STIGMA IN MENTAL HEALTH - THE REAL REASONS WHY IT CONTINUES
Mental health and stigma have been together for centuries. With effective treatments only discovered in 1954 the practice for managing the mysterious mental illnesses thought for centuries to be due to evil spirits, charms was to lock or chain the mentally ill so that others were safe from unpredictable behaviour of the mentally ill. Numerous concoctions and so called remedies were tried and did not work. Some remedies actually did more harm and may have killed the sufferer. Ignorance of the nature of mental illnesses led to theories and beliefs that did not do the sufferer any good. the fear of the mentally ill and mental illnesses. In the name of religious treatments many were subject to exorcism and even beatings to drive out evil spirits.
The advent and widespread availability of chlorpromazine in the 1950s should have diminished the use of cells and chains and all but closed down mental asylums . But the newer and powerful drugs were used with caution and often not used at all despite their availability even in low income countries. It appears that the ignorance, fear and strong prejudice against mentally ill continued the incarceration of the mentally ill - till today - 2015. examples abound of health care staff underutilisation of available psychiatric medicines and continued building of more cells and even large mental hospitals. Feeble attempts at de stigmatisation backed by ignorance and depending on slogans (such as "mental illnesses are like any other illnesses") are demolished by psychiatric units like the one below that continue. If indeed psychiatric illnesses are like any other illnesses then why are the psychiatric units surrounded by high barbed wire fences, locked gates and steel bars and chains used to restrain patients. The Psychiatric wards resemble Prisons not Hospitals
Slogans cannot equate to patient abuse plain for all to see
This barbed wire guarded building is a
Psychiatric ward as an outhouse of a large general hospital
The public rejected this purpose built psychiatric unit of a general hospital with
no fence, locks or gates. Who built this cell and what made this possible ?
This is not a post mortem slab in a Mortuary but a concrete bed of a Psychiatric ward .
Made to prevent aggressive patients breaking the bed. Obviously the staff were not trained to use readily available medicines that prevent outbursts of violence in mentally ill patients with psychoses
This is a open Bath Stall where mentally ill patients unclothed were bathed by attendants with areas for wash, soaped, washed again and the blow dried and dried with towels
Newly built psychiatric ward in 1990s with no access to drinking water
OTHER DISEASES AND HOW THEIR STIGMA DISAPPEARED
Leprosy was a far more stigmatised diseases since even biblical times. With parts of the body being infected with the leprosy bacillus and falling off leaving gaps in the face, missing fingers and toes. This leprosy colony founded in 1930 was the reportedly second largest in the world with over 2,000 inmates . With no known cure inmates were incarcerated in a huge colony out of sight and mind of the people Their children were isolated for 6 months from birth to prevent them getting leprosy.
They lived in small chalets like this and used early treatments with limited improvement. But with discovery of new medicines like dapsone the illness was brought under control. The Leprosy asylum closed in the 1990s as few new patients were admitted as almost all treatment could be done early and from their own homes and treatments done in any clinic or hospital. The stigma disappeared almost overnight and ----and the colony became the largest garden town in the country ! The former inmates became business men and women selling, lovely flowering plants decorative plants, fruits and engaged in lucrative landscaping and turfing contracts - and employing foreign labour.
BUT, the nearby modern general hospital and allied health sciences training centre has no psychiatric ward...........
The Key to the differences between Mental Illness and Leprosy related to the damaging effects of stigma may lie in the commitment by health care professions to wards mental illness. With modern medicines available, the missing link may lie in the training doctors and nurses receive in their training days. Curricula are archaic and teachers and nursing and medical schools marginalise the teaching of psychiatry by making it a minor part of the curriculum and often passing psychiatry not being a pre requisite for becoming a nurse or a doctor.
Unfortunately the emphasis is often on the public stigmatising the mentally ill. The reality is that health care professionals and administrators themselves give less priority to mentally ill through poor training , prejudice and fear. Thus this Cell for housing mentally ill in a hospital was actually donated by a doctor who felt sorry for the mentally ill - but did not know the proper treatment for the mentally ill with available medicines.
This 30 year old patient who weighed less than 25 Kilos was chained in the house for 4 years until he became cachexic and he could not even stand up. He was often seen by a community nurse who was not trained that such mentally ill patients could be treated with available medicines.
This mentally ill patient (below) was tied to a tree in the hope that the nearby grave of a saint could cure him when the same village had medicines that could control his behaviour
Families are often desperate to control the psychotic behaviour that persists despite the
treatments given in hospitals , often with poor services for discharged mentally ill by the health care services. Hence (below )the family built its own cell outside their house in a village .
Unfortunately even modern psychiatric hospitals in well to do countries have locked cells with no windows - and called Serene Room. Limited training is responsible for this state of affairs.
A brave psychiatrist seeing the tragedy of poor services for the mentally ill, started a campaign against stigma by opening a rural psychiatric clinic training Family Doctors and a Stress Management Day Centre and printed posters to educate the public
The real answer lies in starting basic services for the mentally ill in every primary health care clinics with day treatment and rehabilitation and in small rural hospitals and staff them trained staff taught by experienced teachers in psychiatry
One such project has been highly successful in Cook Island ......
more to come
More to come !
