Mental health -- Do we care?
Mental health -- Do we care?
By Chris W. Green
An estimated 400 million people today suffer from mental or
neurological disorders, or psychosocial problems such as those
related to alcohol and drug abuse.
In the national scale, one in five Indonesians are suffering
from such disorders, according to Minister of Health and Social
Welfare Achmad Sujudi.
Public health authorities around the globe say stigma and
discrimination are the biggest obstacles facing mentally ill
people today. Rare is the family that is free of an encounter
with mental disorder, yet almost universal are the shame and fear
that prevent people from seeking help.
"By accident or design, we are all responsible for this
situation today," said Dr Gro Harlem Brundtland, director general
of WHO.
World Health Day 2001, with the slogan "Stop exclusion - Dare
to care," aims not only to raise awareness on the barriers to
mental health care, but also solutions that exist to tackle
mental and brain disorders.
JAKARTA (JP): How does one write about mental health in
connection with AIDS and drugs without adding to the stigma and
discrimination that already cloaks all of these topics?
Just mental health alone is surrounded by 'myths, secrecy and
shame', according to Dr. Gro Harlem Brundtland, director general
of the World Health Organization (WHO).
This can only be exacerbated by any additional stigma.
Nevertheless, we cannot just ignore the links between AIDS, drugs
and mental health.
Many of those who are addicted to drugs have what is called a
"dual-diagnosis" -- they are also suffering from some form of
mental illness. The mental illness may have been the cause of
their turning to drugs, or it may have been the result of using
mind-altering drugs over a long period.
In addition, it is not unusual for drug users in Indonesia to
suffer temporary or permanent mental problems as a result of
botched 'rehabilitation' by incompetent institutions, which
either overmedicate them or place them under too great a mental
strain.
And it's perhaps not surprising that those infected by HIV,
the virus that causes AIDS, often suffer from depression. This is
partly from knowing that they have a terminal illness, but also
as a result of discrimination, that many experience, even from
their own families.
It is clear that HIV is able to enter and infect the brain. As
a result, 30 percent to 60 percent of people living with HIV/AIDS
suffer from some form of dementia or mental disorder, usually at
a later stage of their illness.
Ironically, this seems to affect young people with AIDS more
frequently than adults.
In addition, there is an increasing number of drug users with
AIDS.
Everywhere in the world, they face a double stigma, often
turned away from conventional health care services. Ironically,
it is often the mental health institutions that are more willing
to treat such people, but this often only increases the stigma
attached to them.
Of course, mental disorders, from mild to severe, are not rare
-- if often hidden -- among the general population.
A recent survey by the government has reported a huge increase
in mental illness in Jakarta since the start of the monetary
crisis in 1997.
Again, this is perhaps not surprising, with many people out of
work and lacking the wherewithal to look after themselves, let
alone their families.
'Stop exclusion'
WHO estimates that 400 million people around the world suffer
from some form of mental disorder or psychosocial problem such as
those related to alcohol or drug abuse.
We can only guess the numbers in Indonesia. Yet the more than
30 main mental hospitals around the country are apparently rarely
full, even though, like other hospitals, they are required to
offer a proportion of their places to the poor.
Why is this so?
As WHO says, many of those with mental disorders suffer
silently; many suffer alone. Families are embarrassed to admit
that one of their members may have a mental illness.
Going to a psychiatrist, or even more to a mental hospital,
may be felt to be an admission of madness.
Yet we can treat many of these disorders. Often medication can
reduce or control the problem. Mental disorders connected with
AIDS, as with other so-called opportunistic infections, which
take advantage of an immune system weakened by HIV, can often be
treated or prevented.
And how much better it would be to address the mental problems
of addicts before they turn to drugs, often as a form of self-
medication.
It is therefore most appropriate that WHO has decided to
devote this year's World Health Day to mental health -- with a
message of concern and hope.
As Joyce Djaelani Gordon, psychologist and chairperson of
Yayasan Kita recovery center for drug addicts in Bogor, puts it,
"This should cause us to review the needs of mental health in
Indonesia."
What is needed in relation to drugs? What policies and
services do we need to put into place to reduce the stigma and
discrimination so often experienced by those seeking drug
treatment?
"Not infrequently I see healthcare workers who are scared of
addicts or even treat them as if they were mad," says Joyce.
"But on the other hand, how can we reduce the reluctance of
the public to seek counseling as a result of fear of loss of
confidentiality, or that they will be considered mad?"
Joyce feels that the mental health condition of families of
drug abusers must be given more consideration, both before and
after the drug problems occur.
"Simply insisting that they 'Say No to drugs!', shows
clearly how little thought we give to the human mental processes
needed to resist the temptation of drugs!"
As with so many other elements of health, we cannot just leave
mental health to the government or experts. The community must
show concern, and advocate for attention and improvements.
As Joyce says, mental health is not just for people with
mental illness. Or as Dr. Brundtland puts it, "We must include
solutions and care of mental health in our search for a better
life for all. We must commit to 'Stop exclusion - dare to care.'"
The writer is an AIDS activist.