Slow rain, long time coming

I am a reluctant traveller, but I enjoy coming to India. I dislike being away from my own bed, my guitars and my wife. Sightseeing holidays hold no appeal. Nonetheless, it would be grossly misleading to suggest that visiting Karnataka is an ordeal in any way. This is my fifth trip, and the thing that makes it pleasurable is that we come for a purpose. British psychiatry has taken a lot from India. Giving something back is not an act of charity (although this trip is funded by a charity). It is about partnership, mutual benefit and, above all, recognising that mental health is a global public health issue.

My friend and colleague, Dr Murali Krishna, returned to Mysuru from North Wales a few years ago. Murali is a remarkable old age psychiatrist, still relatively young, with broad clinical and scientific interests. He has an amazing ability to bring people together and to make things happen. He has been instrumental in the formation of partnerships between psychiatrists in Mysuru and a number of UK institutions. The collaboration between the Centre for Mental Health and Society (CFMHAS) and Mysore Medical College and Research Institute (MMCRI) is just one.

Last year there were visits to North Wales and to Karnataka as part of a project funded by the British Council. This year we secured a grant from the Tropical Health Education Trust for a 20-month educational programme. Four academics from CFMHAS and two from Chester University are visiting during November 2015. Three of us are here for the whole of the month.

South India has very high rates of suicide and deliberate self-harm. It is hard to reliably quantify this, but the World Health Organisation has recently published figures suggesting that the per capita suicide rate in the state of Karnataka is three times the rate in the UK (they have similar population sizes). Other states vary widely, but the cited rate for Karnataka is not the highest in India. Our collaboration has published work on antecedents of deliberate self-harm in South India and on establishing a deliberate self harm register here. In addition to overdoses of medication, organo-phosphate pesticide ingestion and self-immolation are both common. Survivors have high rates of treatable mental illness. Although Mysuru has psychiatric services available at low or no cost to patients, most survivors of deliberate self-harm do not have an assessment of their mental state and therefore they are not offered potentially life saving treatment. The THET-funded project aims to change this.

The UK visitors are not here to tell people what to do. There are plenty of problems in UK mental health services at present, and we are in no position to lecture others about their services. We are here to share skills and to develop a programme collaboratively. Changing the behaviour of doctors is difficult, and it is only going to work if the programme solves problems for non-psychiatric staff who treat a large number of very ill people after deliberate self harm. It is a real challenge.

On the way here last July I watched the film “Frank” on the plane. It is about music and mental illness. I thought it was brilliant. Travelling here a couple of days ago I watched Love and Mercy, which is a biopic about Brian Wilson of the Beach Boys. It is another good film on similar themes. I thought it had some flaws, but it moved me so much that tears rolled down my face. It was not the story itself, which is well known to everyone with a serious interest in Wilson’s music. It was the concert footage at the very end of Brian Wilson today, singing Love and Mercy. I saw him a few years ago at Liverpool Philharmonic Hall, and I cried then as well, when he sang “In My Room”. It is fitting that these films have been the prelude to successive visits to Mysuru, but I am not sure I can clearly express why in words. I recommend both of them.