Tomorrow is Mental Health Day:

Love - the greatest cure for mental health

By Nilma DOLE

Mental Health is an issue that is not clearly understood and is ridden with social stigma. Mental health sufferers have long had to endure the pain of being stereotyped as ‘mentally-retarded’ people. Instead of sweeping such issues under the carpet, we need ask why this area of health science is not fully understood.

Sunday Observer spoke to Nivendra Uduman, a mental health specialist who works for the National Council on Mental Health - Sahanaya.

Be happy with your children's achievements instead of pressurising them

Q: Mental health has been a serious issue in Sri Lanka. More often than not, there is social stigma pertaining to such issues. In what way do you think this stereotype is changing nowadays?

A: The stigma related to mental health and mental illness still exists in Sri Lankan society but it is heartening to see that it has been reducing due to the increased awareness raised on mental health issues.

People are gradually beginning to understand that mental illness is not that different from diabetes or heart disease but as someone working closely with this population, I feel that societal stereotypes are what really hinders a care-receiver having a better outcome in his/her treatment. Family support is something that is much needed when caring for those who have psychological problems and this is what we usually do not receive.

We see care-receivers neglected, and unloved, by their families and this contributes to non-compliance with treatment and other psycho-social interventions which eventually hampers the recovery process. There is an urgent need for psycho-education within families of those who are mentally ill.

Q: Mental health problems are still swept under the carpet and not taken seriously. In what way do people need to realise that even depression is treatable?

A: There are many misconceptions when it comes to understanding mental illness, especially disorders like depression. Some believe that it is caused by witchcraft or sorcery, but no, it is like any other medical illness. It is an interaction of biological and environmental influences and therefore manifests both psychologically and physically.

Another misconception is that illnesses like depression are not treatable, but medical science has improved a great deal and conditions like depression are treatable with both medications and psycho-social interventions.

The psychological well-being of a community largely depends on adequate social support and good family systems, and the onset of illness can be prevented by strengthening the resources a community has within it.

Q: Mental health tackles several spheres but what spectrum of this area is not fully tackled in Sri Lanka?

A: There are different populations which are prone to mental illness but in Sri Lanka the geriatric population is not paid much attention to.

There is a need for medical professionals specialising in geriatric care and also institutions catering to the elderly who are mentally ill. General Practitioners need to be trained in mental health as most illnesses may have a psychological factor involved. The psychological well-being of children also needs more attention especially in the school set up. We need trained counsellors in schools so that a child who is distressed can seek immediate help and effective psycho-education programs and healthy parenting techniques must be implemented.

Q: In general, what are the mental health statistics in Sri Lanka?

A: According to research, one in four Sri Lankans suffer from mental illness and it is as common as cancer. Sri Lanka had the highest suicide rate in the world in 1995 and in 2008, the World Health Organisation estimated that three percent of the Sri Lankan population suffers from some kind of mental illness.

Q: Do we have enough experts to help people with mental health problems? Is there a need for such medical specialists?

A: There is a need for more mental health professionals especially in the rural areas in Sri Lanka and also for more institutions dealing with mental health. These professionals could range from psychiatrists, psychologists to counsellors. There is a pressing need for psychiatric social workers to be deployed in the rural areas of the country as there is hardly anyone for them to reach out to, in the event of psychological distress.

Q: How can we deduce if a loved one has a mental health problem? How can we detect the signs?

A: There are several common signs and symptoms of possible mental illness but everything may not be visible at one instance.

• Loss of interest in daily activities
• Withdrawal and distrust of friends and family
• Abuse of alcohol or other substances
• Deterioration of personal appearance and hygiene
•Diminished or increased expression of emotions

These are some of the warning signs that we could look for and it is important to seek early medical help in the event of such behavioural changes.

Q: Do you think the school education system should be better geared for dealing with children with mental health problems?

A: Children are easily prone to mental health problems due to various difficulties that they could experience at school as well as home. There could be instances of bullying, abuse, or just enormous pressure from teachers and parents which the child is not emotionally prepared to handle. Our education system also does not empower a child to accept failure and look at other avenues in case of failure in important examinations like the Ordinary Level Exam.

This immense pressure could lead to children being maladaptive to their surrounding environment and thus leading to mental health problems even in their later years. Teachers must be sensitised about mental health and be taught basic counselling skills. There also needs to be trained counsellors in each school.

It is however pleasing to note that some government schools in the island have initiated counselling centres in their premises.

Q: Neglecting mental health problems leads to serious implications. In what way can people who are affected, seek help?

A: There are many resources in the community which a person with mental health problems could approach. Community mental health centres are equipped with trained counsellors or clinical psychologists and also in some cases psychiatrists. These centres sometimes also offer skills development and occupational therapy for those who are suffering from chronic mental illness.

There are also telephone counselling services now being offered free for all Sri Lankans and these services could be used to seek immediate relief from a problem one may be facing. Hospitals both government and private have psychiatric units or visiting consultant psychiatrists who can be approached for early intervention.

It is important that we empower each other to seek help when we need it, thus reduce stigma that prevails in society against mental illness.

Q: What activities have been planned for commemoratingWorld Mental Health day? Is there a theme this year?

A: The National Council for MentalHealth – Sahanaya is having an exhibition and a public awareness program on October 10 commencing at 9am to mark the World Mental Health Day.

The theme this year is ‘health’ with special emphasis being placed on mental health. There will be representatives from both the Health Ministry and non-governmental organisations having awareness programs. Sahanaya is also having a walk at the Viharamahadevi Park to raise much needed awareness amongst the general public.

Q: What message would you tell people about being more mindful of those with mental health problems?

A: It is difficult to suffer in silence and that’s exactly what the mentally ill in Sri Lanka go through. We as care-givers need to change this phenomenon by accepting them for who they are and by including them in our daily activities and sharing our lives with them. Love beats all forms of therapy and treatment and showing our loved one’s unconditional regard could enhance the healing process a great deal.

We are all human beings after all.

Regain youthful appearance without surgery

by A. B. Lalith de Silva

Signs of ageing such as wrinkles, skin laxity and post acne can now be treated successfully without getting under a surgeon’s scalpel. Here Director of London Antiageing Medical Aesthetics Clinic in the UK Dr K. L. Wickramarathne who has returned to Sri Lanka and practising in Colombo, describes the complexities of the treatment in brief, in an interview with the Sunday Observer.

Q: Can you explain the background of starting London Anti-ageing clinic in UK.

Dr. K.L. Wickramarathna

A: Yes, before I started to work in Cambridgeshire as a consultant I worked as a Family Physician. My special interest when I was a family physician was Aesthetic Medicine. Aesthetic Medicine can also be called a branch of medicine dealing with beauty. I didn’t lose that interest after I became a consultant. Later I studied Aesthetic Medicine in London and started London Antiaging clinic in addition to my hospital work.

Q: What are the treatments that can be used to reverse signs of ageing?

A: There are various methods. I would like to mention a few here. We have been in particular using Dermal fillers, Botulinum Complex treatment, Skin peels, as well as different techniques of skin tightening treatments in Colombo since my return.

Q: Can you explain what you can treat with the above procedures.

A: Wrinkles, Skin Laxity, Square Face, Ageing of the back of hands, Neck bands, Ageing of the chest, Post Acne (pimples) scarring and pigmentation, Stretch marks are a few of the problems we can treat.

Q: Can you please explain about Dermal Fillers?

A: We generally use Hyaluronic acid as a Dermal Filler. When we say a Filer we mean a volume filler. We can potentially treat any fold or depression in the face or anywhere else. But common areas of treatment are Naso Labial folds, (the line running from the nose to the side of the mouth) Under eye areas, and lips etc.

This treatment takes only about half an hour, and doesn’t involve any surgery. We use a local anaesthetic and therefore there is no pain associated with this procedure. Hyaluronic acid is a constituent present within our body and therefore there are generally no allergies or major side effects associated with this kind of treatment.A main feature of this treatment is that the results are immediate. In a matter of about 30 minutes we can regain a youthful appearance.

Q: Can you say something about Botulinum Complex?

Before treatmet                       After treatment

A: Botulinum Complex is used to relax the underlying muscles in the face mainly. When the muscles are relaxed the overlying wrinkles are softened. A good example is forehead lines as well as frown lines above the nose.

If you release the elastic in a garment you can understand how the garment will lose its creases. It is the same principle with the face too. This is also another procedure with very little pain and the treatment takes only about 30 minutes.

Q: Can you use Botulinum Complex to treat problems other than wrinkles?

A: Yes, We can treat the square face and make it rounded. We can also treat excessive sweating by using Botulinum. There are other medical problems as well that can be treated with Botulinum complex as well.

Q: Are there treatments for baldness.

A: There are effective treatments for baldness and hair transplantation is only one of them. Most patients find the other forms of treatment useful.

Q: Is enlargement of tummy an illness?

A: Enlarged tummy can be a part of the syndrome called Syndrome X. It is also called Metabolic Syndrome or Pre Diabetes. People who live in Asia are prone to develop this condition more than in Europe. Both men and women can develop this.

There can be other symptoms of the syndrome namely Increased Blood Pressure, Increased Lipids in Blood as well as Increased amount of Insulin in blood. If treated properly it is not only the size of the tummy that will come down.

We can expect that the blood pressure as well as levels of lipids in blood will reduce. There are various aspects to the treatment and dietary control is only one of them.

Q: Is it expensive to treat these types of problems?

A: No, in general these treatments are not expensive. Dermal fillers are a bit expensive but it is certainly cheaper than plastic surgery. Due to the advancements of Medicine these modern procedures can be done within a short time for a relatively low fee.

Q: Do you also work as a Consultant Psychiatrist?

A: Yes, I worked as a Consultant Psychiatrist in Cambridgeshire. I have also treated psychiatric patients after my return to Sri Lanka.

Q: Recently you delivered a lecture about Stress.

A: Yes, I have delivered this series of lecturers at different places. Recently I gave a lecture at Temple Trees too.

Stress and it’s management is very relevant and important topic and lately even the governments have been paying attention to this problem.

Stress can give rise to health as well as economic problems and therefore it is quite important to manage it properly.

Q: Why did you decide to return to Sri Lanka?

A: Sri Lanka is my mother country. Though I went abroad for post graduate education it is my duty to return here.

Stem cell breakthrough may lead to cure for Parkinson’s and diabetes

By Steve Connor

Scientists have come the closest yet to producing valid stem cells from human embryos created by a similar cloning technique to the one that resulted in the birth of Dolly the sheep – the first clone of an adult mammal.

It is a significant step towards using a patient’s own skin cells to create embryonic stem cells in the laboratory that can be used in transplant operations to treat diseased tissues and organs, from ailments such as diabetes and heart disease to spinal injuries and Parkinson’s disease.

The breakthrough is one of the most significant developments since the discrediting of work published in 2005 by South Korean scientists led by Woo-suk Hwang of Seoul National University, who claimed to have produced the first stem cells from cloned human embryos. It later emerged that the work was flawed and was retracted.

In the latest study, researchers have merged the genetic material of human skin cells with 270 spare IVF eggs to create embryonic stem cells that appear to be capable of developing into specialised cells and tissues. Unlike the Dolly work, the study was not aimed at producing cloned embryos for transplant into the womb but at producing stem cells for clinical use.

However, the embryonic stem cells produced by this technique cannot be used to treat patients because they contain three sets of chromosomes rather than the usual two – the extra set coming from the unfertilised egg cell’s nucleus, which was not removed.

The scientists said that retaining the genetic material of the unfertilised egg, rather than ejecting it before merging it with the skin cell, was the only way they could be sure of producing an embryo that would develop to the crucial “blastocyst” stage, when embryonic stem cells can be extracted.

Although the resulting “triploid” embryonic stem cells carried three sets of chromosomes, tests showed that they were capable of developing normally into specialised tissues, just like ordinary stem cells. Next, the scientists hope to find ways of eliminating the extra chromosomes so the stem cells can be used in transplant operations.

“We need to find a way of removing the genome of the oocyte [egg cell] without removing the function that it performs in terms of development. This function is probably not the oocyte genome itself but something associated with it,” said Dieter Egli of the New York Stem Cell Foundation, a senior scientist on the study published in the journal Nature.

“Our hope is that we can eventually overcome the remaining hurdles and use patient-specific stem cells to treat and cure people who have diabetes and other diseases. What I know is that this will never happen if we don’t make a start. We are definitely closer now,” Dr Egli said.

Professor Robin Lovell-Badge of the National Institute for Medical Research in north London said that although the study did not produce useful stem cells, the work may reveal a way to overcome the problems so that stem cells can be made with the normal complement of genetic material.

Courtesy: The Independent