By Vijita Fernando**
The recent tsunami in Sri Lanka has increased the numbers
of depressed individuals in the country.
To be cast out of your home and your community for being mentally
ill is a sentence to destitution, often a sentence to death. This is
what would have happened to Piyasena, a young man from a rural village in
southern Sri Lanka. Piyasena was lucky. A community-based program
called BasicNeeds spared him the usual fate of most mentally ill people in
the country.
According to the World Health Organization's 2001 World Health
Report, mental illness accounts for 12.3 percent of the global burden of
disease. This is expected to rise to 15 percent by 2015.
In Sri Lanka, 376,000 people suffer from some form of serious
debilitating mental illness, according to Sri Lanka's Ministry of Health.
The ethnic conflict of the last 20 years and the recent tsunami
disaster have increased depression and medically unexplained symptoms.
The stigma attached to the mentally ill is a stigma not only to
the patient, but to his whole family. The family keeps him away from the
community; sometimes locked inside the house, chained, and out of sight
of visitors. The stigma means he is inauspicious, unfortunate, his
womenfolk may never get a proposal of marriage, and he has no access to
medicine or care.
Hope for the Mentally Ill
Basic Needs Basic Rights is a non-governmental organization (NGO)
that has developed the Basic Needs Mental and Development Model. This
model aims at constructing collaborative interventions to demonstrate
that mentally ill people can actively participate in the process of
development.
The approach by this NGO to mental health and development is to
work first with a small community. This is to allow the program to
closely monitor the issues that challenge the mentally ill and their
families. The model which was first developed and tested in South India is
being used as a guide.
"We started the pilot project in 2003 with 34 mentally ill
people. We now have 1283 patients in several villages in the Southern
Province," said Chinta Munasinghe, director of BasicNeeds Sri Lanka.
This growth in numbers of participants has resulted in the
development of the Mental Health Care Through Community Partnership, which
complements the local government delivery structure. Munasinghe explained
that the most outstanding feature of this partnership is a program in
which community volunteers, 30 percent of whom are mentally ill, run
community-based activities.
These activities include monthly mental health camps run in
collaboration with the mental health hospital close to the capital, Colombo,
and the teaching hospital at Ratnapura, 60 miles from Colombo. These
are outreach clinics run by medical officers in collaboration with
general hospitals and outpatient clinics for drug administration at primary
level hospitals in towns.
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"The model acknowledges the right of mentally ill people to
consult and be consulted and goes beyond diagnosis and the provision of
treatment to focus on mental health in a community setting." Valli
Seshan
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While these meet the physical and health needs of the mentally
ill, the social interaction possible through the BasicNeeds project has
gone an extra length in rehabilitating patients into the community.
Piyasena, for instance, is now a member of the volunteer
committee which plays an active role in organizing communities. His duty is to
ride in a three-wheeler announcing through a loudspeaker the news of
events such as health camps or the visit of a specialist doctor to the
community. The significant factor here is that the mentally ill people in
the volunteer committees have earned a firm place in the community,
where earlier they were shunned by those very same communities.
Important Feedback
Mentally ill persons are selected to talk about their experiences
when BasicNeeds meets authorities seeking help to replicate the program
in other parts of the country. This has led to the mentally ill and
their families volunteering to come out with their problems and discuss
them openly.
"There was a session where the mentally ill participants were
invited to talk about their experiences with medication and they discussed
difficulties they faced, including side effects. This open discussion
gave us a lot of insights into problems that patients face, which we
were not aware of. It was a learning experience for us," said consultant
psychiatrist Dr. Neil Fernando, who supervises the patients in their
medical needs and use of medicines.
In addition to monthly mental health camps in the community by a
multidisciplinary team of health professionals, mental health clinics
are gradually being integrated into medical clinics by medical officers
with training in mental health, where the mentally ill are treated
along with other patients.
"This interaction between communities, organizations and
institutions has enabled the wider appreciation of the Mental Health and
Development Model on which this work is based. The model acknowledges the
right of mentally ill people to consult and be consulted and goes beyond
diagnosis and the provision of treatment to focus on mental health in a
community setting," said Valli Seshan, chairperson of the BasicNeeds
India Trust, where the model is being tried out in several villages. The
Indian experience in addition to the experiences of the same model in
different settings in Northern Ghana, Tanzania, and Uganda provide
extensive exchange of valuable ideas and experiences.
Changing Traditions
Village volunteer committees are the bedrock on which the
complete success of the project rests. It is they who encourage the mentally
ill to use the services available. This means that they must patiently
approach the families and encourage them to change their traditional and
conventional views of treating their mentally ill members.
Traditionally, mentally ill patients were not provided with medical treatment, were
hidden away from the rest of the world, and in short were deprived of
their basic rights as human beings.
"The volunteers are trained in the basics of mental health and
organized into self-help groups around the mentally ill. We have had some
volunteers donating small plots of land to start group farms. Temples
and schools in the villages help by getting involved in socializing
activities with the mentally ill," said Lalitha, a member of a volunteer
committee.
This has helped to reduce the stigma and discrimination attached
to the mentally ill. In fact, one volunteer said with a smile, "The
derogatory word that was used to describe a mentally ill person, pissa!,
is no more used in these villages."
The community activities have now gone beyond the limits of small
villages to the attention of medical authorities in the country. These
joint ventures have helped BasicNeeds to reflect community needs and
interests in the formulation of national policies and in setting up
systems.
The project also takes into its fold destitute mental patients
stranded in mental hospitals and rehabilitation centers. It has provided
them, for example, with horticulture therapy at the premier mental
hospital in Colombo in partnership with the government. This project is
gradually extending into a viable commercial enterprise of selling plants
and produce, mushroom cultivation material, and a thriving business of
selling clay pots and ornamental containers to grow plants.
"We have had some of these patients joining formal savings and
credit schemes together with the rest of the community. We are happiest
when we see them being accepted by the community and returning to work
they did before they fell ill," concluded Munasinghe.
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** Vijita Fernando is a freelance Sri Lankan journalist with more
than 25 years of experience. She is a member of the Sri Lankan
Federation of University Women, Chairperson of the Centre for Family Services,
which works with women and children victimized in local conflicts, and
is a board member of a consortium of NGOs working in water and
sanitation in poor rural communities. Your emails will be forwarded to her by
contacting the editor at: ScienceTech@islam-online.net
Pissa means a mad one.
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