Erasing the stigma of mental illness

Mental illness affects 10 per cent of the population of any country and this proportion increases to 25 per cent at times of major traumatic national events, according to Dr Harischandra Ghambeera, senior consultant at the Mental Hospital (Teaching), Angoda and President of the Sri Lanka College of Psychiatry.

Early diagnosis and treatment is the key to an effective cure of such illnesses, according to him.

The shortage of facilities outside the major urban areas and the stigma attached to accepting such an illness in one's family, do not help to achieve this ideal of early diagnosis. That mental illness has a stigma attached to, it is not something new to this country.

You can feel the fear, worry or pity at the mere mention of these two words. These feelings would have been natural just fifty or sixty years ago when such illnesses were not understood. Today, this shouldn't be the case, when there is a much greater understanding of mental illness.

In Sri Lanka, mental illness is virtually synonymous with Angoda. That an entire town would be associated with an illness may seem strange, but this goes back to the founding of the mental hospital there in 1925 by the British colonial government. The hospital was built on the British model, with walls several feet thick and iron bars of equal thickness in inches.

Fear and hopelessness fit easily into such a hostile place and this was the reputation conjured by the name Angoda Mental Hospital. Yet, the task of changing this impression falls on the shoulders of the staff of this very institution. Also, the task of making the public aware of the modern understanding of mental illness also falls on them.

I am writing this as I have had the privilege of seeing this transformation at first hand as a patient's relative in the last fifteen years. The most important change that I have seen is in the attitude of staff. Enthusiasm quickly transfers from staff to patients.

This I have seen at mealtimes and during drug rounds. Patients respond with appreciation to kind and caring staff. In such an atmosphere difficult situations are resolved with calmness and understanding.

That this wasn't always the case goes without saying. It was not long ago that patients were brought in bound hand and foot in chains and kept like that. Is it surprising then that a stigma of fear and dread attaches itself to the Hospital and mental illness?

Removing this stigma is not easy. Significant progress has been made since the appointment of the present Director, Dr Jayan Mendis in 2002.

From a layman's perspective I can only outline with admiration some of the steps that I have seen taken by Dr Mendis and his staff with the full backing of the Health Ministry: The change in staff attitudes mentioned above - this would have required considerable effort in staff training and education. That this is a primary objective at the highest level is reflected in the new name for the training section of the Hospital - Institute for the Study of Mental Health.

The change in admission procedures - unlike previously there is now an Emergency Care Unit for acute patients. If the patient still requires treatment after 28 days they become Medium Stay patients with rehabilitation facilities available to them. It is only as a last resort that they become Long Stay patients.

Regarding the patient as a member of a family - this can be seen in the wards, where each ward has a separate purpose built area where visiting family members can sit in comfortable and pleasant surroundings to enjoy a talk and a meal with the patient.

These areas are also used for monthly meetings where the relatives can meet and discuss with the Psychiatric Social Workers, doctors, nurses and ancillary staff the needs and concerns of the patients.

Keeping families together - the new Mother and Baby Unit was set up with this objective. Previously, if a mother gave birth to a baby, in most cases the baby would have been given away for adoption and the husband would very likely abandon his wife.

Now, husbands are encouraged to be a part of the family and this is possible with the impressive facilities available in this Unit. Buildings to complement modern attitudes - as an example the very impressive new lecture halls are in some of the original buildings designed to house patients bound and chained under lock and key in 1925!

Now, patients enjoy proper communal eating areas and covered pathways to move from one building to another.

Finally, I would like to bring to the attention of all of you members of the public, a unique event which, in my view symbolises the battle to remove the stigma attached to mental illness in this country. Called 'Art Against Stigma 2007' this is an exhibition of works done solely by the patients which will be held at the National Art Gallery, Green Path, Colombo 7, on Wednesday today and Thursday (11) October from 9 am to 7 pm each day.