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.