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Children need a voice in India.I can remember a heated moment with a parent.Couple of years back a 4 year old boy was admitted at our hospital with history of fever and lymph gland swelling. Blood tests revealed Acute Lymphoblastic Leukemia or ALL (a form of blood cancer). ALL is the most common cancer in children and has cure rates of more than 80%, which means it is highly curable.We informed the parents about the diagnosis and the intended treatment plan. The treatment was free of charge at our hospital. The dad was fine and agreed to start treatment. The mother of the child refused treatment. She said ‘God has given my child this disease and it is God's wish that he needs to die’, ‘I do not wish to trouble him with chemotherapy’, ‘Let him die peacefully’. This was the first time in my career I saw a mother wish for her child to die. I was stunned and confused. I thought she was scared of the diagnosis.We had long counselling sessions with her. Senior doctors from the hospital and psychiatrist spoke to the family and the mother, we explained that the treatment was safe and that the child would be kept comfortable. The psychologist and social worker spoke to the mother in privacy and couldn't convince her. We spoke to the elders in the family, they all agreed that the child needed treatment, but they did not want to go against the mother's wishes.We got families whose children were undergoing treatment or had successfully completed treatment and were cured to talk to the mother and the family, but the results were the same.After about a day's negotiations I lost my cool. I couldn't see a child with a curable disease being denied treatment. The mother was not scared of the treatment, she knew the treatment would make her child better. I had a heated argument with the mother. I was angry and frustrated. I couldn't see a child's life being thrown away so easily. She held her child against her chest, there was no emotion on her face. The husband looked helpless. The mother walked out of the hospital with her child. We couldn't stop her.Parents plead with us to save their child's life and do not give up hope even if the disease is incurable. In this case it was the opposite.I don't know what happened to the child. Without treatment he would have definitely died in few days. We tried calling their mobile over the next few days hoping the mother had changed her mind, but it was switched off. The mother had no history of psychiatric illness and was educated.In the West they have systems in place to handle such situations, where the hospital can approach the court and ask the court to take custody of the child and ensure that treatment is given.In India we urgently need to get such a system in place. Laws need to be framed to treat children against the wishes of the parents if an expert medical board and the court feels that it is in the best interest of the child. Decisions need to be taken quickly because in life threatening illness we don't have much time. There is a need to set up child protection service units across the country. Many children are abused by their families or strangers in this country but it never comes out, these children suffer silently. Child rights and protection need to be given more importance in India.http://indianpediatrics.net/dec2010/dec-1039-1046.htm read the paragraph on refusal of consent

Yes, most people who leave a mental hospital do get worse if they don’t seek follow up treatment. A mental hospital is not a long term solution to a mental health issue. They are there to provide a supportive environment when an individual is unable to cope with the tasks of daily living, is suicidal or a danger to someone, including himself. Treatment planning includes follow up mental health counseling and whatever other services are needed to transition home safely.

The psychiatrist is a physician, and will most likely guide the patient in different directions than a counselor. Their professions are very different.As a psychiatrist, a physician, I will take a full medical history, surgical history, review medical illnesses, medications, family history, social history, symptoms of current illness, and so on, in order to formulate a comprehensive diagnosis, and then a treatment plan.The treatment plan may include any of a variety of medications, one of several forms of psychotherapy, more psychological testing, perhaps lab tests, recommendations for primary care physician check up if I’m concerned about low thyroid or any other general medical illness, and so on.Only after establishing a clear diagnosis can I recommend treatment.As a general rule, a counselor would not do such an extensive evaluation, as they don’t have any medical training, and would only be able to recommend counseling.Psychotherapy and counseling are two different treatment modalities.Your talking is having a conversation with whomever you are with. The content will be guided by the training of the person you are with.