Depression easy to treat with early detection

Depression. Half a century ago, this was a word we rarely heard of in Sri Lanka, probably because many were unaware of the nature of the illness, or knew anything about mental illness.

Then, those with mental illness of any sort including depression and nervous breakdowns, were treated by kattadiyas at thovil ceremonies by their families who believed that their abnormal behavioural changes were caused by evil spirits or yakkas.

As health authorities began taking note of the rising incidence of mental illness in the country, persons suffering from mental illness were offered another option; of being treated with drugs and counselling rather than face the much more fearsome ordeal of a thovil ceremony complete with wild dancing and demonised actions on the part of the kattadiya.

However, to be treated for their mental problems, patients had to be sent to the Mental Hospital at Angoda, the only existing hospital for such patients in the island. Cured of their illness these once confused and mentally de-stabilised patients were able to return to society to lead a normal life.

Unfortunately not all were lucky. Many found their employers reluctant to take them back due to the ignorance on their part of mental illness.

Others faced social ostracism by an ignorant society which believed that once a person was declared insane, he would be insane for life. This stigma was also the reason why their own families rejected them and refused to accept them into their own homes.

This resulted in a large number of former patients being incarcerated within the hospital complex at Angoda also referred to in derogatory terms as the pissan kotuwa for the rest of their lives - even after making a full recovery. They thus became virtually prisoners of the hospital.

Today, thanks to awareness raising programs and far sighted strategies by the Health authorities, the plight of persons suffering from depression and related mental conditions, has changed for the better.

Many of them currently engaged in normal activities, manage their basic day-to-day activities by themselves and are learning trades that can give them self employment. All this has empowered them and given them a more positive outlook for their future.

The Sunday Observer spoke to two eminent health officials, the Director, Mental Health Unit, Ministry of Health, Dr Rasanjalee Hettiarachchi, and Head of the National Institute of Mental Health, Angoda, Dr Jayan Mendis on how this change came about and their views on depression one of the commonest mental illnesses in this country.

Director, Mental Health Unit, Ministry of Health, Dr Rasanjalee Hettiarachchi on strategies taken to improve mental health...

Q. Although mental illness covers a wide range of illnesses including depression, many still tend to equate it with a small proportion of serious illnesses such as Schizophrenia and manic depressive illness. Has the Health Ministry introduced strategies recently to detect early and identify the different kinds of mental illness and the specific illness a particular patient is suffering from?

A. Right now we are giving priority to early identification of mental illnesses. This year for example, we are training medical officers, and midwives on how to identify various mental conditions in patients and how to follow up on these patients. We are also raising awareness on mental health among the public.

For example, at the Dayata Kirula exhibition held recently at Kurunegala, we distributed leaflets, posters, to the visitors.

We are also collecting data on mental health patients from our mental health clinics, to gauge if the number of mentally ill patients has declined or has increased.

Q. You referred to mental health clinics. What is the role of such clinics?

A. They generally look after mainly the mental health of patients, offering them counselling, psychotherapy and recreational activities to improve their skills. Some of these clinics run day care centres on their premises where patients can stay for one day and engage in recreational activities and improve the day to day basic skills. Patients are taught relaxation exercises, gardening, and also some vocational training in sewing, making envelopes etc, so that they can earn an independent income.

Q. Compared with private mental health clinics, in what way would you say, the clinics run by the Health Ministry offers more advantages to patients?

A. For one thing the medical officers working at the government mental health clinics spend a much longer time with their patients going one step further to offer them other services such as counselling and psychotherapy.

Offering patients vocational skills and helping them to learn basic living skills is another advantage offered by the day care centres at these clinics.

Q. Are these services monitored and evaluated? If so by whom?

A. Monitoring and evaluating district level mental health services is something we have recently started.

This is done by medical health teams which are dispatched to the districts, whose job is to review the medical services in each district, provide them with infrastructure to develop their clinics and equipment such as laptop computers etc.

Q. Who are the people included in these teams?

A. The teams comprise psychiatrists, medical officers, psychiatric social and psychiatric nurses, as well as occupational nurses.

Q. Do all the districts have these mental health clinics?

A. Not all.

Q. What about separate wards in the hospital for treating mentally ill patients?

A. At present only some districts have such wards. Hospitals in Kegalle and Moneragala hospitals don't have a separate ward for adults.

Q. What about separate wards for mentally disturbed children?

A. Only the Lady Ridgeway Hospital has such a ward.

Q. So is the Ministry of Health doing anything to fill this void?

A. We are trying to develop separate wards for both adults and children in the hospitals in all the districts. But our problem is lack of funds and human resources.

Q. How many psychiatrists are there right now?

A. We have around 60 psychiatrists and another 45 who have fully qualified after training abroad.

Q. Is the Heath Ministry doing anything to fill this gap in qualified personnel for mentally ill patients?

A. We have already trained 103 medical officers and 70 officers have obtained diplomas in psychiatry. More will be trained in the future.

Head, National Institute of Mental Health, Angoda, Dr Jayan Mendis on what depression is and how it can be treated…

Q. As a medical expert on depression, how would you describe this condition. Is it a disease? An imaginary symptom? Or a state of mind which needs to be taken seriously?

A. Depression is a state of mind when you start feeling low, sad and unhappy; when you can’t attend to normal day to day routine and subsequently develop suicidal thoughts and having ideas of suicide.

Q. What happens if the person is not treated medically?

A. It could lead to him/her committing suicide. Early treatment is the key to successful recovery.

Q. Do you see a rise in such patients recently?

A. I cannot say if there is a definite rise, although we do have more patients coming for treatment which could partly be because of more awareness about the illness.

At the same time depression could be on the rise considering the number of people who are unemployed, who work under so much job pressure, and face problems that we did not see in the past...

Q. What is your estimation of the number of mentally ill people in Sri Lanka?

A. We have no recent statistics on this but generally according to international standards, I believe 3-4 percent of the population will have some sort of depression.

Q. Who are the highest risk groups?

A. Elderly persons, young people and females after childbirth.

Q. Why?

A. Elderly females are more vulnerable to depression when they reach the menopausal stage and menstruation period ends, affecting their hormones.

Some young mothers get post-partum depression which is temporary.

Young males in their early 20s get depression due to chemical imbalance and various anxieties and stresses they face in life such as unemployment etc.

Q. What about children?

A. In children depression is not common, although they suffer from psychological disorders which they present in a different way. For example a depressed child may present with multiple physical problems like headache or abdominal pain or withdraw from society or refuse to go to school which would impact on his education.

These symptoms are seen especially in adolescent girls due to their hormones.

Q. Has diet, life style changes, demographic changes also contributed to depression?

A. Yes collectively all these factors have also contributed to depression in a community. Poverty is another cause. So is malnourishment.

Q. Are there different types of depression?

A. Yes, as I said before it varies from mild, moderate to severe.

Q. What is the usual treatment?

A. Medication, antidepressant drugs, cognitive behaviour therapy and shock treatment in extreme cases.

Q. When a patient comes to your hospital at Angoda, what is the usual procedure?

A. We first take down the history of the patient to assess if he/she is a high risk patient.

Q. Can mental illness be inherited?

A. People with a family history of mental illness are at higher risk than others.

Q. If the patient is warded, for how long will he/she need to stay in hospital?

A. For about 2-3 weeks depending on the degree of his illness. We then follow up these cases in the community clinics.

Q. How many patients can the National Institute of Mental Health Sri Lanka (NMIH) accommodate?

A. Around 1,000 patients.

Q. You started a hotline service for people with mental problems needing counselling services from professionals in 2010. Does it still operate?

A. The hotline 1333 is still operating and we have extended the hours from 7 am to 9 pm/ anyone can access us from any part of the world. The service is manned by trained counsellors.

Q. What is the present goal of the NIMH in Sri Lanka?

A. To provide a better psychiatric service through district based psychiatric service with close doctor / patient dialogue with patients being given the highest priority.

Q. Your message?

A. Mental health is easy to treat if you detect it early. It is like any other illness. There is no reason for social stigma to be attached to this disease. Since it can recur patients must continue their prescribed medication with doctor’s advice and those caring for such patients must always be vigilant for any sign or symptom that the illness may be recurring.