Dealing with mental illness

Dealing with mental illness

Yulia Wardani, Jakarta

World Mental Health Day fell on Oct. 10 with little public and
media attention. This is unfortunate because of the severe amount
of psychological trauma the nation has recently suffered.

On Dec. 26 last year, Indonesia suffered from a terrible
natural disaster, an earthquake and tsunami in Aceh and North
Sumatra that killed more than a 130,000 people and left hundreds
of thousands more grieving the loss of loved ones and the
destruction of their old lives. The psycho-trauma of those
terrible events will scar the survivors' minds deeply; and it is
something they will never forget. But while they may not forget
most will cope, especially if they are given help.

The impact of natural disasters on individuals is substantial.
Aside from the hardship of daily living, survivors may experience
physical injuries and mental trauma from witnessing someone dying
or being injured, seeing dismembered bodies or body pieces, being
trapped under debris, or being separated from their families.

Survivors of disasters often experience a range of losses --
loved ones, their homes, neighborhoods, communities, and places
of worship. Although distressing for all, children may be
particularly affected by the loss of their familiar environments
-- home, school, peers -- as they feel safe and secure when they
have consistent and predictable routines.

This can cause anxiety, fear, and a great sense of insecurity
and children's worries and fears manifest themselves through a
range of reactions that generally vary with age.

In 2010, as written in the Strategic Plan for Health
Development, the ratio of mental health disorders in the national
population is predicted at 140:1,000 for people aged more than 15
years old. This number is significantly greater than ratios for
physical diseases, such as diabetes (16:1,000), cardiac and
pulmonary disease (4.8:1,000) or strokes (5.2:1,000). However,
the Ministry of Health estimates that mental health patients make
only 1.5 percent of people who currently receive treatment in
hospitals.

Let us trace where this large number of people with mental
illnesses come from. They often come from poverty, have little
education because of a lack of access, suffer from a low quality
of health services -- all things that ensure they are not able to
cope with their problems.

A socio-political situation where rights violations continue
to be perpetrated and where there is a tension between tradition
and modernity also influences the state of the nation's health.

Meanwhile the movement for mental health development remains
at close to zero velocity. The National Health Department is
still focused on the physical needs of the people. Nutrition,
immunization and family planning are targets for development but
there are no significant programs to increase mental health
awareness or treatment, although so many people are suffering.
The government has made no clear moves to respond the needs of
mental health service providers, especially to promote good
mental health.

Who should be responsible for the mental health of the nation?
I would argue that every person -- families, communities and
governments, both local and central -- should be involved in this
task. But for this to happen we need conducive circumstances so
that the approach is coordinated and not just an ad hoc,
piecemeal one.

We must, of course, start a bold and wide-ranging campaign to
support basic shelter and survival needs of the millions of
people in the devastated communities hit by the tsunamis and the
resulting trauma. With the help of media coverage, many national
and grassroots mental health organizations are already beginning
to provide emotional support and develop strategies and services
to address the immediate and long-term mental health consequences
that are certain to impact thousands of individuals and families.

We are urging all people to do whatever they can to provide
encouragement, support and resources that will be of assistance
to the people who suffer from mental illness. The many mental
health professionals and volunteers working tirelessly to help
people cope with physical hardship and emotional trauma need your
help.

The economic crisis, social upheavals and natural disasters we
have suffered will create untold mental health consequences --
not just for the survivors, or the aid workers, or the poor but
for the entire nation.

Even people who only witnessed the death and devastation of
the tsunami on television will be emotionally affected. We know
that only a relatively small number of mental health NGOs are
making efforts to provide support to families.

This is a truly global natural and human disaster. Yet, the
most important and continuing task to address the disaster's
aftermath will fall on local volunteers and professionals living
and working in the affected countries. Their jobs will remain the
most difficult and the most wrenching, long after the television
news teams are gone and the world's attention moves to new
events. Mental health professionals and volunteers, of all the
relief workers, have some of the hardest and longest work ahead
of them.

The writer is a lecturer on Psychiatric Nursing At STIK Sint
Carolus, Jakarta.