confusion amongst MH professionals abt IPC 309 (attempt to suicide) & IPC 306 (Abetment of suicide). Ppl wonder how a person can be charged with abetment, if attempted suicide is not a crime, because "Mental Healthcare Act has decriminalised suicide"
Wrong!! Read on...1/n
MHCA 2017 has not 'decriminalised suicide attempt'. What it has done is create a PRESUMPTION that attempted suicide is due to stress. IPC 309 continues to remain active, but to use it, the onus is on Police to prove, a person attempting suicide did NOT have stress and...2/n
did it for other reasons. For example, going on a fast to death for political reasons, the Police could charge a person under 309, if they can prove so.
IPC 306 says "Abetment of suicide" and NOT 'Abetment of crime'. So even if 309 was removed as a crime, 306 could...3/n
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