Speech of the Hon Minister of Health for Ministerial Mental Health Summit:
Ladies and Gentlemen
At the outset I wish to thank you for giving me the opportunity to share Sri Lanka’s experiences in mental health care delivery in this forum, which has showcased the best practices, disseminated latest evidence towards building momentum on global mental health issues, with wide participation of the highest political leadership.
Sri Lanka, a former British Colony, has enjoyed free health care, free education and universal suffrage for over seven decades, and hence enjoys health indicators comparable to many developed countries. However, due to life style changes Sri Lanka is increasingly experiencing an epidemiological transition: non-communicable diseases and mental health beginning to figure increasingly in the morbidity and mortality picture.
It is estimated that around 10% of the population is affected mental health problems, over 800,000 suffering from varying degree of depression, one of the leading causes of morbidity. Other mental health issues such as suicide; substance abuse; gender-based violence; the breakdown of social structures and family units; and child mental health are prevalent issues in the country.
Positive transformations: Past two decades saw the gradual, effective integration of mental health services with well engrained primary health care services, latter serving as the core of mental health care delivery. In parallel, emphasis was placed on the need for services to move from the medical model to a bio-psychosocial model of care. Political commitment to mental health changed markedly after the 2004 Tsunami. A national plan of action was developed to deliver mental health services to Tsunami-affected districts. Activities were then extended to districts outside the Tsunami zone.
With these new initiatives, emphasis paid on mental health increased, resulting in the development of National Mental Health Policy for the period of 2005-2015 with the vision of optimizing mental health in Sri Lankan population. It called for the implementation for a comprehensive community based, decentralized service structure.
Another decisive step we took was human resource development, increasing the post PG training towards Specialization in Psychiatry and expansion of cadre positions to cover the entire country. Training in psychiatry and mental health was extended to medical professionals including a one-year diploma in psychiatry for doctors and a one-year diploma in basic psychiatric nursing. The government also created Medical Officer for Mental Health (MOMH) as district focal points at Regional Director of Health Services Office to strengthen the coordination between the national level mechanisms to the periphery. The mental health services delivered by Medical Officer Mental Health included outpatient care, domiciliary care, mental health promotion in schools and community mental health education. They work in collaboration with the primary health care teams functioning under the Medical Officer of Health.
Since 2010 we have increased cadres of mental health workers, particularly Psychiatric Social Workers, Occupational Therapists and Community Psychiatric Nurses. The Acute psychiatric inpatient care services were expanded to almost all the districts of the country while out-reach and clinic based mental health care was made available up to small district and rural hospitals island-wide. Rehabilitation services for mentally ill patients were provided through medium stay units and long stay hospitals established in provinces, however, the facilities and multidisciplinary care in these institutions needs strengthening. Community volunteer organizations were established island wide and the volunteers attached to these organizations provide mental health care at community level while reducing the stigma and discrimination for people affected with mental illnesses.
Despite these important achievements, improvements are needed to provide more timely interventions including psychological therapies, good quality of care in primary, secondary and tertiary care services, good psychosocial support and combating myths, stigma, and discrimination.
Stigma behind mental health is a big challenge to us. We consider media a “a strong vehicle” to promote community awareness on mental wellbeing and mental illness, and also to eliminate stigma and discrimination of the affected. On the other hand, publicity oriented, sensational, unethical reporting could lead to adverse outcomes favoring suicide, increased violence and the use of alcohol and drugs.
Substance abuse is yet another challenge closely associated with mental health. We have banned advertising both alcohol and tobacco and imposed higher taxes on them, imposing a 85% pictorial warning on cigarette packs. We are now moving towards plain packaging and stopping tobacco cultivation altogether by 2020. However, we are yet to take the upper hand in our war against hard drugs.
We strongly believe that strengthening mental health island wide is a dire need at present. We sincerely hope that our interventions will promote mental wellbeing, good psychosocial support at community, family and occupational settings, which will in turn reduce the disease burden. Now we need to work on constructing a society and a culture that understands mental health, that understands why people commit suicide, and help people to get through their battles with common mental health disorders. I wish this first ever Ministerial Mental Health summit a success and have no doubt that the deliberations we had would benefit all of us here today to prioritize our mental health services for the betterment of our people.