With just one day more for World Mental Health Day (WMHD) - October 10 - an initiative launched in 1992 by the World Federation for Mental Health( WFMH) all those involved in achieving its goal to fight stigma and campaign for better conditions and treatment for mentally ill persons across the globe, have increased their efforts to spread this message as three decades on, the number of persons with mental problems continues to escalate both globally and in our own country Sri Lanka.
The Sunday Observer spoke to Senior Psychiatrist and former Director of the National Institute of Mental Health, Angoda, Dr. Jayan Mendis to find out more about this very important albeit sidelined health issue affecting one in three of our population, and his suggestions on how the psychiatric community can ensure optimal delivery of mental health services for all Sri Lankan thereby reducing the number of people of persons needing them in the future.
Excerpts
Q: Mental Health is now acknowledged by health authorities across the globe as an integral part of physical health. How is mental health connected to our physical health?
A. We cannot separate mental health from physical health. According to the WHO, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It includes both physical health and mental health. At the same time there is a physical component as well as a mental component when an illness of a human-being has occurred.
Q: How important is this year’s theme for World Mental Health Day “Make mental health and well-being a global priority for all”, to people with mental issues in our own country Sri Lanka?
A. This is an important health aspect that has long been sidelined and under emphasized. So we must make use of every opportunity we can when it is brought to the table for discussion, to identify existing weaknesses in our patient care services for persons with mental problems and improve them so that all Lankan people in need of such services will be able to receive optimal services and care.
Q: What are the most common mental disorders one sees today both globally and in Sri Lanka?
A. Usually, mental disorders are divided into common mental diseases and serious mental diseases. Common mental diseases in many countries are usually around 20%-30% of their population. These are namely anxiety disorders, panic disorders, stress related diseases and personality disorders. In Sri Lanka, there are no recent published research findings with regard to prevalence and incidents of common mental diseases. However, I think about 20 percent-25 percent of our population may be having some form of common mental disorders.
Q: Research has found that regular exercise and spending time with nature can help you deal with anxiety and depression; do you agree?
A. Yes, I agree. Exercise is a natural and effective way to release your tension, stress and your normal day today anxieties. It will boost your physical and mental energy. Through that it will enhance releasing various kinds of neuro chemicals. Hence, it is advisable for any ordinary public including those without any serious mental problems to perform some kind of regular exercises which will improve their mental health.
Q: Diet - It has been found that healthy diet can improve your mental health and that avoiding certain food like crisps and chocolate, eating more fruits and vegetables as well foods rich in omega-3 fatty acids, such as salmon can boost your mental health. Do you agree?
A. Yes, there have been several studies done in the UK and USA which proves that certain food like fruits and some raw vegetables rich in omega-3 fatty acids can improve general mental health as well as certain kinds of anxiety disorders and stress related disorders..
Q: Age-wise and gender-wise, who are most vulnerable to such diseases? Why?
A. If you consider age, usually most of the mental illnesses originate during adolescence or early adulthood. Usually after 60 years onwards they are more likely to suffer from dementia and depression. However, females around 50 years are also subjected to various forms of mental illnesses during pregnancy, delivery associated mental illnesses and during menopause. Inner anxieties and fears following diagnosis of a serious illness for example can lead to mental problems.
When you encounter medical or surgical disorders, those patients are also subjected to various forms of anxieties and fears and even though the disorder is not that serious, the patient may become over anxious about the diagnosis. When this happens some may not go through the treatment process properly. Some may not even adhere to treatment modality. They may not cooperate with doctors’/nurses’ and caretakers’ advice. Some may even experience a severe form of depression and some may even think about ending his/her life.
Q: How do you treat mentally ill persons in general? Are they given a blanket treatment or each treatment is custom tailored for the patient, according to their specific illness, health status and age?
A. We do not treat people with mental illnesses by giving them a blanket treatment. That approach may have been used in the last century, but certainly not now. At present, the treatments given are according to the patient’s age and by considering the specific symptoms and his/her health status. For example: A young university student who is experiencing depressive disorder will get an antidepressant.
However, if the same illness is found in a pregnant lady, the medication will be a different one by considering the pregnancy stage of the patient.
Similarly, if the patient is a pregnant mother, using the same medication as the earlier student’s case is not applicable. At the same time, if the patient is elderly and undergoing depressive disorder, our approach in commencing the medication might be different.
Q: Are these treatments available at most state hospitals?
A. Yes, most state hospitals in Sri Lanka will normally have a variety of psychiatric medicines to suit the needs of every patient.
Q: We are now in the post Covid-19 period, with fear of new infections and viruses. This has raised the anxiety levels of many patients with Non Communicable Diseases ( NCD’s) such as those with cardiac problems, diabetes, cancer, hypertension, and related illnesses Can this lead to mental problems as well?
A. During the time of Covid-19, the general anxiety level of the population was very high as they had been undergoing various stresses. Further, Covid-19 created and enhanced mortality and morbidity of mental disorders. At the same time, it had more negative effects on patients with long-term mental illnesses such as schizophrenia and bipolar disorder.
Q: Age-wise and gender-wise, who are more vulnerable to psychiatric problems due to the Covid 19 pandemic?
A. Patients who are more vulnerable to Covid-19 are those who are above 60 and those who suffer from diabetes, high blood pressure and various other kinds of medical problems. Similarly, those who have been undergoing various other kinds of psychiatric problems and psychological disturbances are also more vulnerable.
Q: Another issue that is very prevalent in our society, although rarely discussed openly, is Stigma and Prejudice against people suffering from both mental (Schizophrenia, Depression, Dementia and Alzheimers) and non-mental diseases such as HIV /AIDs , TB. These persons are often treated like social outcasts even in some health care facilities while their unequal place in society prevents them from living with dignity in normal society. What is your observation on this unfortunate situation?
A. Yes, I admit that there are non-communicable illnesses about which many people have little knowledge. It is this ignorance that leads to stigma and prejudice. By knowing the illness better, by understanding the illness better, by prognosticating the illness better and having better treatment modalities and other kinds of therapeutic modalities, we can reduce this negative biased approach to such illnesses on the part of society as a whole.
The psychiatric community in Sri Lanka is currently trying to overcome these negative ideas and we are encouraged by the positive feedback we have had so far from the patients and all others involved in our collective efforts.
Q: With regard to Services currently available for mentally ill patients in the hospitals, could you, as a Founder member of the Mental Health Institute (NIMH) and Past President, Sri Lanka College of Psychiatrists in Angoda walk us through some of the most important recent steps taken to reach out to mentally ill persons and at the same time improve the quality of services and care you give them?
A. Compared to some years ago, we have taken quite a number of steps both in our services and care for mentally ill persons. A large percentage of nurses have undergone post basic mental health training. About 200 nurses have undergone training in community psychiatric nursing. So too has a large percentage of Family Health Workers. We also have Psychologists working in some of the psychiatric clinics. When compared to the past, I can say with confidence that we have a satisfactory mental health service all over the country.
However, I admit that further improvements are necessary and there are some gaps in the services which need to be filled as soon as possible.
Q: Does Sri Lanka have half-way houses to help discharged patients to adjust to living in normal society
A. In the past, psychiatric services were mainly confined to Angoda. All the patients in the country have to be admitted to Angoda only with some patients remaining there for many years.
Today our mental service has become decentralised. Each district now has more than one psychiatric inpatient facility. Most districts also have a Rehabilitation facility, Long-term Care facility, Divisional hospitals and Primary Healthcare facility for patients’ assessment, helping us to provide the treatment as early as possible. There are more than about hundred psychiatrists working in the country. There are doctors with diplomas and certificates as well as better trained Medical Officers to deal with mental health conditions all over the country.
Q: Your message to all our readers out there struggling to cope with the stress of modern life?
A. My advice to them is to know how to manage your stress and reduce anything and anyone that raises your stress levels. When you are exposed to unwanted and unmanageable stress, you will face various psychological problems from acute stress to prolonged stress and this may lead to various other psychiatric disorders. Surround yourself with things that soothe the mind like nature.
Practise yoga .Stay physically active and discuss our problem with someone else if you can’t deal with it alone. Helping another with a mental problem on a voluntary basis also relieves and helps you to forget your own pain and inner stress. Avoid smoking and alcohol. Engage in fun games with family and friends.