There is barely any relief for hundreds of mental health patients struggling with chronic depression and psychosis as electro convulsive therapy (ECT) or shock treatment is not being offered at the Institute of Mental Health (IMH), Erragadda here. Lack of access to medicines during the lockdown had resulted in relapse of psychosis, a disorder referring to a loss of contact with reality, in scores of patients in Telangana.
Sources at IMH said they are not administering ECT as they do not have an anaesthetist at present. The institute had only one anaesthetist for years, but she was transferred to Gandhi Hospital in the recent past.
“Since the specialist (anaesthetist) is not available, we are not able to administer ECT which is offered as the last resort. Imagine the kind of agony that patients with psychosis and their attendants are experiencing. Those who take care of the patients at home fully understand what it means to not have the treatment option. Also, we offer this therapy to patients with chronic depression,” the doctors said.
The institute is the State government’s tertiary care centre where all forms of treatment exclusively for people with mental illnesses is supposed to be offered.
A majority of the patients who opt for the government facility belong to economically disadvantaged backgrounds. One cycle of ECT at private hospitals costs up to ₹10,000. IMH remains their sole hope.
Role of anaesthetist
According to the Mental Healthcare Act 2017, ECT cannot be administered without use of muscle relaxants and anaesthesia.
Consultant psychiatrists, seeking anonymity, said that general anaesthesia is administered so that a patient loses consciousness. “Smooth muscle relaxants are administered which also relaxes muscles which help in breathing. An anaesthetist supports oxygenation in the patient. All of this is done so that seizures are experienced only in brain for a brief while,” a consultant psychiatrist said. The therapy lasts only for a few seconds.
Only adult patients are attended at IMH. Minors are provided treatment at Niloufer Hospital, Red Hills. Before providing the therapy, consent is taken either from the patients, or their nominated representative as per advanced direction signed when the patient is in a condition to give their approval.
Relapse and trauma
Doctors who attend patients with psychosis said that some might hallucinate that people around them, including family members, are plotting to attack them. In act of self-defence, some patients might become violent.
“Patients had limited stock of medicines till March this year. During lockdown, those in faraway villages were unable to refill their prescription and ran short of medicines leading to relapse of psychosis and chronic depression. We have seen scores of such cases in the past two months. We often have people pleading us to admit a family member who has become uncontrollable, but we are not in a situation to offer ECT. Hundreds of patients and their family members will be partially spared of the agony if an anaesthetist is allotted to IMH,” sources said.
Till March, the specialist who was shifted to Gandhi Hospital used to visit IMH once a week or 10 days to assist in the ECT procedure. After COVID-19, she got busy with coronavirus patients there.
IMH Superintendent M. Umashankar confirmed that they are not offering ECT as an anaesthetist is not available, and will resume after the specialist is allotted.
Currently, doctors at IMH are relying only on medicines to help patients recover. They said that when dosage of medicines is increased, some patients have side-effects. Since IMH is a tertiary care centre, majority of the patients admitted there experience chronic symptoms or mental illnesses. The institute is expected to provide advanced and latest treatment options.
“But the irony is we are struggling to provide decades-old treatment options and medicines. Means to perform Complete Blood Picture and CT scan too are not available,” sources said. It was published in these columns on September 24 that the institute has a shortage of medicines prescribed to patients with depression and anxiety.