THREAD: for academics & researchers wanting to influence policy makers. Mostly India specific advice. Based on my reading & experience of doing this stuff for > decade now.
At the end, I have also given a link to a very useful Nature paper on this subject
So let's begin..1/n
Rule 1: Policy makers are smart people, smarter than researchers/academics/clinicians. In most countries, its harder to become a senior civil servant than get admission to medical college or a proffesorship. Don't be fooled by the dumb look. That's training. So respect them..2/n
Rule 2: Civil servants/policy makers are busy people. If you do not get their attention in the first 5 min, you are never going to make it. So have a very sharp & effective "elevator pitch" ready before you step into their office. I practice in front of the mirror...3/n
Rule No 3: A PM/CS (policy maker/civil servant) will usually have a stream of ppl since the day begins, who are demanding things. So one very effective way to stand out, is to actually offer help. After making the elevator pitch end with "What can I do to help you?" It works. 4/n
Rule No 4: Be clear what is your ASK. There are things PM/CS can do & things they can't. So don't ask for the moon. Ask for small immediate things they can do & feel good about, while also asking for important things that may take years. Everyone likes to feel effective...5/n
Rule No 5: Do your homework on your PM/CS. With Google these days, it's very easy to do so. You should "know" them well - background, achievements, likes/dislikes, soft spots etc. Even if you are meeting them for 1st time, you should already know the person well...6/n
Rule No 6: Be polite, be firm, be assertive (not aggressive). Never try to ingratiate yourself with them. PM/CS are very acutely aware of power dynamics & it's imp that you ensure you get them to see you as an equal. Your advice will travel further this way..7/n
Rule 7: Stick to the knitting. Know your subject well & do not offer advice/suggestions beyond your area of expertise. They will judge you for it.
Be prepared with your subject knowledge & data. Don't make it up. If you don't know, be honest & say you will get back..8/n
Rule 8: Think like a VC. Out of every 10 such investments of time & energy (in people - PM/CS), one will click & you will get huge policy influence. That's how it works. So learn the art of investing in PM/CS..9/n
Rule 9: Remember things take time. Your only agenda in 1st meeting is to ensure they r interested enough to call you for a 2nd meeting. I don't ask anything from a PM/CS until meeting 3 or 4. First few meetings are only to educate them to see the world from my perspective 10/n
Rule 10: Ask yourself why you are doing it. Are you motivated enough? Can you think like a policy entrepreneur? Understand the policy process & timeframe
Read the paper below.
And best of luck with policy influencing! It can be very rewarding! END nature.com/articles/s4159…
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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
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
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
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
THREAD: #SuicidePrevention
I get annoyed when ppl think the solution to India's suicide crisis is having more suicide prevention helplines. Don't get me wrong, they are absolutely necessary, but not enough! Why? Helplines are crisis intervention. Essential, but...1/n
Are we doing anything to prevent the crisis occuring in the 1st place? Ah, I hear you say - it's bcoz of depression & we need better mental health services. True, but depression is a final common pathway, not the cause of the crisis. Bcoz...2/n
~40-50% of suicides in India, there is no diagnosable mental illness (unlike West). So what's causing the crisis? Let's begin with children! If school going children are dying of suicide, shouldn't we ask what is wrong with our education system? And do something about it?... 3/n
THREAD. Let me tell you abt some myths around #suicide & how you can save lives. #suicideprevention
MYTH 1: Talking about suicide is a bad idea, as it may be seen as encouragement
FALSE. Rather than encouraging suicide, talking openly helps prevent suicide. 1/n
MYTH 2: A person who is suicidal is determined to die
FALSE. Au contraire, suicidal persons are often ambivalent about dying. Emotional support at the right time can help prevent suicide 2/n
MYTH 3: Most suicides happen without warning.
FALSE. Most suicides are preceded by warning signs, either verbal or behavioural. Many will talk to friends & relatives or doctors about wanting to die. Don't ignore it. That brings us to...3/n