Mental illness is curable

Experiencing sudden behavioural changes? :

By Carol Aloysius

Recent statements from top health officials on the mental state of our country are alarming.

Despite conflicting figures, evidence seems to be mounting that many who have a mental illness avoid seeking treatment for various reasons, with stigma attached to the illness being one of the most significant obstacles to treating mental illness.

Founder Director of the National Institute for Mental Health Dr Jayan Mendis explains why mental illness is just another health condition and is eminently treatable with early detection.

Excerpts…

A top official of the Health Ministry recently said one in 4 persons in Sri Lanka have mental problems while 20 percent of them don’t seek medical attention. This was underlined by the Department of Census & Statistics which a few years ago stated that between 11-15% of the population had a mental disorder. Another survey also came up with a new figure which said approximately 51% of Lankans had a mental disorder of some sort. All these conflicting data has confused the public. What is your estimate of the actual number?

A. About 1 in 4 persons may be having mental illness.

However, conflicting data on the exact number may be due to the way they have done studies. Some may have included major psychiatric illnesses and some may have included even the slight change of mental state.

Q. Has there been a surge in mental disorders in Sri Lanka during the past decade? If so, what are the main causes? Low priority to mental health by the authorities? Reluctance to get help due to stigma attached to mental health? Stress of modern life?

A. Today, we find people with mental health disorders seek medical help more frequently than few decades ago, as we now have better mental health facilities for them.

On the other hand, we face many shortcomings.

The question of stigma against mentally ill persons is also one reason for a percentage of people with mental health disorders not taking treatment in time. Stress of modern life also plays a role in producing mental illness in vulnerable people.

Vulnerable

Q. Who are the most vulnerable age groups?

A. Adolescents and young adults particularly are more vulnerable to mental illness. New mothers can also suffer from post partum depression. Elderly persons who live alone cut off from close relatives as well as fear of aging are also more likely to develop mental health problems.

Q. Officials from the Health Ministry have also recently opined that many young people including adolescents are committing suicide. What part does mental ill health play in this growing trend of self harm?

A. This is true.

Those who have not developed strategies to manage their stress as well as those who are more prone to mental ill health and suffer from mental illness are more prone to develop self harm (suicidal) tendencies.

Depressive

Q. What are the most common mental problems you see increasingly being reported?

A. Depressive disorder as well as stress disorder and substance misuse disorders including alcohol related disorders are now increasingly being reported.

Q. Are these problems more prevalent in urban or rural areas? Or both equally? As a doctor who has worked mostly in far flung areas of the country, can you share with us some of your experiences?

A. Stress disorders may be more prevalent in urban areas.

However, other disorders I mentioned may be affecting them equally.

Q. How do you know that someone has a mental illness? What are the symptoms to look for?

A. If a person who has been well controlled in his emotions, shows unusual behavioural changes such as loss of emotional control, irritability, anger, agitation, feeling sad, or even feeling excessively happy, these are symptoms to watch for.

Q. Can they be prevented?

A. Yes. By using preventive strategies such as learning to cope with stress, discussing the problems early, withdrawing from stressful activities, treating patients equally and helping to overcome substance and alcohol use may help to delay or prevent these illnesses.

Q. Are they treatable?

A. Yes. Almost all psychiatric illnesses are treatable using methods I just mentioned such as when you see a change in behaviour or emotions of a person.

As for drugs, there are various medications such as antidepressants, anti psychotics and hypnotics which are helpful in managing these illnesses.

Q. Counselling?

A. Counselling should not be a method of treating mental illnesses. However, you may have to counsel the patient, family or those who are around the patient to prevent a stressful situation which the patient and family are experiencing.

Kattadiyas

Q. Some people go to kattadiyas, while others take herbal medicine to treat mental illness. What is your opinion on these nonconventional healing methods?

A. Going to kattadiyas in the hope of lessening a mental illness or curing it is very common in our country. But this can cause more harm than good; e.g. watching the frenzied movements of a kattadiya dancer can sometimes cause fits, especially in the case of an epileptic persons. Our stand is that, other than alternative therapies such as relationship counselling, motivational counselling and cognitive behaviourial counselling, none of these other methods have been scientifically proved.

Q. What is the usual treatment procedure when a person seeks medical help?

A. We first take a detailed history from the patient and the carer to evaluate his/her mental state, and assess what kind of help the person has. Once a patient is started on a drug regimen, we do follow up action to ensure the patient continues taking his medication regularly.

Q. Any recent breakthroughs in detecting and treating neuropsychiatric disorders, worldwide? Are they also available in Sri Lanka?

A. There are various detecting methods such as MRI, FMRI SPECT which are very useful in detecting numerous psychiatric conditions. Unfortunately, other than MRI, which we now have as an investigating facility, the others are not available here.

Q. Your hospital has undergone many changes since it was upgraded from the Mental Hospital, Angoda, to the National Mental Institute of Health (NMIH) from 2008. What are the most recent changes for better mental health care for patients?

A. When I took over the administration in 2002, I had a vision to improve the hospital under a new name, thus removing the earlier stigma attached to it. Hence various structural changes, policy changes, innovative ideas and most importantly attitudinal change among the staff have been instilled over the years to develop this facility to a training centre in mental health.

We also introduced specialised centres such as psycho geriatrics, learning disabled, adolescent, forensic, prenatal psychiatric units to improve the general adult psychiatric units.

The most recent change to improve mental health care was the introduction of emergency psychiatric service and bringing patients who require emergency psychiatric services to the hospital.

Q. How?

A. A specialized medical team visits the homes of such people within the radius of 50km. A day hospital where patients can come in and spend a day at the hospital and those with minor disorders get therapy as well, is already underway.

Admitted

Q. How many patients do you see daily?

A. About 800 daily, with about 30 acute patients being admitted per day.

Q. Your Health Education Unit which was reestablished as a Mental Health Training Unit in 2006 has been commended for its excellent work. What kind of staff personnel do you train and what is your objective? Are these training workshops confined to just your hospital or available in all hospitals islandwide?

A. Before 2006, there was no place properly designed for mental health training. Today, it is a very important component of our new approach to patient care. Mental health training is given for medical staff, nursing staff, occupational therapy staff as well as volunteers. All the medical undergraduates, undergraduate nurses from universities as well as nurses training units all over the country come here for their specialised learning. Training is not limited to our staff members, as this is the National mental health training centre.

Q. Given the number of patients needing psychiatric care, what do you see as the biggest gaps in their way?

A. We need more qualified psychiatrists. For example more and more psychiatrists have returned to the country. Yet about 15 of them do not have an acute psychiatric ward for them to perform effectively. Lack of transport facilities for psychiatrists in rural hospitals, also prevent them accessing needy people in those areas. Lack of awareness about seeking medications early in mental illnesses (due mostly to stigma) is another gap. So is the frequent discontinuation of medications by patients. Shortages of medical officers of mental health and community nurses are also very serious gaps in giving patients proper care.

Q. The Health Ministry has devised a new approach to mental health care by integrating it as a component in primary health care, involving community participation. What are the benefits of this approach?

A. Providing mental health care in primary health care means that psychiatrists and their team of doctors and nurses and other multidisciplinary team will be able to diagnose illness early and to treat them effectively. They can also follow up their patients in a methodical manner. Educating the public and school children, who are more prone to drug and alcohol abuse and suicides, is also an important aspect of primary mental health care. Non psychiatrists trying to pose as psychiatrists and mental health specialists have been the biggest problem for this development.

Q. Your message to the public on mental health?

A. Mental health problems are easy to manage if patients seek treatment early. Patients with any mental issues should go to a mental health clinic run by qualified professionals without delay. The earlier they seek treatment the easier it will be for them to get help. And beware of seeking treatment through methods that have not been scientifically proved.