For a mentally healthy nation

9 October 2012 09:10 pm - 1     - {{hitsCtrl.values.hits}}

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By   Nalaka Mendis
Emeritus Professor of Psychiatry, University of Colombo
During the last few decades, the governments of many countries have increasingly recognised the pain, distress, disability, death, burden, stigma and economic loss due to mental disorder on both the individual and the family.  Mental health systems have evolved to meet these emerging trends by significantly reforming the traditional centralised psychiatrist-oriented mental hospital-based specialised care. Emerging changes include increasing emphasis on psychosocial distress and mental health, providing more accessible care through local delivery, widening of interventions to include a range of psychosocial approaches, increasing integration of mental health into general health, involvement of general health workers and others having psychosocial orientation in mental health activities, and broadening the responsibility of different sectors to contribute towards mental health development.  

Over the past years Sri Lanka has attempted to introduce such developments through far reaching recommendations by Professor Edward Mapother in 1938, Dr. W G Wickremasinghe in 1966 and again through a series of informal initiatives during the nineteen eighties and nineties. These developments could not be implemented or sustained fully for an adequate period of time to bring about any meaningful reforms to improve mental health care or access to services. This was largely due to a failure of successive governments to develop long-term implementation strategies which led to a dearth of professional staff and inadequate allocation of funds.  As a consequence   mental health services stagnated and sometimes even regressed over the years. In the absence of any initiatives by the government to improve access to mental health services, most psychiatrists opted to focus on clinical work and maintain their professional status making use of the little resources available within the service.

Can the present government which is committed to develop the country in an equitable manner by uplifting deprived communities and regions reverse the above trend? This will entail accepting the challenge of providing the necessary leadership, resources and a development strategy to upgrade and upscale the emerging “district mental health movement” which has been unfolding during the last decade. This new mental health movement aims to provide comprehensive mental health services targeting the needs of those living in a given geographical unit or a district. This unique movement with great potential has led to a major improvement in access to mental health care during the last decade.  

Most district leaders including psychiatrists and provincial administrators increasingly see  their responsibility to provide a range of services within the district. District mental health teams and committees have evolved and are functioning.  Over the last decade all districts have established at least basic services consisting of one or more inpatient units, a large number outpatient and outreach clinics and other specialised services including for alcohol dependence, childhood mental illness, and rehabilitation and counseling services.

We in Sri Lanka need to evolve a modern, accessible, affordable and high quality mental health service to meet the changing mental health needs of the whole population. There is now strong evidence to suggest that in Sri Lanka basic, general and most of the special mental health services could be provided at the district level. A competent and a well trained workforce based in the districts, adequate facilities and the necessary funds are absolutely essential to develop and sustain such a district service by up scaling and upgrading the present district mental health movement.  We cannot ignore the fact that the success of the mental health programme also depends on the extent of input from original research, high quality training, highly specialised clinical services and good management strategies. Such activities should be the responsibility of special centres or units managed by those with competence and expertise who are able to think creatively and innovatively on the basis of evidence. In an era in which mental health issues are coming to the fore of health care it is important for the government to bring about the  reforms to upgrade and upscale the present services so that the benefits of new developments are accessible to all citizens of
Sri Lanka.
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  Comments - 1

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  • Janaki Kalansuriya Wednesday, 10 October 2012 11:29 PM

    Mentally ill head count must be taken in the parliament and treated soon. The country continues to slip further in to the abyss.


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