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.