Keeping your mind fit

Beginning our new fortnightly series on mental health, in association with the National Council for Mental Health "Sahanaya'.

In the past , when we heard the phrase "men tal illness" we conjured up images of ranting and raving people, with uncombed hair and dishevelled appearance, walking around aimlessly- those out of touch with reality. In many a person's vocabulary, words such as "crazy" , "mad" and "lunatic" were synonymous with this image. Now the picture has changed somewhat. When we talk of mental illness we now refer to a person who has difficulty coping with daily functioning and who shows a change in behaviour to the norm.

Yet mental illness still has a label of stigma attached to it. Due to this image of mental illness that most of us have falsely developed and the stigma attached, many a person who needs help shies away from getting appropriate treatment, there by often jeopardising his/her ability to live a productive and healthy life.

In reality, just as our bodies develop physical illness, our minds can develop mental distresses or mental disorder. Mental illness affects a person's thinking, feeling and perception. This can lead to changes in the way he /she behaves and can cause difficulties in day -to -day life. Mental disorders vary from mild disorders such as phobias and anxiety to more disruptive disorders such as schizophrenia and mood disorder. Therefore, depending on the disorder and its severity, treatment may be required. Often with proper treatment, many suffering from mental disorders can effectively return to normal productive lives.

About 1% of Sri Lankans suffer from a major mental illness and about 12.5% from minor mental illnesses. A percentage of people seeking medical treatment actually suffer from emotional difficulties.

Who develops mental illness?

Mental illness can occur in any family to any individual, at any given time, regardless of age, (children, adolescents, adults and the elderly) economic status, race or gender -no one is immune.

Mental illness involves a degree of incapacity that interferes with employment schooling and daily life. People with mental illness as well as family and friends often do not recognize that they suffer from it. Those who have developed mental illnesses suffer rejection from others because people do not understand that the change in behaviour is due to the illness. This needs to be understood and the person needs to be supported.

Some sign to look for...

*A change in usual behaviour

*Inability to cope with day- to- day activities

*Excessive worry /anxiety

*Prolonged apathy and depression

*Abnormal degree of happiness and restlessness

*Undue fears and suspicions.

*Changes in sleeping and eating patterns

*Loss of interest in activities

*Thinking and talking about suicide

*Drug and alcohol abuse

If a person has three or more of the above symptoms, he /she should consider seeking treatment.

Can mental illness be treated?

Mental illness can be treated. Medication, psychological therapies and rehabilitation are the methods commonly used. If the appropriate treatment is received, the majority of people can return to productive life. Therefore, it's important to raise awareness on mental illnesses and to facilitate treatment early on.

What can you do?

*Seek treatment without delay

*Strictly follow the doctor's advice when taking medication

*Seek psychological and rehabilitation services when necessary

*Acquire information about the illness from the relevant sources which will help the individual as well as provide a supportive environment within the family.

Courtesy of National Council for Mental Health Sahanaya.

Mental health for the millennium

Fifteen per cent of the population is at any one time subject to mental disorders, states the NGO Plan of Action for the Year 2000, in the field of Mental Health.

And finally it appears that this 15 per cent's needs are being addressed, with the co-ordinated efforts of the Government and Non Governmental Organizations working to give them a better quality of life.

Wheels have been set in motion for a reintegration programme, which will allow patients of the Mulleriyawa Hospital who have been cured to be gradually placed back within their families. This will allow them to once again function in society in a healthy environment.

"It was a big breakthrough," Mrs. V. Jegarasasingam, Addl. Secretary, Ministry of Social Services and Chairperson, Steering Committee on National Mental Health Week, said.

"On July 1 we went to the Mulleriyawa Hospital and discussed the problem with the Director and the staff. We got in touch with the patient's families, and also counselled their families to take them back," she said.

"Social integration is part of our Ministry. We want to train and use the provincial staff for this work," Mrs. Jegarasasingam said. From the Western Province there are 68 people being reintegrated with their families, in the Wayamba 11, North East Province 5, Southern 19, Sabaragamuwa 10, Uva 3, Central 8, and in the North Central Province 2.

Since 1997 Mental Health Week has been celebrated in Sri Lanka from October 10 -16. The theme this year will be "Mental Health and the Elderly".

A halfway house is to be set up in Avissawella Mrs. Jegarasasingam said. The Minister of Housing has agreed to donate a house for this purpose and Richmond Fellowship International is willing to give 62,000 pounds towards this project.

Chairman, Richmond Fellowship Lanka, Arun Tampoe, speaking of the role of halfway houses said, half-way houses are for those who have been released of their positive symptoms but have the negative symptoms.

"The public at large do not have an understanding that a person can be cured of mental illness. They call it bad luck, 'karma' or say the person is a 'pissa' (lunatic). That is a primitive way of looking at it. A lot of mental disorders can be cured." Mr. Tampoe added that the issue of mental health is as crucial as physical health and well-being although our public has always tried to brush it under the carpet.

"The crying need is for financing institutions," Mr. Tampoe added. "We're always ready to finance cricket or rugger but when it comes to something like this people are not interested," The Health Department spends money on curing people afflicted by self inflicted illnesses like alcoholics. Whereas in the case of mental illness it is not the patients' fault, as the illness is caused by chemical imbalances, genetic defects etc," he stressed.

Dr. Rajaram Subbian, Consultant Redd Barna said, "The priority is expanding the training of medical and non medical mental health professionals. For instance Professional Training for Counsellors is lacking. I wish that the Year 2000 would be declared Mental Health Year," he added.

In Sri Lanka the co-operation between the NGO sector and the Government sector is very important. It is the nexus between these two sectors that resulted in the declaring of Mental Health Week in 1997, Dr. Subbian said.

Ms. Yoga Balachandran, Director, Family Planning Association, who has worked more than 30 years in the field of Family Planning, showed how mental health was linked to every field.

For instance, she explained that women practising family planning in an environment in which the spouses are against it "go through trauma throughout their lives".

Suicide is a very tragic outcome of mental illness. And Sri Lanka ranked first in world suicide figures for many years. But of late it has been reported that suicide figures are dropping. From 7364 in 1993 to 5869 in 1998.

"There are eleven suicide prevention centres in various parts of the island," said Ms. Nalini Ellawela, Director, Sumithrayo Training Centre. "Counsellors need to identify the suicide prone and counsel them."

The suicide prone can be broadly categorised as - (1) Those suffering from mental illnesses, such as Depression and Schizophrenia (2) Alcoholics (who make up 25 percent of the suicide figures) (3) Those who are unable to handle their emotions, who experience feelings of helplessness and those who are suddenly provoked, and use suicide to threaten and as a tool,' Ms. Ellawela explained

The President of Sumithrayo also felt that reporting suicide should be based on facts alone, without unnecessary twists being given to create reader interest. One must be careful not to glamourise when writing of suicide nor to make heroes of those who have committed suicide. She added that politicians also use suicide to prove their point, as in the instance when the Polonnaruwa farmers committed suicide.

Meanwhile, President of the Federation of NGOs for Mental Health and Well-being, Ms. Malini Balasingam, who was instrumental in organizing the participatory seminar titled "Mental Health in the Year 2000" which was held on August 7, said "What's important is that the NGO sector and the Government have got together, because in future the whole idea is to decentralise mental health care."

Ms. Balasingam said the Federation is taking the initiative because they have 26 member NGOs in the field of mental health and well-being and the federation is committed and has a sense of responsibility in seeing that the available mental health services which are extremely inadequate now, can be reorganised and expanded to meet the demand.

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