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Privacy in mental health in India is almost non-existent – my psychiatrist shared my details with my mother without my consent, even though I am an adult!
I have spent 8 years in therapy (irregularly) with various doctors. There was the struggle of dealing with taboos around mental health. There was the constant debate of whether a psychologist is better than a psychiatrist. There was the apprehension of wondering if privacy in mental health is a reality, and listening to well-meaning people tell me that psychiatric drugs always cause infertility.
If there is one thing that I have come to realize in these eight years, it is that deciding to get help is ironically the easiest decision you will make in your mental health journey.
I was 16 when I first decided to get therapy and I wanted to see someone who would help me come out of the trauma I had faced as a survivor of child sexual abuse.
“Only severely ill people require a psychiatrist. You are better off seeing a psychologist!” a relative convinced my parents. As a result, I ended up on the couch of a ‘psychologist’.
What happened with the 16 year old me was that this counsellor decided to sell his ‘career counselling services’ to me and I came back home with a sheet of paper that held my capabilities and personality type. I still vividly recall him telling me “Just do some meditation” and brushing off my problems.
In India, you need to be really careful if you choose to see a psychologist because not only is there one around every corner but also a lot of them are not even properly qualified. Very recently, I was shocked to discover that one of my teachers had just decided to call herself a ‘psychologist’ after she completed a mere certificate course.
While quackery might or might not be too much with psychiatrists, I highly recommend that you go over the qualifications and reputation of a psychologist before you see someone or even better, go for someone who is associated with a reputed hospital!
When I was in college, I was molested while I was returning home from a party and the episode left me feeling restless and anxious for a very long time. It brought back memories of my childhood abuse and I was facing a very difficult time coping.
I decided that I would see a doctor because I was absolutely not comfortable discussing the details of the molestation with my mother or anyone else I knew. After all, the best part about seeing a psychiatrist is that whatever you say remains confidential right?
Armed with an appointment, my mother and I waited for 4 long hours in the hospital of a very famous psychiatrist. Once it was my turn to go in, I truly believed that she would let me speak and help me work through my problems.
However, I could not have been more wrong. She asked me a couple of questions, a quick summary of what was bothering me and immediately wrote out a prescription for depression pills.
What followed was something that is completely unethical and blatantly illegal – she called my mother and the junior doctor and quickly gave them a narration of whatever I had told her and told them I was diagnosed with “depression”.
This happened despite me telling her that my mother did not know the complete reason for why I wanted to seek help.
Not just doctors, even the hospital staff have a responsibility. Another time, I caught a receptionist and a nurse discussing the problems of a patient and I was completely shocked – how did they know the details? Did they overhear it? Should they not be trained to not discuss these things?
Here is what you need to know at this point – you have the COMPLETE right to privacy. Just because someone accompanied you to the hospital, your doctor has no right to give them personal information without your consent.
To be fair, I have not faced too many incidents that have been a blatant violation of privacy but it is important to know your rights as a patient. Your doctor has an obligation, not just ethically, very much legally so to not breach your trust.
Unless you are not lucid or in a state where you might harm yourself or others, your psychiatrist has no business discussing details to anyone else including your family members unless you explicitly give them permission.
While I acknowledge and give due credit to some excellent professionals I have worked with, I have been frustrated with experiences of mental healthcare more than once.
As someone who has gone to therapy for 8 long years, I have also worked with professionals who charge you almost Rs.3000 for an hour, in their plush offices, where you are hushed and escorted into the room of the doctor for some excellent service. These doctors are so professional that they slot your time accordingly and be so careful that not even their other patients would know you are seeking help. However, these are the very expensive doctors who are less than a fraction of what reality is. Not everyone who needs help can afford to see them!
How do you filter through all this and seek the help you need, in an environment that is still fairly not too safe?
Once you have decided to get help, ensure that you pick a doctor who works for you. Here is the catch – the good ones are expensive or busy and the bad ones almost always oversell to you. Find the right balance, do your research and decide on a professional who you can stick to.
As someone who has done this often, it is NOT easy to open up to one doctor after another in an attempt to find the right fit. You are better off doing your research beforehand!
You absolutely have the right to complete confidentiality as long as you are lucid and not in a state to cause harm to yourself! Your doctor is obliged to tell you what you are being prescribed.
I remember asking a doctor how a pill for anxiety works and whether I can supplement it with anything further to help only to be cut down by “Just take these medicines!” I went back to her a few weeks later telling her that I was losing weight rapidly only to be met with a casual “Oh, loss of appetite is a very common side effect!”
Many therapists or doctors here don’t actively discuss your treatment plan or urge you to keep coming back regularly. The onus is often on the individual to persist and go on with the treatment.
Anybody who is advocating ANY OTHER service ranging from yoga to aromatherapy massage to career counselling apart from providing you healthcare probably does not have your best intention in mind.
While the situation might look bleak, it largely depends on the healthcare professional you choose to work with. Not just this, we all collectively have a responsibility to reprimand the professionals who violate a patients trust or privacy. And to do this, it is important we are mindful of our rights.
Over the last two years, I have managed to find someone who understands me, is affordable, mindful of my time and always willing to explain the treatment while completely maintaining my right to privacy in mental health. What’s more? She works with a few friends and family members as well but you will never hear her mention their name!
While working with her reminds me to put my mental health ahead and focus on the progress, the journey to get here has neither been easy nor pleasant!
Image source: Flickr, for representational purposes only.
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It is heartening that you have decided to talk about this issue. Many of the tips you’ve explained are very useful for anyone seeking any kind of medical help. In India doctors are often treated as demi-gods, because in the old days they were a kind and caring and indeed a far more knowledgeable and intelligent lot than the average person. However that is certainly not the case today. Considering the capitation fees for a seat in a medical course, all that really seems to matter (in the majority of cases) in becoming a doctor these days, is deep pockets. Medical colleges are clearly less driven by the idea of excellence than the idea of building capital. In these circumstances patients who are consumers of medical health services, at the hands of doctors churned out by these college are at obvious risk of being conned by all types of average and below average healthcare professionals everyday. The government needs to step in to regulate and ensure quality of services and service professionals. After all health is wealth. The wealth of a nation does hugely depend on the mental and physical health of its workforce and manpower. Patient confidentiality and patient treatment care and comfort should be the priority. In the meantime doctors that violate the desired code of conduct should be named and shamed by patients at least in their known social circles so that they become aware of the consequences of their actions and other patients will not suffer the same fate. I would like to add to your tips on looking for a doc- When one is scouting for a doctor of any kind, it is best to do some research about the person, preferably from people whom you know and trust. Secondly its always good to seek help along with someone you know and trust to be a good decision maker about these things. Third do not feel hesitant to not return to a doctor who is not seeming clear, up front or logical about your treatment.
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