Caring for mental trauma in Sri Lanka

By Nilma DOLE

Mental well-being of families 1. War and riots - The Northeast war and the 1989 riots gravely affected the mental well-being of families who lost their loved ones to the insurgency 2. Tsunami - The death toll of 45, 000 and the 700, 000 left homeless affected 80 percent of Sri Lanka’s coastline population 3. Alcoholism - A variety of factors including tax law enforcement have resulted in alcoholism which is one of the critical mental issues for Sri Lanka in the long term 4. Breakdown of family units due to migration - Mass migration of women in search of employment has resulted in severe disruption in families 5. Domestic violence - Violence against women and domestic violence are issues especially in the rural 6. Sexual violence - Sexual abuse in families is steadily increasing especially due to migration of women and aftereffects of war in the North and East has also contributed to this problem 7. Suicide and access to poisonous substances - Suicide attempts in rural areas especially among farmers and love affairs gone wrong has seen suicidal tendencies in the youth (References - Mental Health Care in Sri Lanka - New Directions written by Dr. Shehan Williams of the Department of Psychiatry, Faculty of Medicine at the University of Kelaniya in collaboration with Dr. Jayan Mendis of the National Institute of Mental Health.)

Untreated mental illness in society might lead to a silent epidemic because we stigmatise mentally-affected patients with our stereotyping mindset. What we don’t know is that we are all vulnerable to mental illness, even though we might look normal on the outside.

We are constantly bombarded with stress, emotions, issues and personal struggles which we have to face in trying times.

The President of the College of Psychiatrists, Dr. Usha Gunawardene said that more than 10 percent of the population is affected by mental illness and this percentage is increasing. She said, “Mental illness can be easily treated with revolutionary drugs and effective therapy at a reasonable price but victims do not seek help fearing that they will be labelled as ‘mad’ if they so much as even go to a shrink,” said the doctor.

Treatment

According to the doctor, the sooner treatment is sought and treatment is administered, the more likely they will return to normalcy.

The doctor said that they are having awareness campaign to dispel the mental health myths that comes with the stereotype of shunning these mental victims aside.

At present, there is a mental health policy for the period of 2005-2015 approved by the Cabinet. The policy document recognises the importance of the mental health issue and addresses key policy framework objectives pertaining to decentralisation and community oriented care.

According to the policy, the different challenges faced in various regions of the country have resulted in the evolution of different models of mental health care, driven by mental health care professionals practicing in those areas and the different types of resources available for mental health in each area.

At present, the Angoda and Mulleriyawa Rehabilitation centres treat mentally-affected patients but even after these patients are treated, relatives don’t take them back.

Major changes in both rehabilitation centres have given better rights and services to the patients but still people need to understand that mental illness is just like any other sickness which can be treated. “Just because your relation has been mentally-affected and they have been cured, it doesn’t mean they have the condition forever,” said Dr. Gunawardene.

Angoda is still the country’s main institution for mental health care for the foreseeable future and patients are brought from all provinces. However, with more centres for mentally-affected patients coming up in provincial hospitals, there is hope that there will be fewer patients brought to Angoda.

At the Mulleriyawa Rehabilitation Centre, a 30-bed acute high dependency unit is under construction, and two more community houses are to be provided for the residents. A kitchen is being built in the ward for 24 patients.

In a bid to support the development of mental health in Sri Lanka, the Mental Health Directorate of the Ministry of Health has supported Community Support Centres islandwide. The aim of these centres is to promote mental well-being, counselling and therapy and after-care needs such as empowerment and education for patients to integrate and adjust back to society.

The community support centres have been set up in nine districts and nearly 30 centres are in place now.

Even though medical expertise is available and readily accessible, there is still a dearth of skilled qualified and experienced professionals in Sri Lanka . While most are stationed in the city, there is a demand for professionals in rural parts of the country.

Also, the brain drain problem has contributed to the lack of professionals when considered on a per capita basis. Another issue in the mental health sector is centralisation of services and the main cause of this is the low level of living and social facilities in the rural area which has also led to people travelling a long distance in seek of treatment.

Another problem is the stereotype of seeking treatment for mental illness and suffering in silence.

Victims opt to try to deal with the problem but severe consequences happen before it’s too late to rectify the problem. Denial of the problem is also part of the problem that we can’t solve the mental health crisis.

Development

The development of care-giving societies together with organisations such as Sahanaya is coming up to deal with the mental health issue and address it on a broader level.

These societies provide the forum to identify consumer and carer needs which ensure community participation and partnership. They will also empower consumers and carers to advocate for minimum standards of care. At present there are consumer and carer societies established in all the districts except the North. The situation in the North is such that the Shanthiham program has been developed to help treat mental health and promoting mental well-being.

In 2001, 42 groups were given mental health training but only 21 are active and the needs of families have to be addressed. Every core group is expected to serve 450 to 500 families in their village.

Even though the policy management and a suitable scheme is in place, more often than not, the groups are not given resources to help steer forward their goals save for a little money from NGOs. More than the Eastern province where a multi-sector collaborative model is in place, the Northern Province needs to have their mental health issues addressed.

According to Dr. Shehan Williams, the Secretary of the College, he said, “We also need a suitable scheme in place to address the issue of mental health insurance for patients.

No insurance company in Sri Lanka will come forward to help in mental health insurance while insurance for disabilities and illnesses are completely covered.” He said that mental illnesses can be genetic and neurological where the chemical imbalances in the brain can also cause it which is more physiological than psychological.

“It is wrong to say that mental illness is caused by malicious charms or voodoo magic but it is a caused by improper function of the brain,” he said.

The flipside is that mental health does lead to depression, suicide and substance abuse when this problem can be solved easily. At least 8000 suicides and attempted suicides take place in Sri Lanka every year. It is a well known fact that more people have died from suicide for the past 25 years which is more than the casualties in the Northeast war.

According to the World Health Organisation (WHO), psychiatric illness is the fourth most common cause of morbidity in the world today which around 450 million people affected worldwide affected by mental, neurological or behavioural problems at any time.

According to research, the mental well-being directly impacts the productivity of the nation. The 2002 World Health Report indicates this issue with the report on Burden of Disease in terms of Disability Adjusted Life Years (DALYs) where it predicts that in the year 2002, depression and other mental disorders will account for the highest disease burden in the world.

Hypertension treatment associated with long-term improvement in life expectancy

Patients with systolic hypertension who were treated with the diuretic chlorthalidone for 4.5 years as part of a clinical trial had a significantly lower rate of death and a gain in life expectancy free from cardiovascular death about 20 years later compared to patients who received placebo, according to a study in the December 21 issue of JAMA.

”Antihypertensive drug therapy has been shown to decrease nonfatal and fatal cardiovascular events in controlled clinical trials and meta-analyses. However, long-term data on gain in life expectancy are not available,” according to background information in the article.

John B. Kostis, M.D., of the UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J., and colleagues conducted a study to examine the effect of blood pressure (BP) lowering on long-term outcomes such as life expectancy.

The researchers obtained long-term mortality data for participants in the Systolic Hypertension in the Elderly Program (SHEP) trial, which was a randomised, placebo-controlled, clinical trial designed to assess the effect of antihypertensive drug treatment (chlorthalidone) in reducing the risk of stroke in patients with isolated systolic hypertension.

Recruitment for SHEP was between March 1985 and January 1988. After the end of a 4.5-year randomised phase of the SHEP trial, all participants were advised to receive active therapy.

The time interval between the beginning of recruitment and the ascertainment of death (December 2006) was approximately 22 years (21 years 10 months).

Of the 4,736 participants enrolled in the SHEP trial, 2,365 (49.9 percent) were randomised to active treatment therapy and 2,371 (50.1 percent) were randomised to placebo. The average age of participants was 72 years, 57 percent were women, and 14 percent were black.

At the end of follow-up, 2,851 of the 4,736 randomised patients (60.2 percent) had died, with 1,416 deaths (59.9 percent) in the active treatment group and 1,435 deaths (60.5 percent) in the placebo group. The researchers found that both life expectancy and time to the 70th percentile survival at the end of follow-up were longer for the SHEP participants who were randomised to the active group compared with those randomised to the placebo group.

Life expectancy gain at 22 years was 158 days for cardiovascular death and 105 days for death from all causes.

The gain in life expectancy free from cardiovascular death corresponds with 1 day (0.89 days) gained per month of treatment.

For all-cause mortality, the gain in life expectancy from 1 month of antihypertensive drug treatment was estimated at a half day (0.59 days).

The authors also found that the active treatment group was associated with higher survival free from cardiovascular death compared with the placebo group (669 deaths [28.3 percent] vs. 735 deaths [31 percent], respectively).

- Sciencedaily

Knee pain common complaint in middle-aged and mature women

New research shows 63% of women age 50 and older reported persistent, incident, or intermittent knee pain during a 12-year study period.

Predictors for persistent pain included higher Body Mass Index (BMI), previous knee injury, and radiographic osteoarthritis (OA). Details of this longitudinal study are available in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).

According to the ACR more than 27 million Americans over age 25 suffer from OA—a leading cause of disability worldwide—with pain being the most problematic symptom for patients.

The economic burden from OA is substantial, with reports estimating the U.K. annual loss of productivity cost at £3.2 billion.

In the U.S., the Centers for Disease Control and Prevention (CDC) estimates job-related OA costs $3.4 to $13.2 billion per year. Prior studies suggest knee OA, specifically, is associated with impaired physical function and substantial societal burden. In fact, the CDC reported close to 500,000 total knee replacements were performed in the U.S. in 2004 with more than $14 billion spent on hospital costs related to the procedure.

“Our study is the first community-based investigation of knee pain patterns using multiple assessment points over a 12-year period,” explains lead author Nigel Arden, a Professor of Rheumatology at the University of Oxford in the UK. “Understanding the prevalence and predictors of knee pain is the first step in developing comprehensive pain assessment plans that could lead to more targeted treatment options for those burdened by OA.” For the present study, researchers used data obtained from participants of the Chingford Study, a prospective population-based study of OA and osteoporosis established in 1989.

- Sciencecodex.com

Healthy Christmas eating

One of the dominant images of Christmas is food. Mention of Christmas brings to mind Christmas Lunch, Christmas Dinner, Work Christmas Functions, Christmas Drinks and other Christmas get-togethers.Christmas is not seen as a good time for anyone on a diet.

It doesn’t matter if you are on a diet to lose weight, be healthy or deal with a disease, the range of food available at Christmas is intimidating for dieters.

However, Christmas need not mean the end of your diet or a struggle through January to compensate.

There are ways to keep your diet healthy during the Christmas season.

Moderation

Keeping things in moderation is a major key to the Christmas overeating issue.

It is easy to say “eat and drink in moderation”, but not quite so easy to carry out so here are some ideas for moderating what you eat this festive season.

-Use a smaller plate ~ your mind will consider it a full plate regardless of its size!

-Where there are choices, take a little of many things rather than lots of one thing. This ensures you are getting a balanced meal and not overloading on a fatty or high carbohydrate food.

-For every glass of alcohol or soft drink, have a glass of water. Water fills you up, has no calories or side effects, is cheap and will help wash out the excesses.

-Help clear the table as soon as everyone finished eating rather than sitting and picking at leftovers.

-Make your own mixed drinks with real fruit juice instead of canned drink.

-Don’t be afraid to take things home for later - especially fruit cake as it will keep for ages!

-Only put out some of the available food so people don’t over serve themselves. More can always come out as required.

Alternatives

Whenever you have control over the food on offer, always look for the healthier alternative to prepare and serve. Likewise, make suggestions to other people who will be feeding you over the holiday period.

This is a good opportunity to make Christmas a bit different this year ~ for instance, try a picnic this year with lots of salads rather than huge roasts or do an activity with friends instead of having a Christmas drinks night.

Some ways to reduce the fat content and increase the nutritional value of Christmas foods are listed below. Which ones apply will depend on the style of occasion you are cooking for.

Vegetables

-Keep vegetables as close to raw as possible. Don’t overcook them.

-Consider a salad rather than baked-in-fat vegetables.

-Use spices and herbs to flavour vegetables, not butter or a creamy sauce

-Steam vegetables rather than boiling them - healthier and tastier!

Consider a spicy potato salad instead of a mayonnaise based potato salad. Better yet, avoid potatoes and choose a green salad

-Avoid bacon crisps and salami in salads.

-Char grilled vegetables are delicious and a little exotic ~ a platter of mixed grilled vegetables look great and can be done on the BBQ to save kitchen space.

-Baked potatoes can be topped with yoghurt or low fat cream cheese or low fat sour cream instead of butter.

-Salad dressings can liven up a salad without adding kilojoules. Try lemon or lime juice, vinegar (many types!) and fresh herbs.

Meat

-Trim as much fat as possible from meat before cooking

-Serve some fresh fish or seafood instead of roast red meat.

-Baste meats with lemon juice (alone or mixed with garlic and herbs.)

-Where possible, Lovo, BBQ or grill the meat instead of roasting it, or roast it on a rack.

-When cooking roast pork, remove all rind and fat prior to cooking. Trim off fat.

Desserts

-Supply a fruit platter or fresh fruit salad ~ a hot Christmas day makes this most appealing!

-Have the fruit platter consisting of assorted fruits, local and imported.

-Have some fun with a yoghurt dip with fresh fruit.

-Fruit mixed with yoghurt and frozen is a delicious treat. Drizzle it with chocolate and no one will know it’s healthy!

-Sorbets are a light finish to any meal or can be served at Christmas drinks. Choose a recipe without much sugar in it, though.

-Make a cake with pureed fruit in place of some oil or butter ~ yummy!

- Fiji Times