Mental health-related issues are often overlooked and brushed under the carpet in Sri Lanka due to lack of awareness, long-standing attitudes and lack of resources provided to manage a complex public health matter. The fact remains that many, including successive governments have done little but to organise an annual mental health day, leaving the institutions, practitioners, patients and their loved ones with little respite.
The lack of prioritisation of addressing mental health, even in the broader public health system, and the lack of adequate oversight and accountability, leaves those who need assistance or treatment worse off in some cases. With Sri Lanka trying to “recover” from the multiple crises it faced in the last few years, especially in the health sector, governments must pay more attention to mental health issues.
The state of the national mental health apparatus, and its key institution, the National Institute of Mental Health (NIMH), was laid bare by the Human Rights Commission of Sri Lanka earlier this week. The fact-finding mission into the NIMH comes in the wake of numerous allegations levelled against the institution over a period of time. There have been complaints and legal action taken regarding patients being abused and mishandled at the institution. Granted there will be significant challenges in caring for those who have varying levels of mental health issue, the complaints about being mishandled and abused.
An Interim Report released by HRCSL, based on its fact-finding mission on the Right to Health and Liberty of Patients at the National Institute of Mental Health, has flagged the seriousness of the status quo of the NIMH in Sri Lanka. In the 10-page report, the HRCSL expressed its concerns about the practice of admitting patients with substance misuse problems to NIMH’s regular-patient and acute wards instead of a separate unit. The HRCSL has also flagged significant issues about the forensic psychiatry unit’s lack of operational staff, especially prison guards. The joint housing both remand and convicted prisoners (patients in both acute and intermediate stages) in the same space has also been flagged. The quality of the food provided to those in the care of the institution has also been called into question by the HRCSL report.
Another issue flagged by the report highlights cultural perspectives and stigma about mental health, many patients, including some who have been treated and deemed fit for reintegration back to society, not being able to do so because of family members abandoning them at the institution. The same has been observed about visitation, despite visiting hours being granted from early morning till 6 p.m. in the evening. This matter is reflective of the overall general view about mental health in Sri Lanka, including that of some governments, that the matter is best debt with being kept “out of sight – out of mind”. Given the deep religious-cultural linkages Sri Lanka boasts to many faiths, the lack of empathy and understanding for those who are diagnosed with mental health issues, is a deplorable reality of our current society.
Overcrowding and understaffing has been identified as a core problem faced by many of the units at the NIMH. The conditions of the accommodation at the institution has also been highlighted, with questions raised about lack of natural lighting, the effective use of suitable lighting systems and the availability of fans being questioned. The HRCSL has also observed that the number of beds for the number of patients in some units was inadequate, thus requiring some patients to share beds or sleep on the floor. This is not an acceptable situation. Further, lack of storage space to store patients’ personal property in the wards has also been flagged. The practice of removing mosquito nets to reduce suicide risks, while commendable, has not been followed up with alternative to stop some mosquito bites.
Given the lengthy period of strife and economic downfall Sri Lanka has faced since 2019, and the general isolation – lack of mobility that citizens had to endure during the Covid-19 pandemic, it is likely that many Sri Lankans are suffering from mental health issues. A recent study by two universities in Sri Lanka found that a shocking 19.4% of the Sri Lankan population suffers from depression. In a comparison with other Asian countries, the prevalence of depression in Sri Lanka is notably higher, with only 16.1% of Asians experiencing this mental health condition. As such, it is incumbent on the Government and policymakers to address mental health-related issues as a matter of priority.