Mentally Speaking...

Read any interesting news items about mental health lately? Note a common trend: they invariably infer that the plight of the mentally ill is a symptom of a dysfunctional society. Often the stories will shock with the discovery of new mental diseases and the drugs needed to treat them. Contrary to what mainstream media may tell us, there's more to mental health than psychiatric clinics, drug regiments and the stigma that goes with being Œsick in the head'. Here's another perspective.

At the risk of oversimplifying the issue, there are two general types of mental upsets. Firstly, there is mental illness or mental disease, usually caused by a condition in the brain that requires treatment with medication and therapy. Practitioners qualified to assist such cases are psychiatrists (medical doctors with specialist training in mental diseases), with a support network of psychiatric nurses, therapists, and of course, family and friends.

Secondly there are "life's dramas", those stressful significant events with mental repercussions, such as money woes, broken relationships, anxiety over exam results, or trauma due to the death of a loved one. Usually, we recover over a period of time. We are able to talk about what's happening with friends and family. Generally, the only qualification required to assist in such cases is the willingness to lend an ear. If this is not enough, then advice from qualified counsellors is recommended. Sometimes, these stressful experiences can lead to mental illness, though a good counsellor with a psychology or social work background can help people recognise and deal with their stress, and are also able to refer cases for specialist consultation and therapy or treatment.

So the majority of mental illness cases should be a treatable, commonplace occurrence, right? Wrong.

Worldwide, and particularly in Pacific islands countries, there are simply not enough psychiatrists or qualified counsellors. In Fiji, for example, there are less than five psychiatrists and similarly few qualified counsellors providing mental health care services for a population nearing one million. In most Pacific islands countries, laws and policies addressing mental health are archaic and ineffective, largely due to the inherited stigma and rigid medical approach associated with being mentally ill.

As a medical rather than a development issue, mental health tends to be ignored at the bottom of a long list of medical priorities in our part of the world. If it were a development issue, there would be jobs and money to help with rehabilitation of criminals, more focus on the mental health of our children in schools, more resources given to the mental stresses faced by new mothers, more attention paid to the root causes of alcohol and drug abuse in our pacific islands. Right now, the reality is simple. Mental Health Promotion is only accorded lip service.

Let's go back to how Pacific media handles mental health. News coverage proves useful in attracting attention to the mental health issues, but their impact has a transient shock quality and does little to further a debate on what our health systems or our politicians are doing in this regard. The result is that the broader mental health issues are sidelined. The initial shock impact remains, and the overall impression of mental health is a negative, uninvolved one. A level of analysis and debate aimed at developing and informing a truly holistic understanding is a responsibility that all stakeholders (the media, medical and community development arenas) must assume.

If we are to seriously consider the root causes of mental illness, we must examine its relationship with other social issues. In the Pacific, civil unrest, unemployment, and natural disasters take their toll, particularly among our youth. Suicides, robberies, physical and sexual abuse amongst and against Pacific Islands youth are rising. This trend in our region supports academic estimates that at least one in ten people suffer from some form of mental illness. Worldwide, the neglect of mental health issues holds up social crises that mirror the Pacific experience. So what do we do?

Perhaps we need to take a more holistic view of mental health' and alter the perception of what it actually is. We need to realise that mental health is everybody's concern. More government ministries must take mental health into account, and development programmes should include research funding that examines the impact of mental health issues. For instance, law and justice programmes should include a preventative component that addresses the root causes of criminality. This will aid in rehabilitation and prevention.

Amidst all the information on new diseases and drugs that we're seeing, the growing range of ways to describe our medical ills and corresponding fixes must be treated with caution. Our strategic response to mental health and even our definitions of health, must be placed in our Pacific context. We must recognise that our own ethnically diverse traits and cultural behaviours may not necessarily fit into the norms and definitions inherited from medical science. We need to define and own the roles of counselling and medical treatment.

The priority, therefore, should be to develop a holistic supportive infrastructure within Pacific Islands countries for people in distress, people with mental disease and those supporting them. Communities should be included in this infrastructure from the outset. Mental health is everybody's concern. We just don't know it.

Hardly sounds like another health problem, does it?

€ Andrew Peteru is the Foundation of the South Pacific International's Regional Health Manager based in Suva, Fiji.