Author: Dr. Sukheshni
Mental health is more than just the absence of mental disorders or disabilities. "Mental health is the state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community" . On this basis, it can be said that mental health is fundamental to our collective and individual ability as humans need to think, emote, interact with each other, earn a living, and enjoy life. There are various social, psychological, and biological factors that act as determinants or determine the level of mental health of a person at any point of time . Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, physical ill-health, and human rights violations .
Some mental disorders can be prevented; most mental and behavioural disorders can be successfully treated; and that much of this prevention, cure and treatment is affordable . However, according to WHO despite the availability of treatment, nearly two-thirds of people with a known mental disorder never seek help from a health professional due to factors such as stigma, discrimination, and neglect . Where there is neglect, there is little or no understanding. Where there is no understanding, there is neglect. "Mental illness is not a personal failure. In fact, if there is a failure, it is to be found in the way we have responded to people with mental and brain disorders," said Dr. Gro Harlem Brundtland, Director-General of WHO, on releasing the World Health Report . The responsibility for action lies with governments, says WHO. Currently, more than 40% of countries have no mental health policy and over 30% have no mental health programme . Around 25% of countries have no mental health legislation. The lack of access to affordable treatment makes the course of the illness more severe and debilitating, leading to a vicious circle of poverty and mental health disorders that is rarely broken .
People with these disorders are often subjected to social isolation, poor quality of life, and increased mortality . These disorders are the cause of staggering economic and social costs. Estimates made by WHO in 2002 showed that 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report shows that 50 million people suffer from epilepsy and 24 million from Alzheimer's and other dementias . About 877,000 people die by suicide every year . Furthermore, barriers to effective treatment of mental illness include a lack of recognition of the seriousness of the mental illness and a lack of understanding about the benefits of services. Policymakers, insurance companies, health, and labor policies, and the public at large – all discriminate between physical and mental problems .
Mental health services are centralized at the national psychiatric hospital . Short-term emergency care and primary care are available at divisional and sub-divisional hospitals, health centers, and nursing stations Nationwide. This care is provided by public health nurses, public health doctors, or physicians who often have a lack of mental health training and inadequate facilities for psychiatric patients . Mental health care and psychotropic medications are supplied to the population free of charge. Fiji is fortunate to have a wide range of conventional anti-psychotic (tablets, short-acting and long-acting injections) and antidepressants available as well as a limited number of newer psychotropic medications such as olanzapine and fluoxetine, which are also supplied free .
Fiji has the highest suicide rate in the South Pacific, four times more than the road death toll . Fiji's mental health services were established in 1884, comprising a single ward to care for mentally ill expatriates. Services have since expanded to include the St. Giles Hospital, which provides outpatient, psychosocial rehabilitative, and community psychiatric services . St. Giles is also responsible for conducting mental health awareness and training for health workers and the public and provides input at a national level for mental health policy, plans and legislation . Psychiatric training is available at the undergraduate nursing and medical levels. The Fiji School of Medicine is in the process of developing a postgraduate psychiatric program . With its limited resources Fiji needs to integrate mental health services into the general and public health systems to achieve a comprehensive and integrated mental health system .
The stigma with St. Giles Hospital has fostered a very tragic catch- 22 scenarios whereby people are reluctant to seek assistance for mental health problems while their conditions worsen, sometimes resulting in them being brought to St. Giles Hospital forcibly, adding again to the stigma associated with being mentally unwell that prevent people from seeking appropriate assistance and turning to alternative means of treatment . There is a dire need to educate the public and promote community awareness on mental health issues . Other challenges include the limited resources available, both financial and human; the lack of trained mental health professionals and allied mental health professionals; limited community mental health and psychosocial rehabilitative services; archaic infrastructure, and the need for new legislation which is in line with the modern-day practice of psychiatry . However, this is not to say that Fiji’s mental health services have not continued to develop and evolve despite the challenges and short-comings .
Despite the outlawing of corporal punishment, some school teachers are struggling with the law . There have been cases where they have to go through disciplinary proceedings because they have allegedly breached the law. Under pressure, they resort to the only way they know . Some call it tough love, not corporal punishment. Such harsh forms of punishment for misunderstood children struggling with hidden mental health issues can worsen the child’s condition or even cause mental health deterioration . The challenge at school with corporal punishment can be best dealt with if they have a full-time mental health expert who can provide basic consultations and diagnosis . In the new National Budget, Public Health Services, which includes mental health, gets $6.4 million. While we cannot compare ourselves with New Zealand, the Government there has allocated a record NZ$1.9 billion to mental health over five years in the first well-being Budget . When we enjoy positive mental health, the students’ academic performance, national productivity, and the economy will improve .
In the midst of COVID-19 pandemic, mental health and wellbeing of whole societies have been severely impacted and is a priority to be addressed urgently,” she told reporters at a briefing . “The isolation, the fear, the uncertainty, the economic turmoil – they all-cause or could cause psychological distress,” said Devora Kestel, director of the World Health Organization’s (WHO) mental health department . Outside of the health sector, the WHO report said many people are distressed by the immediate health impacts and the consequences of physical isolation, while many others are afraid of infection, dying, losing family members facing economic turmoil, having lost or being at risk of losing their income and livelihoods . In addition, frequent misinformation and rumors about the pandemic and deep uncertainty about how long it will last are making people feel anxious and hopeless about the future . It outlined action points for policy-makers to aim “to reduce immense suffering among hundreds of millions of people and mitigate long-term social and economic costs to society” .
According to Dr. Ifereimi Waqainabete, local healthcare workers need to be trained accordingly to handle such matters . A UN Expert also stated that the Fijian population’s mental health is an emerging priority . He also added that it is critical to have psychological interventions for children and adults with mental health conditions at the community level and healthcare workers should be empowered to be involved in the provision of mental health support and care .
Fiji is also a participating in two regional initiatives: the START (Suicide Trends in At-Risk Countries and Territories) study, a WHO study on suicidal behavior in the western pacific region; and is a member of the newly formed Pacific Island Mental Health Network (PIMH Net) which was officially launched in April 2007 . There must also be a commitment to improve the delivery of mental health care services through its integration with primary health care. Other services are also available which include the Stress Management Ward (SMW) at CWM, Community Psychiatric Nursing (CPN) Clinics and Home-Visits, Community Rehabilitation Out Reach Program (CROP), Youth Champs for Mental Health (YC4MH), Fiji Health Sector Improvement Program (FHSIP), National Committee on the Prevention of Suicide (NCOPS), Fiji Health Sector Improvement Program (FHSIP) and the Life Enhancement Activities Program (LEAP) in Labasa.
Advocacy and promotion of mental health should be strengthened through the development and implementation of policies and legislation, not only in the realm of health, but in other spheres such as education, housing, social welfare, and employment opportunities, that will positively impact on the mentally ill and mental health care services .
In a developing country like Fiji with limited resources, it is necessary to utilize what is available. There is a need to integrate mental health care into the community and the general health care system and decentralize current mental health services . We must also involve our communities and establish services and programs that will allow mental health care consumers to access help where they live in the least restrictive environment and without fear of stigmatization .
The development of infrastructure in the outer areas is vital to establishing appropriate and wide-ranging community mental health care services . The implementation of the newly passed mental health decree, which emphasizes the need for strengthening and further developing community mental health care, including preventative and rehabilitative services, is also vital to achieving an integrated and comprehensive mental health system .
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