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| Sunday, 29 February 2004 |
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Features |  |
| News Business Features Editorial
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Mental health : A new approach to caring by Carol Aloysius The tranquil setting of a miniature Japanese garden with a statue of the Buddha overlooking it, is the first thing that catches your attention before you enter the building. At the outer entrance is a life-size mural depicting the tragic story of Patachara's life, her trials and tribulations and her meeting with Lord Buddha where she finally found solace, done by talented artist Bharatha Liyanage. "We have designed the exterior of this building to have a soothing effect on anyone entering it," says Professor Samudra Kastiriarachchi head of the Dept. of Psychiatry at the Teaching Hospital, Kalubowila, who ushers us in with her assistant Dr. N. Kumaranayake. Opened in November last year with assistance from the President's fund, on the premises of the teaching Hospital, Kalubowila, the 3 storeyed Centre for Community Mental Health is a sort of half way home for mentally ill patients who initially are treated at the main hospital. "It is not a permanent home for any patient.Nor is it another psychiatric ward", Prof. Kastiriarachchi stresses. "Patients from the hospital are brought here to recuperate and learn to adjust to a normal routine before they return home. We keep them here for about two weeks, give them occupational therapy and mentally prepare them for a normal life once they return home. We also advise and counsel their carers as to how they should deal with such patients". One of the advantages of the unit is that it is entirely separate from the main hospital. Sending a patient here directly from the hospital removes the stigma attached to them, she feels. The biggest advantage of course is that it provides everything a mentally ill patient could possibly need under one roof, thus removing the hassle that such patients face once they are newly discharged from hospital. "Mentally ill patients need special after care by skilled persons and it takes time for them to adjust to normal life and resume their usual activities. Even simple tasks like bathing or eating could be a problem for some. At this unit we try to give them that support so that they will have better self esteem and confidence in themselves when they return to their own home", she says. A guided tour of the building was an eye opener. Built with the special requirements of mentally ill persons in mind, it houses almost all the services required by them. On the ground floor, a Child Assessment room provides educational play equipment for young children. Here a therapist conducts group therapy for child inmates using the medium of art to help the children express their feelings and emotions. "Besides being beneficial to the children, it has also helped their mothers to find support from each other. We are trying to extend this idea and encourage patients and carers to form their own support groups as well" , says Prof Kastiriarachchi. Adjoining it is the Adolescent and Seniors Assessment room and the Occupational Therapy room. It is in the latter room that the patients spend much of their time learning simple functional tasks such as cookery, and sewing. A special room has also been set apart for patients to relax and get rid of their tensions. "Our emphasis is on group therapy and we have set apart a special room for this', says Dr. Kastiriarachchi. The same floor accommodates the Female ward, a 15 bed spacious room which includes a Nursing Mother's room separated by a half wall from the rest of the ward, where a disturbed patient can still nurse her child in privacy while being observed by the nursing staff. The second floor houses an Intensive Care Unit for very disturbed patients, which contains the minimum of furniture and grills on the windows to prevent patients from harming themselves. Next to it is the ECT ray room which administers shock treatment to patients when necessary. A Psychologist cum social workers room, a second child assessment room, a nurses room and the Doctor's cum patient's library are also housed at the end of the floor. The unit also provides a room for the child and family. On the third floor is the Student's teaching room or Conference hall where medical students learn to sit and speak to a patient and, present case studies. A Counselling Room further down the corridor has a special in-built Observation room where medical students can watch a patient being counselled via a two way mirror, unnoticed by the patient. 'This centre was set up as a model for care of mentally ill patients outside the hospital environment," says Dr Kastiriarachchi who first conceived this idea following a study to find out the causes for the high rate of suicide and violence among young adolescents. The major finding from this study was that the majority of suicides and violence among young adults related to their low self esteem. "It is when people have a negative feeling about their self worth and abilities that they become depressed and turn suicidal or wreck their frustrations on society by violence", she says. "Depression is the main cause for suicides. Most of the patients housed here suffer from some form of depressive disorders including Dementia in the case of elderly persons. The Study conducted among a selected number of students from age 15 to 18 in the Homagama divisional Secretariat, involved 35 students (male and female), 17 parents and 41 teachers. The students who were given open- ended questions came up with largely negative replies. Their main grouse against elders and the causes for their low self esteem they said were largely due to poor communication with parents and teachers, poor appreciation by parents and teachers, lack of knowledge about adolescent behaviour by parents and teachers, high expectations by elders, constant fault finding in front of others, among other things. "Self esteem is the greatest gift we can develop in our children because with self esteem anything is and will be possible. We are what we think we can be. This is why I believe that self esteem enhancement in their children should be one of the foremost tasks of any parent", she says. It was to help develop their self esteem and reach out to those suffering from depression and other psychiatric problems in a non medical s facility, that Dr Kastiriarachchi says the Unit has launched a unique project involving school going adolescents. This Schools outreach program is at the core of this novel project to help the mentally ill. Conceived and headed by Dr. N. Kumaranayake, it was a disturbing discovery he made while working as the DMO at the Kurunegala hospital at Polvitigama, that inspired him to begin this program. "I found that sixty percent of the patients at this 100 bedded hospital were either alcoholic patients or those who had suffered violence or attempted suicide. The leading cause was attempted suicides. In the five years I worked in this district there were over 235 suicide deaths and 825 attempted cases of suicide. To find out why there was so much suicide I decided to form an organisation with some others called Vinivida and train ten community workers to counsel young people. I am grateful to the Dept of Psychiatry at Peradeniya and the assistance of Dr. Ranil Abeysinghe consultant psychiatrist who came to our help", he says. When Dr. Kumaranayake was transferred to the Kalubowila hospital and the new unit was set up, Prof. Kastiriarachchi encouraged him to take his project to the schools. Several schools in the Colombo district thus became involved in the Schools outreach program which was funded by Interpharm co. Ltd. He is grateful to the Chairman of the Export Association of the Chamber of Commerce, Graetian Gunewardene for agreeing to fund the project for a further period. "The program is unique and it is the first time that such a program is being carried out in schools", he says. Emphasis is on various aspects relating to depression and low self esteem. Hence programs focus on Positive thinking, showing students how to manage anger and deal with stress, promote communication skills, learn relaxation techniques. Students and teachers are also shown how to identify Depression which he says is a neglected field today. As he points out," Any village mother knows when her child has caught the flu or has some infectious disease. But when it comes to recognising the symptoms of depression, very few parents or teachers are aware how to detect such symptoms. Loss of appetite, lack of energy, loss of libido and lack of sleep are some of the common symptoms of Depression, he adds. A program in counselling for people in different professions has also been recently started at the Sri Jayawardenepura University. Many of the programs planned for Carers is done with close collaboration with HelpAge and the local Alzheimer Association, adds Prof. Kastiriarachchi. She says that while the available nursing staff and the doctors are doing a splendid job, the Unit needs at least ten more nursing sisters to train them in outdoor therapy and run different programs for our patients especially in the health education sector of the outreach programs." We also require a full time psychologist, and a committed group of volunteers willing to spend time and help our patients with love and patience." she adds. The Unit which admitted its first patient in November last year, now has an occupancy rate of over 60 percent in its wards. Considering the rising incidence of violence and suicides in this country, there is no doubt that this unique facility which is hundred percent oriented towards helping the mentally ill, is a welcome step towards a suicide and violence free society. |
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