Integrating people with mental illness into the development process

by Ranga Chandrarathne

The National work shop on 'Integrating People with Mental illness into the Development process' not only shed light on the issues concerning integrating people with mental illness into the development process ranging from social exclusion to poverty but also provides insight into the socio-economic benefits that the society can derive from such a move.

In a presentation based on a case study of sustainable livelihoods module developed in Angunukolapelessa, Dr. Margaret Kuruppu establishes links between poverty and mental illness.

Owing to the poverty which leads to economic deprivation, mental and behaviourial disorders started to surface. People with mental illness are generally excluded from the family and considered as 'one more mouth to feed'. However, sustainable livelihood module focused on highlighting the fact, which mentally ill people could actively participate in the development process.

The programme encouraged inclusion of people with mental illness at family and community level. Some of the income generation projects which have been implemented are home gardening and pot/plant vegetable as 'occupational therapies'. The case study showed a remarkable degree of acceptance of people with mental illness into the community and the gradual reduction of stigma.

Enterprises such as running groceries, banana cultivation, brick making, plants nurseries and floriculture which have been commenced with micro credit schemes, recorded a 95% recovery rate. The livelihood programme demonstrated that people of "Angunukolapelessa" are productive and that the model can be applied to other impoverished areas in reduction and sustainable development programmes.

However, the capacity building issues involves imparting technology, improving marketing, accounting and business skills, and packaging and progress in these areas would entail more integration of people with mental illness into the development process, enabling them to make a substantial contribution to the economy.

Community Physician Dr. Shiromi Maduwage, in her presentation on 'Family relationship and Psychological wellbeing of people with mental illness', explores the close nexus between family and people with mental illness in Sri Lankan context.

Since in most of the developing countries, people with mental illness live with their families; 80-95% of psychiatric patients in Sri Lanka live with their families, the psychiatric patients? well being by and large, depends on the kind of relationship they maintain with their families.

Looking after a patient, invariably, can be rewarding or burdensome to their families. So it is important that the relationship between family and the psychiatric patients should be strengthened in order to create an atmosphere conducive to people with mental illness at family and community levels.

She identified factors such as self-reliance (the ability to remain independent, related to self-esteem and a positive self-image which contribute largely to emotional wellbeing) on the part of patients, personal growth, purpose and harmonious relationship, which contribute immensely to the overall wellbeing of the people with mental illness who are living with their families.

The series of programmes aimed at promoting long term family relationship in a community and improving psychological well-being of the mentally ill in the community, have been carried out in seven Divisional Secretariat Levels (Angunukolapelessa, Dikwella, Katuwana, Suriyawewa, Suruwirugama, Embilipitiya and Panamura).

The activities include awareness programmes on mental illnesses and treatments, family education programmes on home based rehabilitation and periodical follow-up of the patients by team of Mental health professionals and the programmes resulted in increasing understanding among family members, improving mutual support between ill persons and other family members and the improvement in management of domestic life and environment in homes.

She pointed out that sharing understanding of family problems of other mentally ill people, building of coping skills and reduces discrimination within the family would contribute to creation of conducive atmosphere at home for people with mental illness.

The presentation by Dr. Jayan Mendis on the 'Horticultural Therapy projects' deals extensively on the state of the Mental Hospital at Angoda prior to the project and the positive change brought about by the project to the hospital. The condition at the hospital was appalling with hospital staff terrorizing the patients. He further mentioned the care provided in the hospital was worse than the care provided in a prison.

It has also been found out that the hospital staff was not trained and at most instances consist of persons sent by politicians. The staff used patients' beds, toilets, TV's and most of the facilities available to them. A notable case was an assault on a Bhikku. Generally, assaults on the patients by hospital staff were not reported as well as patients' injuries.

Dr. Mendis further observed that the families of the patients had never had enough facilities to talk to the patients. The Horticultural Therapy Project which was commenced at the abandoned office of the Director Mental Health not only generated income to the patients, in addition to rehabilitating them, but also helped to improve the environment of the hospital.

As the nurses union blocked this development and the nurses were not released for the work, a group of supporting staff was trained and products yields from the project is sold at the stall 'Shakthi' set up at the hospital premises. While part of the income generated by the shop goes to the continuance and the development of the project, a fraction is deposited in participants' accounts.

The presentation on 'Community-led Interventions in Integrating Mental Health into Development' by Consultant Psychiatrist Dr. Neil Fernando deals with the defects in the traditional system for delivery of mental health care and the need for new initiative which would address the present issues.

Dr. Fernando points out that the existing system of delivery of mental health care is more or less, a centralized and hospital-based, disease-oriented structure with mental health care delivered by medical personnel. The news system Dr. Fernando proposes is a one that is de-centralized, community based and patient oriented with community participation.

He further stressed that community-led interventions could be made through consultative workshops, mental health camps, self-help groups, spiritual cultural interventions, mental health promotion and children-led interventions.

Developing a village mental health plan and forming a village mental health committee are some of the measures taken in the consultation process and regular mental health camps conducted at village level had increased the public awareness on the issues and provided psychiatrist drugs.

The self-help groups have contributed to reducing stigma and networking and family cohesion among the community in addition to their intervention in crisis situations. Dr. Fernando asserts that the self-help groups have trained persons with mental illness in income generation projects.

The pilot project conducted involving 724 persons with mental illness and 5847 others in the high risk group yielded impressive findings that 72% of persons with mental illness engaged in income generation projects independently compared to 28% prior to the projects.

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