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Challenges in SL’s mental health arena: Brain drain & lack of medicines
View(s):- Dr. Sajeewana Amarasinghe details how the Sri Lanka College of Psychiatrists is helping to cope with the situation
By Kumudini Hettiarachchi
Powerful was the focus on numerous mind-related issues as local and international Psychiatrists gathered in Colombo this weekend.
‘Quality Mental Health Care in South Asia’ was the theme as the 21st Annual Academic Sessions of the Sri Lanka College of Psychiatrists and the 15th SAARC International Psychiatry Conference were inaugurated on Friday (July 26).
Friday evening’s highlight was the induction of the new President of the Sri Lanka College of Psychiatrists for 2023-2024, Dr. Sajeewana Amarasinghe, followed by his wide-ranging speech on ‘Psychiatry in Sri Lanka: The Past, Present and Future’.
From left: Sri Lanka College of Psychiatrists Secretary Dr. Malsha De Silva; Outgoing President Dr. Kapila Ranasinghe; Chief Guest Dr. Lade Smith; new President Dr. Sajeewana Amarasinghe; Guest-of-Honour Dr. Astha Tomar; and SAARC Psychiatric Federation President Prof. Shehan Williams. Pix by Akila Jayawardene
The President of the Royal College of Psychiatrists, Dr. Lade Smith graced the occasion as Chief Guest and the President-elect of the Royal Australian and New Zealand College of Psychiatrists, Dr. Astha Tomar as Guest-of-Honour.
Diving deep into the challenges faced by Sri Lanka, Dr. Sajeewana Amarasinghe brought to the fore the economic crisis and brain drain which had seen not only the migration of Psychiatrists, but also junior doctors as well as nurses.
The numbers told a sorry tale – even though the cadre of General Adult Psychiatrists working for both the Health Ministry and universities should be around 100, some Consultant-led units were vacant while there was an inability to retain sub-specialists. Permanent Psychiatrists were not available at 27 stations including several major stations such as Anuradhapura, Badulla, Ampara, Mannar, Mullaitivu and Kilinochchi.
Outgoing President Dr. Kapila Ranasinghe inducting the new President Dr. Sajeewana Amarasinghe
Dr. Sajeewana Amarasinghe
He went onto spotlight how child psychiatry and old-age psychiatry services have also been severely impacted. Currently, there were only five Child and Adolescent Psychiatrists, all based in the Western Province, with no Child Psychiatrist at the second largest paediatric hospital in the country, the Sirimavo Bandaranaike Children’s Hospital, Peradeniya. Child psychiatry outpatient services in all major General Hospitals were mostly conducted by General Adult Psychiatrists. This was while at the other end of the spectrum, there were only three Old-age Psychiatrists based in Colombo, Kalubowila and Ragama with none even in Kandy or Galle.
Another cause for concern, according to Dr. Amarasinghe was the lack of forensic psychiatry, with no PGIM-certified (Post-Graduate Institute of Medicine) Forensic Psychiatrists. There were only three acting Consultants at Mulleriyawa’s National Institute of Mental Health (NIMH), Kandy and Galle.
However, he held out hope against fears of a collapse of the system, when he explained that Continuous Medical Education (CME) in child psychiatry was being provided for General Adult Psychiatrists while also improving the mental health knowledge of Medical Officers (MOs) and improving skills and knowledge among other stakeholders such as nurses, social workers, occupational therapists, police officers, emergency department staff, LGBTQ (lesbian, gay, bisexual, transgender and questioning) community and the public. Child-friendly school programmes are also being held by the Health Ministry and the Sri Lanka College of Psychiatrists.
Dr. Lade Smith
Focusing on the lack of Clinical Psychologists in the government sector, Dr. Amarasinghe said that the college was working with the Health Ministry to fill this vacuum.
Another major challenge in Sri Lanka was substance use (alcohol, heroin, methamphetamine, cannabis etc.) and the resultant disorders, with few services being available in response, he said, adding that the college was working towards resolving this issue.
Dr. Astha Tomar
Lamenting that psychiatric patients have been badly affected by the lack of medicines, Dr. Amarasinghe detailed how the college was actively involved in the committee tasked with drawing up an essential drug list, as well as in monitoring the supply of medications and intervening when necessary.
In conclusion, he was very hopeful that the long-awaited Mental Health Act, a draft of which has been handed over to the Health Secretary recently, would soon see the light of day.
The comprehensive programme of the sessions, meanwhile, had been the fruit of the tireless efforts of the Conference Chairpersons Dr. Chathurie Suraweera and Dr. Chamara Wijesinghe.
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