By P.K.Balachandran
Colombo, September 13 (Daily Mirror): In Sri Lanka, the suicide rate (which is the number of suicides per 100,000 population) had come down to 14.6 in 2019. But still, it was on the high side in comparison with many other countries. In India, the suicide rate was 12.7; in Pakistan, 8.9; in China, 8.1; in Bangladesh, 3.7; and the world average was 9 per 100,000 population.
An increase in the suicide rate could well be an offshoot of deteriorating mental health or an increase in mental distress in the population, with people unable to cope with life’s stresses.
Trouble could arise at an early age, say the school-going age, though the elderly are more vulnerable. Mental stress may be triggered by an amazing range of factors with widespread consequences. The consequences are also multifarious. According to the recently released UN Development Report for 2021-22, mental distress weighs on human development in many ways, ultimately limiting people’s freedom to live the lives they have reason to value.
“The effects are especially damaging to children and can perpetuate inequality in inter-generational cycles of mental distress and socioeconomic hardship. Breaking these cycles requires action from people and policymakers on three fronts: preventing distress, mitigating crises and building psychological resilience,” the report says.
These are known facts and yet, mental health has been a neglected field in many countries including Sri Lanka. Though, lately, there has been an increase in awareness of the role that Western techniques can play in containing or curing the disease and psychiatric treatment is being availed of.
In their paper entitled: Demographic Characteristics of Suicides in Sri Lanka from 2006 to 2018, H.A.C.D. Senavirathna and R.M. S. Sanjeewani quote the World Health Organization (WHO) to say that in 2015, every 40 seconds, someone was committing suicide somewhere in the world. Low and Middle-Income countries in the South-East Asian region accounted for 39.1% of suicides, though this region hosted only 25.9% of the total world’s population.
Looking at the demography of suicides in Sri Lanka, significantly more males committed suicide than females. The authors of the above-mentioned study strongly recommended that priority be accorded to tackling stress among males. As for suicide by females, the numbers were higher in Sri Lanka when compared with female suicides in other countries. In this respect Sri Lanka was second only to China, the authors say. Family disputes were the major cause.
Since the tendency to commit suicide was more pronounced in the working class, the problems this class faced were at the bottom of the tendency. Harassment by husbands and family disputes typically arose from economic want, scarcity or social discrimination.
Sri Lankan Tamils showed a greater tendency to commit suicide than the Sinhalese. In 2011, the suicide rate among the Tamils was 32.04 and among the Sinhalese it was 19.38 per 100,000. The suicide rate among the Muslims was lower.
Suicide is only one outcome of mental stress. Psychiatric disorders account for about 13% of the global diseases. Nearly 80% of people with mental disorders live in low- and middle-income countries.
However, the task of improving mental health is hard because mental health is not considered important in most societies including Sri Lanka. Mental health and distress are grossly under-reported and therefore under-treated or not treated at all.
In their paper entitled: The Stigma of Mental Illness in Sri Lanka: The Perspectives of Community Mental Health Workers Rajarata University’s scholars, Namali Samarasekare, Mathew Lloyd Millins Davies, Sisira Siribaddana, said that stigma and the deep-rootedness of traditional beliefs hindered the reporting of mental illness and also treatment. Furthermore, mental illness in one person in the family results in the entire family getting tainted.The whole family is considered prone to mental illness. Such families find it hard to get their females married off. Therefore, families hide members who are mentally sick or impaired. Many do not know that mental problems can be fixed by the use of modern medical practice. People routinely resort to exorcists. At any rate this is the first line of treatment.
Mental patients are isolated because they are believed to be aggressive or unyielding, if not violent. They are socially excluded as a defense mechanism. People are scared of being assaulted by them. So a safe distance is kept from the mentally ill. Street urchins provoke them for fun.
As stated earlier, priority is given to exorcists in treatment. “The most common response to mental illness was that Gods and Devils caused it. The afflicted person is believed to be paying for mistakes in a past life.” Another commonly ascribed reason was that spirits might have caused mental illness. People think that the mentally ill person might have within him, the spirit of a dead father or mother. This is probably because mental illness sometimes occurs after the death of a loved one. With society becoming more and more competitive and the availability of jobs gets reduced, failure to pass exams, or gain employment, could cause mental illness.
The family of the mentally sick person would first go to the village-level officials and leaders. “They consult the Gamarala, a fortune teller, a spiritual leader (Katadirala), and god master (Kapurala, Devala), each with different roles in traditional medicine, before considering Western medicine. This causes a significant delay in reaching allopathic services creating a cycle whereby the delay causes late diagnosis and reduced efficacy of allopathic medicines, further enhancing the belief that these medicines are ineffective, thus causing these services to remain low in people’s priority when gaining help.”
Depression in particular is not identified as being a psychiatric disorder. People don’t see it as an illness. But depression is pervasive.
Services for mental illnesses were not considered to be a priority in Sri Lanka compared to other kinds of health services. Even in the health sector, mental health is treated differently; priority is given to physical illness, the authors say. As a result, even health workers felt stigmatized.
In their paper, Development of mental health care in Sri Lanka: Lessons learned Samudra T Kathriarachchi, V Lakmi Seneviratne, and Luckshika Amarakoon say that while coping with natural and anthropogenic disasters, political unrest, and economic hardships, a major reform of the mental health system had taken place in the last two decades.
“The current level of service provision shows an upward trend in providing basic care across the country. The general public has shown an interest in the allopathic system of psychiatric care, with an increasing trend in the use of resources,” they note. This is a very encouraging development.
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