The increasing emphasis on the mental well being of the Lankan people in a new drive by the President and Health Ministry has brought this much neglected subject out of the closet and placed it at the center of almost all discussions relating to general health.
The Sunday Observer spoke to Senior Lecturer, University of Sri Jayewardenepura, Consultant Child and Adolescent Psychiatrist, Colombo South Teaching Hospital, Dr Yasodha Rohanachandra who draws on her experiences to identify early symptoms of mental illness and the services in place in state hospitals.
Excerpts…
Q. Mental Health came into new focus recently when the Health Ministry decided to give priority to mental well-being making it a component of the revised Health Services Master Plan for the period 2010-2025. How do you define mental illness in layman’s language?
A. It is not merely the absence of mental illness. It is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life and work productively and fruitfully to make a contribution to her or his community.
Q. If mentally unstable, can it affect a person in everyday life?
A. Mental illness affects many aspects of a person’s life. It can cause poor attention and lack of motivation which can hinder one’s education and work performance. It can affect social relationships, friendships and intimate relationships. Mental disorders can lead to impaired judgment and poor decision making which in turn can cause people to engage in risky behaviours. However, each person experiences mental illness differently. It depends on many factors including the nature of the illness, their personality and available social support. Even the effect of the same mental illness can be different in two individuals.
Q. Is this because these conditions are linked to the brain?
A. Yes. The brain is a complex organ which controls all our thoughts, feelings and actions. Effective function of the brain depends on efficient communication between brain cells. Chemicals called neurotransmitters are the mainstay of communication between these brain cells. Psychiatric disorders occur when there is an imbalance in these chemicals, which lead to inefficient communication between brain cells. This may cause abnormalities in thoughts, feelings and actions. In addition, defects or injury to certain areas of the brain can cause psychiatric disorders.
Q. Excessive hostility or anger?
A. Anger becomes a problem when it becomes out of control and harms you or people around you.
Q. Are more women than men or vice versa affected by mental disorders? Why
A. Certain disorders such as depression and anxiety are more common in women, whereas disorders like schizophrenia are commoner in males. The increased likelihood of women to develop depression starts around the time of puberty. Therefore, female sex hormones may play a role on the female preponderance of depression. Women are also more likely to experience adverse life stressors such as sexual abuse and domestic violence than men.
Q. What are the main contributory factors for mental disorders?
A. Most psychiatric disorders have a genetic contribution. In many disorders, there is no single gene responsible but it is due to the multiple small effects of several genes.
Family discord, parental indifference, parenting styles characterized by overprotection and lack of warmth, bullying and childhood physical and sexual abuse have all been implicated in the development of psychiatric disorders.
Q. Symptoms to look for in 1) young children 2) youth and adolescents 3 ) middle aged 4) elderly.
A. In young children, any recent change in behaviour can indicate a mental health problem. For example, recent onset irritability, disobedience or aggression, deteriorating school performance in a child who previously had good or average school performance, reluctance to go to school, not engaging in previously enjoyed play activities, sleep disturbances, changes in appetite, new onset fears, clingy behaviour and new onset bed wetting can all indicate mental distress.
In adolescents recent onset irritability, aggression and disobedience are common signs of underlying psychological distress. Giving up previously enjoyed activities are common signs of mental health problems. In the middle aged, mental illness may present as changes in mood, level of activity, abnormal false beliefs, abnormal perceptions, changes in sleep and appetite and decline in day to day functioning. Elderly can present with any of the symptoms that middle aged people present, as well as memory loss, decreased concentration, disorientation, difficulty in word finding, changes in personality or difficulty in performing everyday tasks.
Q. Gaps in the delivery of efficient mental health services?
A. Poor mental health literacy among the general public is one of the main reasons that people do not seek help from mental health professionals. Psychiatric disorders are often attributed to be caused by malevolent charms, evil spirits and astrological problems by the public. Other reasons for poor help seeking in psychiatric disorders may be negative attitudes and stigma against mental health problems.
Q. Stigma and prejudice attached to mental instability? How has the Health Ministry tried to overcome this?
A. Several programs to improve mental health literacy among the public are being carried out. The Ministry also aims at shifting care for mentally ill from separate ‘Psychiatric hospitals’ to general hospitals, which is also important in reducing stigma against mental illness.
Q. How is mental disorder detected and by whom?
A. There is no specific test to diagnose mental disorder. Diagnosis is based on the patient’s signs and symptoms, and requires a detailed history of the patient’s presenting symptoms, duration and progression of symptoms, level of functioning, past history of any mental health problems, etc.. A special training in Psychiatry and specialized skills are needed to make a confirmatory diagnosis. It is best done by a Psychiatrist.
Q. Can a mental illness disappear on its own ?
A. Most mental illnesses do not improve on their own. If mental health issues arise while adjusting to a new situation, these adjustment disorders may improve on its own. All other mental illness needs treatment, either psychological therapy or medication.
Q. What happens if it is untreated?
A. The obvious effect of untreated mental illness is decline in mental health. When mental illness goes untreated, especially, when undiagnosed, it can affect one’s interpersonal relationships, and cause a person to withdraw from social contacts resulting in social isolation. Untreated mental illness in a young person will lead to missed days of school and deterioration of school performance. Same will occur with work performance in an adult.
It can lead to poor management of physical health, miss doctor appointments, ignore symptoms, making bad lifestyle choices. If untreated, one psychiatric disorder may even give rise to another psychiatric disorder. For example, untreated anxiety disorders often end in depression.
Q. What is the usual treatment procedure?
A. The patient can be brought to the outpatient department of a government hospital with mental health services, where an appropriate referral to the psychiatric services will be made. The individual will then be assessed by the mental health team to decide on further management.
Q. After treatment is there any follow up of cases? Who does this and how?
A. All patients who have been diagnosed with mental health disorder need proper follow-up at the follow-up clinics conducted by the mental health team. If the patient was treated at a distant hospital, once the mental state is stable he or she may be referred back to the follow-up clinic in their closest hospital.
Q. Briefly outline the important aspects of the revised Master Plan on Health and what its goals are in relation to mental health.
A. Some of the proposed activities related to mental health include; shifting the focus of care from long stays at mental hospitals to non specialized health settings, increasing public awareness on mental health, conducting life skills based health education programs for schoolchildren, conducting awareness programs for parents on adolescent health problems, supporting marginalized groups at risk of mental diseases and capacity building of health care workers with knowledge and skills in delivering a range of mental health care.
Q. Your message to students, parents, teachers, employers on the importance of mental wellbeing?
A. No one is immune to mental health problems. It could affect anyone at any time and at any age. People with psychiatric disorders get better with treatment and many recover. They can be as productive as others in employment. Friends and family can be important influences to help someone get the treatment and services they need.
Q. Do you have a hotline?
A. The National Institute of Mental Health (NIMH) has a mental health helpline 1926, where any individual can call the helpline and receive mental health assistance from the staff at NIMH.