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Dr. Mridula Naga : »Show empathy for those affected by mental illness, their families »

Against the backdrop of the pandemic having led to an increase in mental illnesses, Dr (Mrs) Mridula Naga, Consultant Psychiatrist, exercising in the private sector after a long service in the government service, explains the perspective of those who suffer from mental health problems as well as their family members, with World Mental Health Day being celebrated this October 10 under the key theme of mental health being a universal human right.

As World Mental Health Day is observed on October 10, it is important to note that this year’s theme is ‘Mental health is a universal human right’.
The World Health Organisation (WHO) states in its constitution that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. In Mauritius, although the right to health is not enshrined in the Constitution, medical services are being provided without any discrimination.

Let us first explain what mental health is, before diving deeper into whether Mauritians are in a position to avail such services to the best of their ability, and if not, what further can be done to ensure optimum access to mental health medical services for our people.

Mental health – why is it important?
The WHO defines health as “a state of complete physical, mental and social well-being” and not merely the absence of disease or infirmity.
Mental health is a crucial aspect of health, and mental health problems are very common. As per WHO statistics, 1 in 8 people lived with a mental illness in 2019, and their incidence has only increased post-pandemic. It is important to note that the life expectancy of people with mental health problems comes down by at least a decade, mostly due to modifiable health behaviour like sedentary lifestyle, poor diet and smoking (which in itself may lead to cardiovascular diseases). Addiction is also a comorbidity seen in this group of people. Another reason for reduced longevity could be the cardiometabolic side effects of certain psychiatric medication.

Therefore, it is important to recognise and treat mental illness so that a person may live a healthy and productive life.

What is being done in Mauritius to treat mental illness?
Coming to Mauritius, while medical services are being provided without discrimination, we must ask ourselves certain key questions: Are the services being made use of by the people? Is it sufficient for people with mental illness?

Having said that, the largest onus of staying healthy is on the individuals themselves. First of all, they must maintain good mental health. To achieve good mental health, it is important to have a healthy lifestyle, i.e., partake of a healthy diet, do adequate exercises, undertake relaxation, and avoid substance misuse and abuse.

If someone has mental health problems, they have to avail themselves of the services provided. But are they capable of doing so? To understand this, it is helpful to understand what it is like to suffer from mental illness.

What is it like to suffer from mental illness or have an affected family member?
Addressing this question reveals many underlying issues. Some of these are the person’s knowledge and recognition of the illness, the reaction of their relatives, and society’s attitudes.

Often people do not realise that they are suffering from a mental illness, or they hesitate to acknowledge it. Why is it so? Two main reasons are stigma and ignorance.

Ignorance because we do not talk about it openly and misconceptions are found to be more common than knowledge about the illness. The symptoms of mental illnesses are often subtle and may present as changes in behaviour, lifestyle, mood swings, and so on. This may not be noticed and perceived as symptoms of an illness. Take the example of a Depressive Disorder which is very common. According to WHO statistics, globally, it is estimated that 5% of adults suffer from the disorder. When someone suffers from a Depressive Disorder, they feel low, show lack of interest in routine activities, have poor appetite, difficulty in sleeping, feel weak and get tired easily etc. Consequently, their behaviour will be affected, and they may not go to work, or will not be able to look after the house, cook etc. At work, they may be absent often or their output may be low. This may be interpreted as laziness and relatives and colleagues get annoyed with them. This worsens the situation and when depression is severe, it can even lead to thoughts of harming oneself, and, at the worst, attempting suicide.

On the other hand, if those affected were aware that these are symptoms of an illness, they could have consulted a doctor and received appropriate treatment. The good news is that depression is a treatable illness, and in most cases can be cured.

Another reason why people avoid treatment is because of stigma. Stigma towards mental illness is seen in all countries. In Mauritius, such stigma is especially strong, causing people to suffer in silence as they do not wish to be labelled. They are anxious that others would get to know about their illness, and worried that if workmates know, they will be ridiculed. They often refuse medical certificates from psychiatrists as they are worried it will interfere with their promotion and career prospects. Students too face a big challenge if they are ill, by being bullied and called names.

People with mental health problems experience discrimination as well. Stigma and discrimination make it difficult for people to find work, enter into lasting relationships, or have life partners. The highest degree of stigma and discrimination are faced by people with serious mental illnesses.

What are the different types of mental illnesses?
There are disorders of mood, psychotic disorders, personality disorders, substance use disorders and addiction, sexual disorders and many more.
Anxiety disorders and mild depressive disorders do not pose a great burden on the person and family, but when someone suffers from serious illnesses like Schizophrenia or Bipolar Disorder, it takes a heavier toll. As the disease progresses, the person risks losing out on studies, employment and relationships and could consider themselves a burden to their family and society. Society has stereotyped views about mental illness. Those affected are often unjustly portrayed as being aggressive and violent, as also ridiculed, harmed or exploited. They are additionally discriminated against when they look for employment or housing. In many countries they end up on the streets as vagrants.

Here, family has a great role to play. If they are aware that their family member is ill, they should seek help, take them for treatment and support them. Their interaction with the person makes a major contribution in maintaining good health, preventing relapses and being productive.

How can we help people with mental illness?
The most important factor is early recognition, diagnosis and appropriate treatment. As mentioned earlier, there are several mental illnesses of varying degrees of severity.

Minor ailments like anxiety disorders and mild depressive disorders may be relieved with short term treatment, counselling, psychotherapy and medication, along with family support. In other cases, treatment is crucial, and when a person is in remission, rehabilitation is very important.
Indeed, rehabilitation can play a key role in keeping the person functional and productive. When the illness is severe, they might lose a lot of faculties essential for independent survival. The importance of rehabilitation in such cases cannot be stressed enough. It is important to have personal recovery, along with clinical recovery, in order to find ways to live well, despite mental health problems.

Early recognition of mental illness symptoms can be key to treatment too, and here, education through mass media and social media platforms can be effective. It is important to stress on the medical model of mental illness. In ancient centuries, it was considered a curse of Gods or affection by evil spirits which led to treatments like trephining the skull to let out spirits, sorcery etc. Science has advanced since; and with the advent of molecular biology and imaging techniques like brain scans, it has been established that there are morphological changes in the brain and gene alterations. Thus, mental illness has absolutely nothing to do with evil spirits.

If a person is treated adequately and appropriately, in most cases they can improve and be functional. Indeed, they can live a good life and avoid burdening their family and society. However, while people with depressive disorders can make total recovery, it would still be the case that some serious illnesses need life-long treatment.

How does Mauritius support those affected by mental illness?
In Mauritius, psychiatric treatment is available in the public and private sectors. Of course, while treatment facilities are available, the person has to seek help and attend on their own accord.

Unfortunately, there are cases where the person might refuse treatment due to the nature of the illness. There are laws pertaining to mental health which can be made use of, to take such people for treatment. Community care is of great help in these instances. Many countries provide community care where a member of the mental health team visits the patient at their place. In this way, prompt treatment is given and further deterioration, prevented.

In the private sector too, mental health services are available. However, there are certain hardships and drawbacks. For example, many insurance companies do not reimburse any psychiatric treatment charges, and in-patient treatment is minimal/virtually non-existent for such patients.
Also, while a few NGOs offer rehabilitation facilities, they are limited and more need to be established.

Significantly, society has a major role to play towards the well-being of its members, and this can be affected by changing the attitude towards mental illness and through the mandate of governing bodies. In Mauritius, people who have certain percentage of incapacity receive an allowance from the government, which is of great help to them.

Ultimately, improving services provided to people with mental health issues, supporting them emotionally and physically, and promoting programmes to reduce stigma will go a long way in uplifting affected people and ensuring that they are treated with respect and dignity.

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