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| Sunday, 12 October 2003 |
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Features |  |
| News Business Features Editorial
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Inside your home but... Out of your mind The prevalence of mental illness has become a problem of increasing magnitude in Sri Lanka, though tragically neglected. Social attitudes pose one of the biggest obstacles to bringing the issues to light and dealing with them. Vimukthi Fernando begins a long night's journey into the realities of the lives of the mentally ill.
Nalindra, is a young boy of 13 years. Studying in sixth grade, he finds it impossible to cope up with his studies for he cannot understand what he reads. It is with much effort he reads his lessons. His greatest fear is to read out loud to the class, where everybody laughs at him on his muttering and incomprehensible words. At home, he gets beaten by his father for every mistake he makes doing his homework. Though concerned persons repeatedly tell his parents that Nalindra needs professional help they refuse seek it, saying that the boy is simply lazy. Saman is the eldest of a wealthy family, a joy to his parents, which lasted but a very short time. He lives secluded in a thick walled room in the house farthest from the reach of outsiders, getting the attention from just one dedicated aid for nearly two decades. His parents do not want to get help for him, in case the rest of the world will get to know. Saman's existence is well hidden. Three lives in the community, different and yet so similar. Hypothetical, but not different from reality. These three people have no physical and observable illness. But, are they well? And if they are sick, why are some families reluctant to get professional help? What makes them lead their lives as they do? What brings out the different reactions from their families? What could their families have done differently? If these three people had a choice what would or could they have done differently? Yes, it is still not a subject much talked about. Perhaps, just once a year, when a day comes to commemorate 'Mental Health.' Otherwise, they are a forgotten entity discriminated against by society. In an attempt to bring their plight to light, the Sunday Observer spoke to a few experts in the field of mental health, Nalaka Mendis, Professor of Psychiatry University of Colombo, Corsini Perera, Clinical Psychologist and President, Sri Lanka National Association of Counsellors and Harishchandra Gambheera Psychiatrist and Secretary of the College of Psychiatrists. What is mental health? we questioned. "What is health?," questioned Corsini Perera. Common man's definition of health is the absence of illness. But, is it true? "Illness and wellness are two polarities. In between, there could be various categories of illness and wellness. Wellness is the positive side, which takes you towards health. Transpose the same concept to mental health. Between wellness and illness, there are various categories of mental conditions." he says and points out that WHO defines mental health as a "well balanced and coordinated development of all aspects of human life, physical, intellectual, emotional, behaviourial and even spiritual. If in a person most of these aspects are developed and are in an ongoing state of development, such a person is on his or her way towards greater and greater health and mental wellness." How can one detect this sickness? "It is very much like any other illness. Tiredness, inability to eat are some of the symptoms of physical illness. In a mental illness excessive worry, fear, sadness, difficulty in concentration, feeling of discomfort and changes of behaviour such as social isolation, restlessness, irritability, dullness are some of the signs that could be observed" says Nalaka Mendis. "Sometimes it is totally inappropriate behaviour such as laughing aloud at times of sadness, sometimes there is no emotional response at all - some will never cry nor laugh, and some will hang on to false and irrational beliefs and some will see, hear, taste, smell and feel things which are not there in reality," adds Harishchandra Gambheera. "Early identification and medication is extremely important" The common mental disorders or illnesses such as depression, schizophrenia, Alzheimer's disease, epilepsy, mental retardation, substance abuse and disorders of childhood and adolescence could be diagnosed accurately. "Some can be prevented and all can be successfully managed and treated" announce WHO bulletins. What makes early detection and care and medication when necessary so important? "A group of people can go back to society and back to their normal lives, another group though they cannot go back to their normal life could be taken care of at their homes and another group needs medical care and rehabilitation," says Harishchandra Gambheera. With proper medication and care the relapses could be prevented and the period where they do not get sick could be lengthened. What is the prevalence of mental illness in Sri Lanka? Though there are no epidemiological studies conducted in the field of mental health taking the clinical experience and global data into consideration "Ten per cent of the population is estimated to be suffering from mental disorders" says Nalaka Mendis. And according to WHO data, 25 per cent of the global population have suffered from a mental disorder at some time of their life. What is the commonest form of illness prevalent? Depression, agrees all three experts. "It is curable if treated well and short lived. Sometimes it stays about six to nine months but most of the time its duration is shorter," says Harishchandra Gambheera. However, depression is an illness which drives many people to suicide. "One percent of global deaths are due to suicide and one million people kill themselves each year" says Nalaka Mendis. Mental illness, unbeknown to us seems a very common illness, that almost all of us suffer from. But, unlike in physical illness what prevents us from seeking professional help for mental illness? Though the number of persons seeking professional help is on the rise, there are certain hindrances preventing them seeking help, says Corsini Perera. "There still seem to be the feeling that going to a psychologist or a psychotherapist will leave them with a bad track record. Or their friends and neighbours will label them mentally sick. Another difficulty people seem to have is that they don't seem to see their unwanted behaviour as something changeable. They seem to have a subtle feeling that they are born with it and they have to live with it till they die. There again is the subtle form of thinking some undesirable behaviour as nothing wrong. The word 'hati' (that's his or her way) is commonly accepted. There seem to be some kind of unhealthy rationalisation of such difficulties. Also again another aspect is the tendency towards passivity in our people and unassertiveness which I guess are related to cultural values, which in the long run could prevent us from taking steps to resolve the difficulties we live with," he points out. "The stigma is huge. WHO statistics show that a large number of people do not seek care for mental illnesses" says Nalaka Mendis. Only 30 percent of those people who needs care get help, while 70 percent do not get any form of care. Mental illness has serious social stigma attached to it. Not only those who suffer from it but even their families are marginalised and ostracised. Therefore, they shy away from treatment, deny the sickness and not even talk about it. However, the stigma should not be so, he points out. "Mental health is a part of health just like physical health. Mental and physical health are interdependent. They are interwoven threads. Any person with a mental illness has a higher chance of getting a physical illness and vice versa." Though it is a sickness people try to shove under the carpet, "the burden of mental illness is more than double that of cancer or heart disease. In the ten most disabling conditions of the world, five are mental illnesses" says Nalaka Mendis. The social and economic burden is very high. And yet, the care and services available for the mentally ill seem to be woefully lacking in Sri Lanka. The issues are many and varied, from the lack of trained psychiatrists, finances and awareness to that of the authorities in the field preventing proper training from reaching the grassroots level workers and the general apathy. Next: What ails the mental health sector in Sri Lanka, and what could be done by the policy makers, health sector authorities and the public at large? ************ The ailing mental health sector in Sri Lanka - Points to ponder * The Mental Health Ordinance dates back to 1873. The draft Act handed over to the ministry on October 10, 2002 has yet to see light of day. * Only 32 psychiatrists to serve close to 20 million people. The ideal number of psychiatrists according to WHO standards is 1,800 while the minimum WHO standards require 480 psychiatrists in the country. * Only 3 hospitals to provide secure in-house care, Angoda, Mulleriyawa and Hendala all concentrated in the western province. * Only in seven out of 24 districts can a patient obtain some form of mental care - Colombo, Kandy, Galle, Kurunegala, Anuradhapura, Batticaloa and Jaffna. (Source - College of Psychiatrists) |
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| Editorial | Security Produced by Lake House |
Hasini is a beauty, who usually draws a second look from the opposite
sex. She holds an executive job in the public relations sector and meets
many different persons during the course of her career. Married with a
daughter aged five, she has recently developed a fear, of people following
and spying on her to kill her. Her family sought professional help since
she started accusing her husband and her own mother of trying to poison
her.
