MENTAL HEALTH OR STRESS MANAGEMENT
Asian Federation of Psychiatric Associations
AFPA
BLOG 3
ACTION IN MENTAL HEALTH - DEEDS NOT WORDS -
The BIG Divide between Theory and Practice
Many diseases that attracted worse stigma than mental illnesses would still be stigmatised if the only action they attracted was lament and words. In crude terms hot air. Chest beating followed by childrens' art competitions forums on stigma and heavy doses of finger pointing and bashing of the public blaming them for the stigma alone would not have largely eliminated Leprosy, elephantiasis, polio and tuberculosis from the country and closed leprosy hospitals, and tuberculosis asylums . Scientific efforts found remedies in research labs but public health measures and ministry of health funding won the battles against the scourge and the war against STIGMA.
The lessons learnt from the Leprosy and TB control and elimination are there for almost all to see. Almost all because those in positions to decide on public health, funding and training to control mental illnesses appear to have not learnt the message. The result is that health care professionals, administrators, insurance companies, university teachers , nurses and nursing schools and many others in positions of power themselves stigmatise a group of diseases included in the ICD-X. The stigma of mental illnesses will not go away in the eyes of the public as long as officialdom refrains from committing resources to control the diseases like it does other diseases.
Mental illnesses are not the result of choice by the sufferer to become mentally ill. By the same standard neither can those who chose to smoke excessively , drink alcohol in excess or expose themselves to STI be considered responsible for their disease. To treat mentally ill with less resources, facilities, expertise and common courtesy and deprive them of adequate treatment is not good medical practice. To eliminate TB a nationwide a preventive campaign, widespread detection and screening teals were set up and case tracing by trained and dedicated staff tracked down vulnerable persons and treated them for their problems. Such strategies are not easily seen in or available for mental illnesses .
Conferences, Meetings, Discussions and more discussions and glossy books......
have not reduced let alone eliminated the disease . In low income countries the disease is treated in less than a third of the sufferers although the medicines recommended by the WHO essential medicines list are widely available and themselves low in cost. With generic medicines available the costs have dropped precipitously. The practice of good mental health services depends in a prejudiced nursing and medical world learning first hand the diagnostic and basic skills in treatment never seen by them. exposure to practices in demonstration treatment centres, day treatment centres or model psychiatric wards are very rare so that in many Low income countries staff dealing with mentally ill or stressed persons fall back on locked cells, strong restraints rather than useful medicines in adequate doses within safety limits to control emergencies and dangerous situation of patients going out of control./ Once seen this practice is replicated, reinforced and taken hold as the gold standard in mental care .
All the TALK, Conference findings, more discussions on good Medical Practice falls by the wayside. The real problem is NATO = No Action Talk Only. One Wonders if the discussants at big conferences on mental health really practice passionately what they ardently preach . Or perhaps the conferences are opportunities to to Talk and Talk - and not meant to be put into practice !
This is a psychiatric ward over 50 years old and patients with psychoses are assessed and treated from across the bars
These are mental hospitals in high income countries in the Asia Pacific region, built in the mid 1990s and the 21st century at costs exceeding 400 million USD and routinely treat patients in rooms and surroundings worse than those in old prisons.
The mainstay of care is appears is steeped in preoccupation with old fashioned pre chlorpromazine concepts of maximum security large locks, strong bars and wrought iron doors.
What is more important is what has become of the training in modern evidence based psychiatric practices that most should have been taught ?
A large part of the reason for this may lie in the hospitals or wards the doctors and nurses are trained in . The theory of modern least restrictive care may be taught in the opposite settings of incarceration that are based on locks grilles and bars of a century ago.
The impact of powerful medicines available to work as chemical restraints has remained less important than reinforced doors and strong locks and prison like security that have remained well into the 21st Century. And even when used these are used with extreme caution in microscopic doses.
Depot injections of long term anti psychotic treatments and clinics or teams to ensure their
regular availability to patients is a major problem in developing economies.
Professor M P Deva, FRCPsych FRANZCP
Professor of Psychiatry, UTAR
Founder Patron AFPA
Malaysia.
More to come.........
devamp37@gmail.com
