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Why first psychiatric consultation happens as ‘An Emergency’ in many patients?

Psychiatry is one of the youngest specialties of medicine, dating back only about 200 years. Till then, altered behavioural, emotional and personality functionings were attributed to supernatural powers, like evil spirit, ghosts, black magic, curse, etc., a phenomenon still prevalent in many rural settings in India and other developing countries too.

In general, awareness about mental disorders and related issues is very low in the society. So, symptoms of impaired mental health are not noticed in time, either by the patient or by the relatives. Even when noticed by the person or by the family members, it is not easily acknowledged, because of the prevalent stigma that ‘if somebody has mental illness, he or she is somehow weak and inferior’. Many a times, the family and the person with the symptoms explain it away on the basis of adverse life circumstances. These ‘denials’ and ‘distortions’ allow the illness to grow in severity. Even when outsiders notice it and mention it, the family gets upset and pressurize the person ‘to behave normally’ rather than to seek mental health care.

Eventually, the illness worsens to a point when it is no longer be hidden and it becomes an ‘open secret’. Still, there will be ambivalence towards mental health care seeking. At this stage, frequently some embarrassing social incident happen because of the mental health issues of the patient. If it involves others outside the family, it precipitates a mental health crisis and the persons is rushed to the nearest hospital or psychiatric centre as ‘An Emergency’.