Resistance to any change and new ideas for
management of patients reportedly exists at all levels
LAHORE: According to reports all is not well at the country’s biggest mental healthcare facility in Pakistan i.e. Punjab Institute of Mental Health at Lahore. Failure to get any appropriate response from the Punjab Health Department to streamline the working of the institution and improve its functioning, some members of the Board of Management is reported to have submitted their resignation.
The Board of Management was entrusted the responsibility in February 2023 when the institution functioning was found to be highly un-satisfactory. This, it is further learnt, was depicted in extremely poor patient care of hospitalized patients which had resulted in five hundred patients permanently living in the wards for years. Out Patient Departments were over crowded and only a few doctors were assigned to take care of over nine hundred patients attending the OPD daily. Almost seventy percent of these patients were taking drugs for several years irrespective of their need since no one ever re-evaluated them. What was most surprising to find was that a vast majority of medical officers working at the institution had no interest in psychiatry but were there for several years. Many of them used to attend the hospital for a few hours every week. Most of them as well as vast majority of paramedical staff had very little knowledge of basic mental health disorders besides assessment and management of patients suffering from mental disorders. It is further alleged that pilferage and corruption at multiple levels had contaminated the entire institution. There were rampant malpractices, malady of apathy, callousness. Those working at the institution were found to be resistant to any change and opposition to new ideas was present at all levels.
The newly formed Board of Management is reported to have held over five dozen meetings on weekly basis which was attended by consultants, administration staff, nursing staff, social workers and psychologists. As a result of these meetings, Board of Management is reported to have developed elaborate plans to reorganize the chaotic state of affairs in the institution on several fronts with the objective to elevate it to match international standards.
In their resignation letter, the board of management members have stated that their “painstaking struggle to provide optimal patient care, enhance training of doctors and nurses, establish punctuality and discipline, eradicate corruption etc. were repeatedly impeded through multiple overt and covert ways by defiant groups amongst employees. The latter were totally resistant to any change for the better in the hospital and created enormous hurdles in this regard especially when matters involving corruption and negligence had to be investigated.”
Punjab Institute of Mental Health, even after 125 years, they have stated “sadly remains a dumping ground for patients who if effectively treated could have been safely managed in the community. Almost all patients are suffering from eminently treatable psychiatric disorders, but tragically this right to timely and appropriate treatment is denied to them because of an equally serious malady which afflicts the staff of the hospital at an endemic level This is the disease of criminal apathy, indifference, extreme resistance to change for the better and finally, being ignorant about their ignorance.”
The resignation letter also highlights the fact that they discovered, to their great surprise, that the hospital administration had developed a direct liaison with certain officials at the Punjab Health Department. This collusion resulted in further impediment of instructions issued by the Board of Management. As such the prevailing situation has produced the worst, non-conducive and prejudiced environment for effective functioning of Board of Management. Frustrated and fed up with this arrangement, the board members have stated, they “are of the candid opinion that this mockery arrangements in honorary capacity cannot be pulled on anymore. We are senior people in our own particular specialties. Continuing to serve here will affect our credibility, reputation, and professional integrity. Hence, “do not wish any scar on our working status by continuing to offer our services in this deplorable environment and this commination should be considered as our formal resignation.”
According to another report, the Board of Management has been dissolved and a new Board is likely to be constituted soon. There is no denying the fact that this institution is faced with numerous problems but efforts are being made to improve its functioning but these reforms will have to be implemented gradually and no quick fix should be expected. A number of postgraduates are also now under training and it is hoped that some of them will earn their fellowship in the days to come. There is no separate budget for mental health and the existing financial allocations for this institution are not enough keeping in view the number of patients hospitalized and visiting in the OPD.
It may be mentioned here that during the last few decades, there have been tremendous developments in the treatment strategies for patients suffering from mental health disorders. Early timely diagnosis and treatment have enabled to treat these patients in the general medical wards and in the community all over the world. At present we are in the process of investigating as to why we have failed to adopt this, what are the reasons, and how the situation can be improved. We will be contacting all the stake holders for their viewpoint to come to some conclusions. Hence anyone interested including the hospital administration will be most welcome to share their side of the story.
