Why invest in mental health?
- In Nepal, mental health is not given the importance that should be accorded it. That’s unfortunate because with just a little bit of effort, we can provide much better mental-health services to our citizens
Aug 6, 2014-
The mental-health sector here is one that is perpetually neglected. People and stakeholders alike tend to think that providing mental-health service is a luxury that we can ill afford in a country where many of its citizens are still dying due to hunger and common illnesses like diarrhoea and dysentery. Till date, the government has allocated less than one percent of its total health budget towards mental-health programmes. The stakeholders too seem to have no knowledge whatsoever of how important their work is.
Take for instance, the health certificate issued as a prerequisite for obtaining a vehicle license or for taking up a foreign job. Although there are separate questions/ columns in the relevant forms for mental-health issues, they are usually filled up by the health professionals who have the least idea about what they are doing.This attitude towards mental health is probably a product of the prevailing ethos in the educational institutions themselves. The medical colleges, responsible for producing trained health professionals, do not teach enough courses on mental health. It’s little wonder then that, even for them, health simply mean physical health; and the consequence is that many people with dangerous mental illnesses may be driving buses in our country, putting hundreds of lives at stake; and many people return immediately from their job stints abroad, having severely exacerbated whatever mental illness they were suffering from.
The problem in our society starts with the common misconceptions and stigmas related to mental illnesses: that mental illnesses are rare; that there are no scientific treatments for them; that once patients become mentally ill they become ill for a lifetime; that treatments are costly and need sophisticated technology; that drug dependence is a moral problem; that mental illnesses should be kept under wraps, so on and so forth. To make matters worse for us, the global data has time and again proven that mental illness is sometimes even more burdensome for developing nations. Illnesses like depressive disorders, substance-abuse problems, epilepsy and mental retardation are proportionately more prevalent in developing countries. That’s why we cannot neglect our citizens’ mental health issues if we want to improve the health and productivity of our people, and thus the overall economy.
But the way out of this mess is not a difficult one: mental-health issues can be tackled at the primary health-care level with the existing human resources, if we provide at least some training--it’s something that doesn’t cost too much. In fact, the mental-health field is one where even developing nations can catch up with the very best nations, as it requires no sophisticated technology. All that is needed is that health professionals have the clinical skills to interview patients and prescribe treatments like medications or psychotherapies. A well-trained mental-health professional can provide world-class treatment anywhere, even in resource-strapped countries like Nepal, anytime, on the basis of his skills alone. In a country like ours, where the cost of providing such services is still relatively low, unlike in the developed world, we should be able to do better. And because the examination/ treatment of mentally ill patients can be conducted even without the professional’s touching the patients, mental health services can be effectively provided over the Internet, a practice that is now an established specialty called tele-psychiatry.
It’s important that we understand how mental health affects so many spheres of life. When people are mentally healthy, they lead better-quality lives and are more productive.Furthermore, with any physical illness, there can be many allied mental-health issues. Especially in the cases of chronic non-remitting illnesses, like diabetes, hypertension, heart and kidney failure, cancer etc, attendant mental disorders like depression and anxiety are almost the rule rather than the exception. So without addressing the issue of a patient’s mental health, any treatment one offers him can be incomplete. And even if a person were to be physically fit but mentally ill, that person can easily become dysfunctional and a burden to his family and society.
That is why the WHO has come up with the apt slogan, “No health without mental health”.
As far as the human resource here is concerned, Nepal now has a fair number of mental health professionals (more than 100 psychiatrists/ 20 clinical psychologists and dozens of psychiatric nurses and social workers); we are proportionately at par with our neighbouring countries; we actually have more professionals than Sri Lanka, which is known for its exemplary mental-health services among the SAARC nations. Thus, if Sri Lanka can provide great mental-health services in its country, we should be able to do so in Nepal too.
Dr Rabi Shakya is Assoc. Prof. & Head of the Dept. of Psychiatry, Patan Academy of Health Sciences
Published: 07-08-2014 09:36