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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 therapyat 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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