The rapid spread of Covid-19 has brought about significant changes into our daily lives. The fear of contracting the virus restricted our movements and we faced new realities such as working from home, home schooling, unemployment and most of all lack of physical contact with family members, friends and colleagues. Thus looking after our mental health has become more important as we struggle to overcome fear, worry and stress in the context of this pandemic.
How do we navigate through mental health crises that we see today? To educate and create awareness on managing mental health, `World Mental Health Day’ was held on October 10 under the official theme `Mental Health in an Unequal World’, as set by the World Federation for Mental Health. World Health Organization also emphasised on the need to scale up quality mental health services at all levels. During this year’s campaign, WHO showcased the efforts taken in some countries which will become an inspiration to others, under the theme `Mental health care for all: let’s make it a reality’.
The responsible organisations in Sri Lanka did not fail to do their part in creating awareness on dealing with mental health issues and breaking the stigma attached. Directorate of Mental Health takes the initiative in creating a society where mental well-being and human rights are valued and promoted and people with mental disorders have affordable access to appropriate mental health and psycho social care free from stigma and discrimination.
Main factors
“Mental health is everybody’s concern. Rising cost of daily living expences where you have to earn more at the expense of the leisure time, family issues, work stress, education, policies of other people around you, all these factors affect the mental wellbeing of a person. Thus majority of the factors that affect the mental wellbeing of a person lie outside the health arena. To sustain the mental wellbeing of the people it has to come from other sectors as well,” Director of Mental Health Directorate, Dr. Rohan Ratnayake said.
He added that Sri Lanka has improved a lot in the field of mental health since Sri Lanka became a victim of the Tsunami incident in 2004. “After the Tsunami there was a huge improvement in mental health field. We had influence from other countries as professionals came and worked with our professionals here. This happened decades ago but since then we have experienced a huge progress in how you address mental health issues and wellbeing” Dr. Ratnayake added.
He said the directorate is now poised at promoting mental wellbeing before it turns into a health issue which needs treatment. “We are giving much significance at present to mental health promotion and work place wellbeing. This is to assist people to stable not only physically but also mentally before their mental wellbeing is affected by factors. It is fairly a new approach even though the concept was there for a long time because of lack of district level staff and resources the directorate could not address mental health promotion. Now, we have placed promotional activities as a priority,” Dr. Ratnayake said.
National policy
“Human interaction is important for everyone no matter how much ever they work online or have online education. Unless you connect with your community and contribute to your community, a person will not be mentally fit. Thus we are at the highest level to formulate the policies and guidelines. With the help of other stakeholders, directorate has revised the previous mental health national policy and 2021-2023 policy which will be launched very soon is available now. Policy covers and gives guidance to all the stakeholders in mental health and interested parties.
Directorate has also prepared a guidance for the school authorities, as the Government is keen on reopening schools especially to promote psychosocial wellbeing of the students. Schools can utilise the district level mental health staff for assistance. The suicide prevention action plan is another priority the directorate is working on now.
The directorate also runs programs and activities for substance abuse prevention that is alcohol and other drugs. We are also concerned about child mental health and their wellbeing. As we are facing more and more natural disasters, we have programs to address the psychosocial wellbeing of the people affected. The directorate also support the district level system to improve their infrastructure with funding which enables them to have their own training programs and other activities,” Dr. Ratnayake said.
How did Covid-19 impact the mental wellbeing of the people in our society? The stakeholders explained that the lock downs had both negative and positive impacts on people.
“Covid-19 did not make much difference in suicide rates in our country. In 2019, suicide rate was 3,135 out of which 2,489 males and 646 females died by suicide. In the year 2020, the suicide rate stood at 3,074 with 2484 males and 590 female deaths reported. There was not much of a difference here compared to countries like Australia where they experienced a huge drop in suicide rates due to lock down. However, what we realised was from the call rates 1333 gets 80 per cent were female callers. Women call and share their problems where as men are reluctant to get assistance. So there is an issue here,” the CCC Line (Courage, Compassion, Commitment) Manager, Ranil Thilakaratne said.
“As negative impacts, suicide attempts, domestic violence, child abuse, divorce rates have been high during the lock down periods, there have been positive impacts too with families coming together in unity, beginning to appreciate little things in live and even starting home business to sustain their income. We also noticed a hike in our call rates and earlier most of the calls were to deal with loneliness, financial issues, relationship issues that affect the mental health of people. During Covid-19 lockdown period the calls were mostly regarding the fear of life, what tomorrow will bring and the employment uncertainties,” Thilakaratne said.
He added that mental issues are not merely sickness but also the work pressure, bullying and fear also affects the mental wellbeing of a person. “Companies are now promoting mental wellbeing, mindfulness, psychological safety as measures for suicide prevention. We need to talk about mental wellbeing and mental issues more and educate more to normalize it. If anyone faces an issue which makes them feel unstable, they can talk to a friend, a teacher, a parent or call helplines. We should encourage people to talk and also to listen. People should not be judgmental but should respect the person who talks to you as they trust you,” Thilakaratne said.
Working together with other stakeholders, CCC Line, a toll-free suicide prevention hotline has launched many programs to create awareness on mental health issues. Meanwhile a volunteer for ‘Sumithrayo’, Jomo Uduman said the volunteers look not only at mental health concerns but also at all other concerns that involve the wellbeing of a person.
“Our approach is in a non judgmental manner with unconditional acceptance and empathy. ‘Sumithrayo’ is feelings oriented so we steer a caller towards their pain and help them identify and explore those innermost feelings, offer them emotional support and empower them to make life enhancing choices. Above all, we offer an active listening ear, which in the process, we are also able to hear what is not being said,” Uduman said.
Caught in a race
“Pre Covid-19 all of us were caught up in the rat race, with barely any time for ourselves or our loved ones. On a positive note, lock downs brought people and families together with an opportunity to bond, appreciate and understand each other better. There was time for rest, recharging and recreation indoors. At the same time there were many people who were and are affected economically due to loss of employment and livelihood that made them unable to provide for their families. Together with this there was a lot of misinformation and disinformation that was flying around which could be referred to as an Infodemic. All of this caused anxiety, fear, stress and uncertainty. People with underlying mental health concerns may have got worse while some may have begun developing initial symptoms due to the severe pressures of surviving the pandemic and even by watching their loved ones suffer from the illness or even succumb to it.
Their inability to grieve and perform last rights as they would have under normal circumstances would have been very painful and difficult to endure. During these trying times ‘Sumithrayo’ supported people via telephone. There were many people who contacted us and who were comforted and supported emotionally,” he said.
Uduman said that unfortunately support centres seem to be only concentrated in and around Colombo which serves as a disadvantage for people in other areas. “Even if you look at the hundreds of Psychologists who pass out every year all of them are in and around Colombo.
Generally, as soon as somebody in a rural area is seen to be behaving differently, they are taken to the Psychiatric ward of the closest government hospital when all they may need is somebody to talk to about their feelings. Of course, places like ‘Sumithrayo’ and CCC are accessible by phone from all over the country but often people may want to talk to somebody in confidence face to face. So policy makers and stakeholders must get together and provide such a service in towns and cities in every district.
It is important to note that the majority of suicides, attempted suicides and self-harm are from rural areas. A person may attempt or complete a suicide not because he or she wants to die but because he or she wants to stop the pain. Often this pain has become compressed inside a person because he or she has not had an opportunity to share their feelings and speak freely about them without the fear of being judged or labelled,” he said.
‘Sumithrayo’ has been offering this service free 365 days of the year for the past 47 years. Since 1974 when the founding centre in Colombo was established, ‘Sumithrayo’ was the first crisis center in Sri Lanka and has been in the forefront of suicide prevention: befriending and empowering the lonely, depressed, despairing and suicidal with emotional support. This is a free and confidential service. The Colombo centre with the strength of almost 100 volunteersrecieves over 8,000 calls per year who seek befriending via face to face, telephone, by letter and email.
Role of Sumithrayo
“Sumithrayo seek to alleviate human misery, loneliness, despair and depression by listening to and befriending those who feel that they have no one else to turn to who would understand and accept them. The service is delivered by a group of volunteers. Volunteers are carefully selected and trained to befriend people who are emotionally distressed. Training gives them the skill of befriending. Volunteers are not counselors but befrienders. Befriending is the art of positive listening to troubled feelings and helping distressed persons to explore healthy options which can ultimately lead to empowerment and a positive approach to life’s issues,” Uduman stated.
The outreach arm of ‘Sumithrayo’, 'Mel Medura' provides services with a well-established alcohol and drug demand reduction program. The specialty of it is that the help seekers are rehabilitated in their own environment rather than in an enclosed location. This is guided by a group of professionals both local and international and any person who seeks help can drop in. The unit is non-profit oriented and works at the primary, secondary and tertiary levels of supply and demand reduction of harmful, dependence producing psychoactive drugs. However, greater emphasis is placed on the preventative rather than the curative aspects of a wide range of community concerns which tends to diminish health.
With all the initiatives taken by other stakeholders Sri Lanka can be optimistic about creating a mentally and physically fit society in the near future.