Sri Lanka Faces Increasing Mental Illness

[Guest guest]

Arthur C Clark (2001 and 2010 lives here and survived last years tsunami

with great property damafe. The recent tsunami in Sri Lanka has

increased the numbers of depressed individuals in the country.

 

 

Basic Needs for Mental Health

By Vijita Fernando**

http://www.islamonline.net/English/Science/2006/05/article05.shtml

 

 

Photo: a man who went mad after losing his family in the tsunami

 

 

To be cast out of your home and your community for being mentally ill

is a sentence to destitution, often a sentence to death. This is what

would have happened to Piyasena, a young man from a rural village in

southern Sri Lanka. Piyasena was lucky. A community-based program

called BasicNeeds spared him the usual fate of most mentally ill

people in the country.

 

According to the World Health Organization's 2001 World Health Report,

mental illness accounts for 12.3 percent of the global burden of

disease. This is expected to rise to 15 percent by 2015.

 

In Sri Lanka, 376,000 people suffer from some form of serious

debilitating mental illness, according to Sri Lanka's Ministry of

Health. The ethnic conflict of the last 20 years and the recent

tsunami disaster have increased depression and medically unexplained

symptoms.

 

The stigma attached to the mentally ill is a stigma not only to the

patient, but to his whole family. The family keeps him away from the

community; sometimes locked inside the house, chained, and out of

sight of visitors. The stigma means he is inauspicious, unfortunate,

his womenfolk may never get a proposal of marriage, and he has no

access to medicine or care.

 

Hope for the Mentally Ill

 

Basic Needs Basic Rights is a non-governmental organization (NGO) that

has developed the Basic Needs Mental and Development Model. This model

aims at constructing collaborative interventions to demonstrate that

mentally ill people can actively participate in the process of

development.

 

The approach by this NGO to mental health and development is to work

first with a small community. This is to allow the program to closely

monitor the issues that challenge the mentally ill and their families.

The model which was first developed and tested in South India is being

used as a guide.

 

" We started the pilot project in 2003 with 34 mentally ill people. We

now have 1283 patients in several villages in the Southern Province, "

said Chinta Munasinghe, director of BasicNeeds Sri Lanka.

 

This growth in numbers of participants has resulted in the development

of the Mental Health Care Through Community Partnership, which

complements the local government delivery structure. Munasinghe

explained that the most outstanding feature of this partnership is a

program in which community volunteers, 30 percent of whom are mentally

ill, run community-based activities.

 

These activities include monthly mental health camps run in

collaboration with the mental health hospital close to the capital,

Colombo, and the teaching hospital at Ratnapura, 60 miles from

Colombo. These are outreach clinics run by medical officers in

collaboration with general hospitals and outpatient clinics for drug

administration at primary level hospitals in towns.

 

" The model acknowledges the right of mentally ill people to consult

and be consulted and goes beyond diagnosis and the provision of

treatment to focus on mental health in a community setting. " Valli

Seshan

 

While these meet the physical and health needs of the mentally ill,

the social interaction possible through the BasicNeeds project has

gone an extra length in rehabilitating patients into the community.

 

Piyasena, for instance, is now a member of the volunteer committee

which plays an active role in organizing communities. His duty is to

ride in a three-wheeler announcing through a loudspeaker the news of

events such as health camps or the visit of a specialist doctor to the

community. The significant factor here is that the mentally ill people

in the volunteer committees have earned a firm place in the community,

where earlier they were shunned by those very same communities.

 

Important Feedback

 

Mentally ill persons are selected to talk about their experiences when

BasicNeeds meets authorities seeking help to replicate the program in

other parts of the country. This has led to the mentally ill and their

families volunteering to come out with their problems and discuss them

openly.

 

" There was a session where the mentally ill participants were invited

to talk about their experiences with medication and they discussed

difficulties they faced, including side effects. This open discussion

gave us a lot of insights into problems that patients face, which we

were not aware of. It was a learning experience for us, " said

consultant psychiatrist Dr. Neil Fernando, who supervises the patients

in their medical needs and use of medicines.

 

In addition to monthly mental health camps in the community by a

multidisciplinary team of health professionals, mental health clinics

are gradually being integrated into medical clinics by medical

officers with training in mental health, where the mentally ill are

treated along with other patients.

 

" This interaction between communities, organizations and institutions

has enabled the wider appreciation of the Mental Health and

Development Model on which this work is based. The model acknowledges

the right of mentally ill people to consult and be consulted and goes

beyond diagnosis and the provision of treatment to focus on mental

health in a community setting, " said Valli Seshan, chairperson of the

BasicNeeds India Trust, where the model is being tried out in several

villages. The Indian experience in addition to the experiences of the

same model in different settings in Northern Ghana, Tanzania, and

Uganda provide extensive exchange of valuable ideas and experiences.

 

Changing Traditions

 

Village volunteer committees are the bedrock on which the complete

success of the project rests. It is they who encourage the mentally

ill to use the services available. This means that they must patiently

approach the families and encourage them to change their traditional

and conventional views of treating their mentally ill members.

Traditionally, mentally ill patients were not provided with medical

treatment, were hidden away from the rest of the world, and in short

were deprived of their basic rights as human beings.

 

" The volunteers are trained in the basics of mental health and

organized into self-help groups around the mentally ill. We have had

some volunteers donating small plots of land to start group farms.

Temples and schools in the villages help by getting involved in

socializing activities with the mentally ill, " said Lalitha, a member

of a volunteer committee.

 

This has helped to reduce the stigma and discrimination attached to

the mentally ill. In fact, one volunteer said with a smile, " The

derogatory word that was used to describe a mentally ill person,

pissa!, is no more used in these villages. "

 

The community activities have now gone beyond the limits of small

villages to the attention of medical authorities in the country. These

joint ventures have helped BasicNeeds to reflect community needs and

interests in the formulation of national policies and in setting up

systems.

 

The project also takes into its fold destitute mental patients

stranded in mental hospitals and rehabilitation centers. It has

provided them, for example, with horticulture therapy at the premier

mental hospital in Colombo in partnership with the government. This

project is gradually extending into a viable commercial enterprise of

selling plants and produce, mushroom cultivation material, and a

thriving business of selling clay pots and ornamental containers to

grow plants.

 

" We have had some of these patients joining formal savings and credit

schemes together with the rest of the community. We are happiest when

we see them being accepted by the community and returning to work they

did before they fell ill, " concluded Munasinghe.

 

 

** Vijita Fernando is a freelance Sri Lankan journalist with more than

25 years of experience. She is a member of the Sri Lankan Federation

of University Women, Chairperson of the Centre for Family Services,

which works with women and children victimized in local conflicts, and

is a board member of a consortium of NGOs working in water and

sanitation in poor rural communities. Your emails will be forwarded to

her by contacting the editor at: ScienceTech @ islam-online.net

 

Pissa means a mad one.