JP/17/JIWA

JP/17/JIWA

Mental health still not a priority

Emmy Fitri The Jakarta Post/Jakarta

Unlike campaigns for high-profile diseases such cancer and HIV/AIDS, World Mental Health Day that fell on Oct. 10 got the cold shoulder here -- even from the health authorities.

The lack of attention to the issue is a true reflection of the lack of understanding of how mental health is closely linked to physical health, and how an unhealthy mental state could lead to a decrease in people's life quality.

Cliched, but real problems, like limited funds for mental health care and perpetual stigmas on mental illnesses worsen the situation in Indonesia.

Countries ranging from the U.S., Britain, Norway to Australia and New Zealand enthusiastically promote mental health awareness on that particular day -- and also in the following days and weeks. Support for the campaign also came from the tiny Pacific island of Palau, and also from Nepal.

In its official website, www.wfmh.org., World Federation of Mental Health (WFMH) commented, "We like the support in the tiny Pacific island of Palau, where the government prints a mental health day message on government pay stubs for that week."

"We are also amazed to learn about World Mental Health Day banners in Kathmandu (Nepal) than about the posters in London. We are surprised when the first report after Oct. 10 arrives from Benin in West Africa."

Some countries that are not very wealthy and that are also preoccupied with a myriad of other problems still care about mental health issues. That's possibly because they are conscious of the fate that awaits them if they remain ignorant about this issue.

According to the World Health Organization, at least one in ten people worldwide have suffered from clinically significant mental health problems during the past 12 months. And 30 to 50 percent of people with psychiatric disorders remain undetected and untreated, even in rich countries.

At home?

Senior psychiatrist Professor Sasanto Wibisono spoke at length about the background in understanding the situation here. But succinctly, he concluded that "as a whole, rapid global development has impacted on human mental health as it affects the culture and lifestyle of people."

People have to adjust to new lifestyles and learn to adapt to cultures that are not part of their upbringing, he said.

Corruption practices were not part of culture, Sasanto claimed. People lose their grip on their life values and became confused about what's wrong and what's right. "We see shifting personal judgments on what used to be shameful, now becoming something normal."

"Acculturation is a painful process for people who have adjustment problems. Like it or not, even for those with a strong ability to handle the process, they are also in limbo because we will never know our limits. Life becomes so stressful," Sasanto told The Jakarta Post.

Sasanto said that he did not know what was the most sensible way to address the issue but he pointed out the urgency of continuing to raise public awareness about mental health issues.

"And our education curriculum must be reformed because social adjustment problems can stem from education failure," said Sasanto, who is chairman of the Indonesian Psychogeriatric Association.

Modernity versus sanity

Changing lifestyles -- coming together in a package with 'modernity' -- also completely alter the profile of physical health, he continued.

"In the past we only knew infectious diseases, but at present we see more and more people getting non-infectious diseases, like cardiovascular disease, HIV/AIDS, diabetes and other diseases that are a result of changing lifestyles."

Although he had no exact figures, Sasanto claimed that in Indonesia -- with its current lingering socio-economic and political problems -- one percent of its total 210 million population may have mental health problems.

Mental health problems can manifest themselves in various forms such as anxiety, depression and stress, and can also manifest as physical health problems; what in the past the medical fraternity referred to as psychosomatic diseases.

Because of this alarming situation, WFMH selected "Mental and Physical Health Across the Lifespan" as this year's theme for World Mental Health Day.

Sasanto's colleague, Irmansyah, said restlessness, anxiety and depression were also commonly found in patients with chronic diseases like diabetes melitus, cancer, cardiovascular disease and HIV/AIDS.

"Unfortunately, most of the time these mental problems are ignored, and even if found, are not properly treated," he said in a statement made available to the Post.

There was rising co-morbidity between physical and mental health, Sasanto also confirmed.

"In the case of a chronic diabetes melitus patient, for example, he may not comply with the diet and other treatment because he is losing hope. Feeling frustrated about the length of the treatment can also be a cause."

"In extreme cases, we call it passive suicide."

In addition, bad behavior, constituting a crucial component in mental health, became a prominent cause in eliciting physical problems. Irmansyah said the smoking habit was a 'good' start to causing heart disease, lung-related problems and even cancer.

Meanwhile, Irmansyah said a study in Australia showed that people with chronic mental diseases like depression and schizophrenia tended to die of physical diseases.

"People with mental health problems are usually ignorant of their physical condition and this is made worse be the reluctance of family to take their sick ones to the doctor," he said.

A person with depression also tended to show bad behavior like eating disorders, smoking, and alcohol and drug abuse -- all of which could lead to physical health problems, said Irmansyah, who is a psychiatrist at the Cipto Mangunkusumo Hospital.

Both Sasanto and Irmansyah said doctors too must learn about co-morbidity between physical and mental health, and hospitals should start fostering multi-disciplinary teams to handle cases.

"We've started it already with some cases but the public too must be aware of this issue so they know where to get help and how," he said.

"Everything ends up with government willingness to see mental health as an issue," Sasanto said.