A Study on Knowledge, Attitude and Practices of Emergency Physicians in Management of Patients with Mental Health Disorders in the City of Hyderabad, India

Mental health (MH) disorders are a major cause of morbidity and disease burden affecting over 450 million people worldwide (1). The government of India estimates, in its MH policy, that 2 out of 10 Indians are likely to suffer from some form of mental illness by the year 2020 (2). Depression has been linked to common conditions that present to the Emergency Department (ED) such as cardio-vascular illnesses, stroke, COPD, diabetes, chronic kidney disease, and cancer (3-9). As such, the prevalence of depression was found to be higher in ED patients when compared to the general population (10). Mental disorders, if unattended to, can lead to a worse outcome of the primary illness and has been linked to longer hospital stays as these patients show poor levels of self-care (11). Patients presenting with deliberate self-harm or suicidal attempts are not uncommon to the ED and the cause is often attributed to mental illnesses (12). The Indian National Crime Bureau Records reports more than 100,000 deaths due to suicide in the country every year from 2004 to 2014 (13). Suicide was the second leading cause of death among 1529 year olds globally in 2012 (14). Children and adolescents may also present with non-psychiatric problems as such somatization, behavioral disturbances, or substance abuse (15). In India, there is approximately one psychiatrist per 200,000-300,000 people (16). Seeking professional help requires insight and motivation, and that becomes even more difficult with underlying social stigmas and poor awareness in society (1719). As such, these patients end up in the ED in moments of crisis. To address the gap between increasing the burden of mental illnesses and limited resources, the WHO suggests that primary diagnosis and basic management of MH disorders be done by primary care physicians (20). This becomes more relevant in the Indian scenario because Emergency Medicine is a new specialty. Newly established EDs are increasing in the country and it is essential that our programs and policies be more sensitive to the patients’ needs. Screening patients for MH disorders in the ED is recommended (21, 22). Hyderabad is a major Indian city with a population over 3.9 million (23). As there are no studies on MH assessment in ED in India, we