Patterns of Practice and Attitudes to Referral for Mental Health Needs among Practitioners in Northern India.

To the Editor, Since time immemorial, stigma is closely associated with mental illnesses. Due to stigma, misconceptions about mental illnesses as well as lack of awareness, a large proportion of patients with mental illnesses remain untreated or consult traditional healers, which attribute to a large treatment gap as found in the recent National Mental Health Survey 2015–16, sponsored by the Government of India Gururaj et al. (2016a). Due to stigma, in most parts of the world, non-psychiatrist practitioners treat patients with mental illness, and antidepressants are commonly over-prescribed medications Kar (2015). Over the past few decades, a new subspecialty has emerged which works at the interface of psychiatry and other medical disciplines. It is known as consultationliaison psychiatry, and it intends to deliver collaborative care for patients having medical illnesses with psychiatric co-morbidities Chen et al. (2016). Consultation-liaison service improves mental health care for up to three months; also improves client satisfaction and medication adherence Grover et al. (2014). A cross-sectional study was conducted on non-psychiatric practitioners in a city in North India. The study participants were general medical practitioners (nonpsychiatric medical practitioners). To be included in a study, the participant must be a medical practitioner (clinician) with a minimum MBBS degree. Written informed consent was taken from the participants. Study participants were evaluated on a semistructured questionnaire that intends to assess attitudes and practices about mental illnesses. Approximately 200 medical practitioners were approached during the survey, but only 61 (30%) were responded. Consented and completed in all respects. Most of the participants, 44 (72.14%), were male, and 17 (27.86%) were female. The specific difficulty reported for not giving consent by the practitioners is lack of time. Among participants, nearly 98% dealt with patients with psychiatric illness, out of which nearly 30% treated the patient. More than half (63.93%) of practitioners refer the patient to the psychiatric department, whereas 36.07% of practitioners had treated the patient with psychiatric problems by themselves. Particularly 88.52%practictioners referring the patient to psychiatrists, and more than 91.8%reported psychiatric problems are associated with medical illness. More than 42.62% prescribe psychotropic medication, out of which benzodiazepine is