Lack of LGBTQIA+ Topics in Indian Psychiatry Training

The study highlights urgent need for LGBTQIA+-inclusive training in Indian psychiatry residencies.

AsianScientist (Mar. 13, 2024) – A review of postgraduate psychiatry question papers from three major institutions in India has found that psychiatry university examination questions seldom cover LGBTQ+ topics and found no difference in question patterns before and after the decriminalization of homosexuality in India in 2018. According to the study published in the Asian Journal of Psychiatry, gender-affirming care topics were not covered, highlighting the urgent need for a more LGBTQ+ informed approach to the country’s psychiatry residency training programs. This would better equip mental health providers to deliver affirming and inclusive care.

The researchers belong to three different institutions. Dr. Jithin T Joseph, clinical research fellow and senior resident in psychiatry at the Kasturba Medical College, Manipal, led the study. Dr. AM Miller, senior resident, Psychiatric Rehabilitation Services, National Institute of Mental Health and Neurosciences, Bengaluru, and Dr. Sreya Mariyam Salim, senior resident, Department of Psychiatry, Government Medical College, Manjeri, were co-authors.

They analyzed questions received by postgraduate psychiatry residents under the National Board of Examinations (NBE), the National Institute of Mental Health and Neurosciences (NIMHANS), and the Kerala University of Health Sciences (KUHS) over 10 years between 2013 and 2023. The researchers found that out of the 2,373 questions reviewed, only 11 (0.46 percent) were about LGBTQ+ topics. The percentage of LGBTQ+ questions was 0.5 percent in the NBE papers, 0.67 percent in the NIMHANS papers, and 0.15 percent in the KUHS papers.

The study noted that recent changes in the classification of LGBTQ+ identities aimed at removing the stigma associated with them are yet to be reflected in the questions.

The researchers also found that most questions were about gender incongruence — when a person’s chosen gender differs from their biological sex – pathology and management. Some of the questions used outdated terminologies such as SRS and sex change operation instead of Gender-affirming medical and surgical treatments (GAMST).

“High prevalence rates of various mental health disorders have been documented among the LGBTQIA+ community. Therefore, this study underscores the pressing need for a more LGBTQIA+ informed approach in our psychiatry residency training programs, aiming to better equip mental health providers to deliver affirming and inclusive care,” said Joseph, Miller and Salim in their joint response to Asian Scientist Magazine.

Inadequate knowledge among healthcare professionals, the obstacles faced by LGBTQIA+ individuals in healthcare settings, and the limited opportunities for medical professionals to undergo training in LGBTQIA+-informed care motivated the doctors to conduct this study. The doctors pointed out that the undergraduate medical curriculum, last updated in 2019, does not incorporate any provisions for queer affirmative training.

In 2021, the Kerala High Court instructed the National Medical Commission (NMC), a regulatory body that governs medical education and medical professionals in India, to remove queerphobic information from undergraduate medical textbooks. However, the doctors said no steps have been taken to date.

“While the National Medical Commission recommended an update of the postgraduate psychiatry training include a module related to gender, it has yet to be implemented,” they said.

Salim noted that this lack of training may be particularly relevant to mental health professionals, who play a pivotal role in ensuring patient care. She added, “Therefore, we aimed to examine the extent to which present psychiatry training incorporates LGBTQIA+ informed practices. ”

The absence of a standard way to assess the adequacy of Indian psychiatry training concerning LGBTQIA+ topics posed a methodological challenge for the researchers.

Moreover, the doctors said that using question paper review as a methodology to evaluate the adequacy of training may not accurately represent the actual training, as theory papers typically do not encompass clinical training and practical learning. According to the doctors, studies have demonstrated greater competence in serving LGBTQIA+ clients when curricular hours and exposure to LGBTQIA+ patients are increased. Therefore, they recommend incorporating modules that provide LGBTQIA+-informed training into postgraduate programs. Salim added that further research is warranted to explore this area’s optimal clinical and academic practices.

Source: Kasturba Medical College, Manipal ; Image: Yipei Lieu/ Asian Scientist Magazine

The article can be found at: How LGBTQ+ informed is Indian psychiatric training? An analysis of postgraduate exam questions across three universities


Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Puja is a multimedia journalist based in Kolkata, India. She writes about social justice, health, policy, LGBTQIA+ issues and culture.

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