Webinar – Abhasa Rehabilitation Centre’s History and Future Plans
In our weekly webinars, we talk about various industry scenarios and challenges of rehabs across the country along with the de-addiction and mental health challenges faced by the mental health community and people in general.
In the eighth webinar of the series, we invited Mrs Gayathri Arvind – Founder and MD of Abhasa Rehabilitation Centre, and Dr Rohit Garg – Senior Consultant Psychiatrist at Abhasa and Director of Mind Vriksha Clinic, New Delhi. The webinar was hosted by Mr Vikram Kumar – Managing Director of RehabPath, India. In the webinar, Dr Garg and Mrs Gayathri Arvind shared their views on Abhasa Rehabilitation Centre’s history and future plans.
In this blog, you can read the summary of the webinar, or you can watch it online here.
Vikram: Please tell us about your background and throw some light on the history of Abhasa’s journey.
Mrs Gayathri Arvind: Abhasa is a psychiatric nursing home. We treat all forms of addiction and mental health disorders. At Abhasa, we wanted to give clients a family-like ambience with much love, care, and support. Addiction has been a sensitive topic for me. I had someone in my family who had undergone a similar problem. It took years for us to get that person back to normal life. This journey has taught me many valuable lessons, and I got to learn more about addiction. I was able to empathise and relate to the families undergoing similar problems. For treating addiction, you need holistic treatment and a particular environment with love, care, and attention, along with professional help. It is the reason for starting Abhasa.
Dr Rohit Garg: I practice as a consultant psychiatrist in New Delhi. I have been associated with the National Drug Dependence Treatment Centre, which has developed guidelines for the treatment of addiction and its related research work done across the country – run by AIIMS, New Delhi. I’ve been working with psychiatry and addiction-related programs for almost 13 years. We have been doing mental health and de-addiction related work in various states like Punjab, Haryana, Rajasthan, UP, and Bihar. Stigma is the biggest problem we face while working in the field of psychiatry or mental health. People don’t understand mental health or its problems. Addiction is also seen as a behaviour and a habit rather than being seen as a disease. It has proven to be a disease. We work towards bringing awareness about it.
Vikram: Please share details of your out-bound programs.
Mrs Arvind: People suffering from mental health and addiction disorders tend to suppress their feelings. The feeling of getting locked up in a rehabilitation centre is an add-on. It is the reason we have these out-bound programs. We want to show them there is a beautiful life ahead without any substance. Situated in the Western Ghats, we can take them out for activities like trekking, bird watching, nature walks, and river rafting. Travelling gives us many lessons. We can socialise and see life from a different perspective.
Vikram: Dr Garg has won many awards, including the Best Doctor Award by Medihealth Magazine in 2011 and 2013. He specialises in adult, child, and geriatric disorders. Can you please tell us about your research work in Repetitive Transcranial Magnetic Stimulation and Cognitive Behavioural Therapy?
Dr Garg: Thank you Vikram and Gayathri for introducing Abhasa. I would like to add something here. “Abhasa” in Sanskrit means constant exercise. When we deal with mental health, addiction-related issues, or any other problem in life, the efforts we put to solve them is “Abhasa”. It represents our non-stop endeavour to constantly learn and improve.
Now coming on to what you just asked, RTMS or Repetitive Transcranial Magnetic Stimulation is a non-pharmacological treatment. It’s not about medicines here. It has been found out that every problem relating to mental health like aggression, violence, addiction, OCD, or anxiety brings specific pathological changes in the brain. It is where the problem arises.
With the help of RTMS, we are either able to suppress certain areas in the brain or create excitations to give quick relief. It is an easy procedure. You sit in a comfortable chair. A magnetic coil is placed onto your skull. The strong magnetic field generated by the coil either stimulates specific areas of your brain or suppresses, depending upon the reason for doing it. The person starts feeling better within 4-5 sessions. Usually, the minimum number of sessions required is 20-30. It is safe and does not have any side effects. Whether a person is 15 or 80 years old, it is safe for their use. After the session, they can go home. They don’t have to take any injections or medications for this treatment. Once the person feels better, they can use it for upkeep. With the help of RTMS, a person may not require medication for long. They can take the RTMS session once a month and carry on with their life.
It has shown good results, especially in depression, OCD, and anxiety. Many research studies have shown that magnetic stimulation can be helpful in the treatment of addiction. You need to train yourself in the technique and its procedure. Placing the coil at the right point is the most important thing. Besides, if you don’t use the right intensity of stimulation frequency, you may not get the right results.
In CBT or Cognitive Behavioural Therapy, cognition means thinking. Behaviour is associated with the thought process. To bring a change in life, either we need to change our thought process or change our behaviour. CBT teaches us how we can control our thoughts, and if we fail to do so, how can we bring change in our behaviour. There are specific ways in which we can change negative thinking into positive.
I think CBT should be part of the curriculum in schools. If children from 1st to 12th standard in schools are taught how to counter their negative thoughts, the world would be a much better place.
Vikram: Talking about these two techniques, are we using them in Abhasa? What are the other programs that Abhasa offers?
Dr Garg: RTMS is a technique that requires special equipment. It is an expensive mode of treatment. It is equally expensive to have this facility at your centre. RTMS is one of the new value additions we are looking at next in our efforts to offer advanced facilities at Abhasa. It is similar to OPD-based treatment. People who do not opt for indoor programs are more likely to use it. They visit, take RTMS treatment and go back to their house. It will reach only a small number of people if we have it for indoor setup. It is value addition, and if we can have it, that will be helpful.
When you are dealing with any mental health or addiction issues, there are many programs like detoxification and relapse prevention. It cannot be one program for everybody. Each person has their problems or issues. They have different motivation levels while visiting us, in terms of what they want to work on. Some people have problems only relating to addiction, while some have a dual diagnosis of both psychiatric and addiction problems. A specific program is tailored for an individual to benefit them in the best possible way.
Rehabilitation is quite a stigmatising word. If you tell somebody to go to a rehab, they get scared. They feel as if they’ve been sent to jail. Rehabilitation means coping yourself to lead the best quality life, to develop your abilities, or living life most efficiently.
The first thing which matters the most is the assessment part. When a person visits, we look from one perspective that they are suffering from addiction. We, sometimes, fail to understand its cause. Is it stress, psychiatric disorder, personality, or behaviour?
I believe once you know the problem, half the battle is won. In many cases, patients who have come to us have already spent years, taken multiple admissions in various rehabilitation centres while only focusing on their addiction. When they visit us, we assess underlined disorders leading to problems. The moment those problems are fixed, there are different results.
You also have to build rapport with the patient. Somebody does not enter your centre and share their entire life. The comfort must come in. It is the second important step. Mrs Arvind takes a personal interest in this by interacting with everybody on a personal front.
After rapport and comfort building, we start working on different problematic areas. It could be CBT, relapse prevention, family therapy, or counselling. As Mrs Arvind said earlier, it has to be a holistic approach. You can’t only focus on the patient.
There are many misunderstandings among the family members and inter-personal relationship issues. We need to resolve all those things before the person goes back home. It is also essential for family members to understand what to do and what not.
They must understand addiction from a deeper perspective, rather than considering it a behaviour or a habit. Much importance is given to the family counselling. It becomes a significant risk factor for a person’s relapse because after the treatment is over, they have to go back to their house.
If we don’t fix that environment, the chances of relapse are going to be high. We are not only working on an individual here; we also work on ten more people in the family. We do an intensive amount of therapy and work at Abhasa for better results.
Across the world, you see the results of rehabilitation homes or centres with 5 or 10% success rate. Some say 100%, others say 77% or 80%. I do not feel it’s true. At Abhasa, we’ve had excellent results. Most of the people we have had are doing good in their lives at the moment.
Vikram: Can you tell us about the length of the programs? Would you like to talk about any specific facility provided by Abhasa?
Mrs Arvind: Regarding the programs, once we get an admission, we do a detailed assessment. We have a staff ratio of 1:2. We monitor the client from a week to 10 days. Based on our assessment, we tell the family how long it will take for the treatment. Some people come for 15 days, while some stay for six months. It all depends upon the problem and how the client receives it. The length of the stay is customised.
Dr Garg: From a medical point of view, it has been said that there is a reward circuit in our brain which has to do with proteins, hormones, and dopamine. It takes approximately 3-months’ period for that circuit to settle down. Usually, it has been seen that if anybody works on self for 90 days, the chances of their relapse are less.
For mental health programs, it could be from 15 days to 6 months or more. A person suffering from a mental health issue is admitted to a rehabilitation centre because he is not manageable at home. There can be certain treatment issues at home, like not taking medications regularly or eating proper food. They may not be able to exercise or do anything.
Overall, a person should stay for at least a month or up to three months at a facility. It should be the mindset of the family and the person to get the benefits of the rehab facility.
Vikram: What is the format or structure of the program?
Dr Garg: The moment you tell any family or patient that they are going to rehab, the first response is fearful. The structure starts there itself – from explaining everybody about rehabilitation. If you put a survey on Facebook, most of the people would not understand its meaning. They think they are being locked, beaten, or made to clean the floors. We ask them to visit the place first. If they have any questions, counsellors there can provide answers regarding treatments, plans, and programs.
There are many other factors at play. Let’s say I’m holding a job. I have to go for three months. Do you think it’s going to be easy? No. How do I manage my job? How do I manage my family? How do I manage my finances? I may have some legal obligations. I may have to attend important meetings. We need to attend to these queries. When the person is comfortable and ready, the program starts.
Now we have a holistic approach. Another one is a medical approach that includes medications and preventing any substance-related withdrawals. They can have severe withdrawals like seizures, delirium, sleepless nights, aggression, or anxiety. With the help of the medications, you prevent them and make the process easy.
Another important part is AA. 12-step programs do help people. It goes hand-in-hand with medical support in realising alcoholism and what we need to do about it. It also gives a little spiritual angle. It shows different aspects of alcohol behaviours.
AA becomes an integral part of the treatment. There are many sessions like JFT – Just for Today and group sessions that have become part of AA. People also take part in sharing sessions where they share problems, how they fought, what they lost, and complications faced in life because of the substance. It overall helps them for a better recovery and quality of life down the line.
The third is the psychological component. The trained psychologists understand your behaviour from childhood. You bring up yourself and build your thought process and personality. The trained psychologists try to dig out your subconscious fears, desires, or behaviours that add-on to the mental health or addiction issues.
The fourth part is physical health. Our mind and body are connected. Until you are not fit, it is difficult for the mind to operate and vice-versa. Combination of outdoor programs like trekking and hiking with intensive programs at the centre like Zumba and exercises can help a person get physically fit.
Vikram: What are your views on involuntary cases?
Dr Garg: It is a controversial topic, and I would not want people to judge my comments. I want to share my thoughts and what the law says to which people may or may not agree.
When any person has mental health issues, their cognitive skills do not work properly. Then involuntary admissions come in. In terms of addiction, many people are in denial. They are at the verge of losing life or causing harm to themselves, family, or the people around. The role of involuntary admissions comes into the picture here.
Under section 89 of the Mental Healthcare Act, 2017, if two psychiatrists believe that a person is not able to rightly judge what’s best for them, with the consent of family members, he can be admitted to a centre involuntarily for almost 30 days, extendable up to 90 days.
100% of involuntary admissions become voluntary when they realise its importance after staying at the centre. The biggest fear of family is the patient’s aggression or resentment upon their return. Actually, it is the opposite. They thank family members and counsellors for bringing them back into life. A person should work with his own will.
Vikram: Since Abhasa is located in the Western Ghats, how does it feel when a person visits?
Mrs Arvind: Before starting Abhasa, I had one thing in mind – to break the stigma people have about rehabilitation centres. I wanted to give them a place where people can be themselves, identify & work on their triggers. It is not about architecture. It is about people who are working with clients. We were particular about selecting the staff. Since we are located in the Western Ghats, we can provide multiple outdoor activities. We want patients to explore good things in life. When you have a mental health disorder, you confine yourself to a place. We want to show them that there is a beautiful life ahead.
Vikram: What is the situation right now? What is your plan for the upcoming months? How are you helping people solve the challenges of COVID?
Mrs Arvind: We are taking all precautionary measures for COVID. We have most of our staff residential, including psychologists. It is an advantage to get less contact with the outside world. With doctors and medical professionals, we take video sessions currently. Let’s see what the future holds.
Vikram: If somebody needs to participate in those video sessions, where should they go?
Mrs Arvind: They can approach us through our website and contact through phone numbers mentioned on it. We are taking admissions once the patients get COVID negative test results and follow required protocols.
For instance, a person who has to come from Delhi to Coimbatore, it’s a one day quarantine along with COVID test. We repeat the same procedure after 3-4 days. If the reports are negative, we take the admission.
Online sessions are majorly for the clients of Abhasa. If there is any problem linked to the addiction, we address it. In case a client needs treatment, we contact the doctors through video sessions.
Vikram: When we are home, we have access to necessities like mobile phones and home-cooked food. How do things happen at Abhasa? Do you allow families to meet or bring outside food?
Mrs Arvind: On day one, we do a detailed assessment for the family. After this, we watch their routine for ten days. Depending on this, we create a road map for the client. The first step is a routine checkup with the physician, and the second is creating a meal plan with the help of a dietician. Clients can also grow their vegetables since we have an organic garden. At times, we do let them order food from outside or cook. We celebrate all functions. We make sure they don’t miss their house or loved ones.
Dr Garg: When you visit, it is about looking at yourself. Today, social media and mobile phones are the biggest distractions. We want people to focus on themselves and their programs completely. That’s why such things are not allowed. In general, if there is any necessity like online class or meeting, depending upon the need, we provide them with the facility.
Family members are not allowed in the initial weeks. Regular family meetings and counselling sessions are conducted in the later stages.
If a person is doing better, they can go out for lunch with family and come back. These step-wise approaches are taken.
We also allow the clients to go back to their house during weekends. Slowly, it introduces them back into their natural environment. It also helps in assessing how the person may behave when they get back home.
Vikram: Are there any interesting cases you would like to talk about?
Dr Garg: Yes. One case came from Goa. The initial information given to us was that the person is only abusing cannabis. He was in rehab for more than a year. Family members felt his health was deteriorating. After he visited our centre, we assessed him. We found that he was not only suffering from cannabis addiction but also schizophrenia. When we cured his schizophrenia, the addiction problem was gone. His treatment was delayed for more than a year because of being misdiagnosed or not being diagnosed.
There was another case of alcohol addiction. Family members always complained about the person’s binge drinking habits. He had bipolar disorder (when you suffer from mood swings – high or low phase). Every time he would get into a high phase, he would drink to the maximum possible limit. His mood was irritably aggressive. The moment we treated his bipolar disorder, his addiction problem was almost cured.
Vikram: The post-rehab phase is also risky. What do you suggest to a person on how to take care of the post-discharge phase?
Dr Garg: When they get discharged, we tell them the journey doesn’t end here – it begins. Now you are going back home. As soon as you enter a controlled environment, your addiction mind starts telling you to be the best person in the world. It plays so much with your normal mind that you feel as if you have controlled your addiction. But as soon as you go out of that environment, you lose control. We have seen people relapsing in 2 hours, where they relapsed even before reaching home.
We tell them not to think, that they have won the battle. We tell them to take medications, follow-up with their doctor and counsellor. We teach them about various relapse identification methods such as how and when they might be relapsing like any desire of co-entering or increased cravings towards addiction.
A patient came back and told us that he had gone back three times from the wine shop. He won’t be able to go back sober the 4th time. He asked us to take him in or help.
You have to be self-aware. Even the family members are asked not to trigger their addiction. We ask family members to seek help if they are not able.
Another thing you should know is that relapses are common. Don’t think you have lost if you relapse. It is part of your recovery. We can start again.
If you feel like relapsing, visit the facility and stay there for some time. We also advise our patients to visit Abhasa every other month and spend a few hours, which is free of cost. They can have lunch or a session with us where we can rebuild cognition or thought process. It will let you stay in touch with the process and help recover better.
Vikram (Question from the participants): Mental health problems are now becoming a major concern in our country, driving people to take bitter steps. What do you think could be the reason for the sudden rise in such cases?
Dr Garg: There is a general view on it apart from the research. The world has changed. There is the stress of competitiveness, success, and career. There is only so much to do with nuclear family setups. It also has to do with social media and lesser human interactions. Earlier, you would have friends’ gatherings and sit on a ground to share or cycle around. Less human interaction is adding to the stress. There has been an increase in substance abuse disorder.
Most of the people feel cannabis is herbal, organic, and it is okay to consume for relaxation. It is leading many people to anxiety, bipolar disorder, OCD, and psychosis. I request everyone to stop using it. Unhealthy lifestyle is also a major cause of stress.
I think mental health issues existed before as well. Since awareness is increasing, people are talking more about it and are able to identify themselves. It is also leading to an increase in the number of cases.
Vikram (Question from the participants): Please explain the difference between a rehab and a de-addiction centre.
Dr Garg: Rehabilitation is not only about leaving an addiction. It is about bringing in physical, mental, and cognitive abilities together to live the best life. De-addiction centres mainly specialise in handling addiction-related problems.
Rehabilitation centres use a holistic approach; a person is not only treated for their addiction issues but also taught to handle their stress, which is the most important trigger factor for relapse. They get help in developing their mental or cognitive abilities and taught how to handle themselves and not relapse.
Vikram (Question from the participants): What is the treatment payment structure of Abhasa?
Dr Garg: There are different kinds of services and plans for an individual. You can choose to be in a dormitory or a shared room. People who stay there for a long period, Abhasa has a curtailed treatment payment structure for them. You also get discounts and incentives if the stay is extended above three months for specific reasons.
I want to mention here that Mrs Arvind has been kind enough that she allowed one person to extend their stay after three months free of cost. It is how you have to take things forward. We are open to help people and work out the payment structure.
Vikram (Question from the participants): An addict having mental health issues, created ruckus in the family, appears to be doing very well to the outside world. How to approach such a situation?
Dr Garg: Usually, we feel that he is operating at the best level in the outside world. But people will have problems in the outside world also. Let’s say he can perform at 300% compared to a normal person but is only operating at 80%, which may look normal to us.
It is normal for people to show their anger and aggression with their loved ones. No matter how chronic the problem is, they never get violent with us.
As a family, we must understand how to avoid any confrontations, aggression, or violence. Don’t try to prove an alcoholic’s alcoholism, or that they smell, or so on.
Many people have personality issues. Manipulative behaviour and lying are part of addiction. Any person saying he is smoking 5-6 cigarettes per day is smoking 8-9 cigarettes. A person saying he is taking three drinks means he is taking at least five drinks.
If they are outside and something comes up, they will end up creating issues there as well. They cannot live the best quality of life outside.
Vikram (Question from the participants): How to get rid of hot tea with cigarette addiction?
Dr Garg: Everything is behaviour. You join two things like having smoke after food or smoke with morning tea. It is a mix of behaviour and patterns, called conditioning. Every time you take hot tea, your mind associates it with smoking. You do not have to think every day the same. It becomes a reflex action. The best way to break it is when you are having tea, try having it in an area where no cigarettes are available. Don’t go to a tea shop or stall. Try shifting to another tea like green tea or coffee.
Medications are available to stop nicotine withdrawals. If used under a doctor’s prescription, it can give good results. You will have to do it a minimum of 21 days or up to 3 months.
Vikram (Question from the participants): Would you like to share any messages with us?
Dr Garg: We must focus on the solution rather than the problem. If you have that approach in life, nothing can cause a problem. The best solution may not be available, but second or the fourth-best may be available. Let’s choose them and move on. Any time will not stay forever. If there is a bad time, there will also be a good time. Maintain a good lifestyle.
Mrs Arvind: It is okay to have a problem. But it’s not okay to not address the problem at the right time. Mental health stigma has to be removed from people’s minds. The same can be said for addiction. It is better to seek help because it can only be given to the ones who ask for it. You can reach us through our website, email, or phone numbers.
If you have any other substance abuse problem, get help as fast as you can. Go to your nearest psychiatrist or a rehab centre and get the help you need. All the rehabilitation centres are open.
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