Features

Bridging the gaps in mental health

Published

5 years ago

2021/10/10

World Mental Health Day falls today on the theme, ‘Mental Health in an Unequal World’

Consultant Psychiatrist and Senior Lecturer from Kotelawala Defence Univeristy, Dr. Neil Fernando throws light on the widening treatment gap in mental health, calling for a four-pronged strategy to enable wider community access to mental health services.

by Randima Attygalle

Mekala (name changed) made history as the first young person from her village in Sevanagala to enter Medical College. All was going well for the budding doctor until she was diagnosed with Schizophrenia in her fourth year. A chronic brain disorder, Schizophrenia affects the way a person thinks, acts, expresses emotions, perceives reality and relates to others.

It took nine years for Mekala to recover and when she made an appeal to the authorities to let her complete her medical studies, she was turned down on the basis that her grace period to complete her course had expired. With her hopes shattered, Mekala had a relapse.

“Despite experts in mental health making a case for the young medical student to allow her to complete her studies, making an exception to the existing rules, the authorities rejected the case, which was very sad,” recollected Consultant Psychiatrist, Dr. Neil Fernando who was among the specialists that treated Mekala.

While that was the sad plight of a medical student here, the story of the American mathematician, John Forbes Nash Jr. was the opposite. He spent years at psychiatric hospitals being treated for Schizophrenia. When his condition improved, he was allowed to return to the Princeton University to teach. Not only was Nash welcomed by his colleagues but he also won the Nobel Prize in Economic Sciences in 1994. He opened his acceptance speech with the forthright comment, “I’m a Schizophrenia patient.” Nash’s struggles with his illness and his recovery inspired Sylvia Nasar’s biography A Beautiful Mind and later a film by the same name starring Russell Crowe as Nash.

World Mental Health Day was observed for the first time on October 10, 1992. It was started as an annual activity of the World Federation for Mental Health by the then Deputy Secretary General Richard Hunter. Hunter began his career in the mental health field during World War II when as a conscientious objector he joined the Civilian Public Service programme. Hunter, a law graduate, while serving a hospital for the mentally ill patients, was disheartened by the lack of awareness of mental health which drove him to advocate for it.

This year’s theme for World Mental Health Day- ‘Mental Health in an Unequal World’ highlights that access to mental health services remains unequal. This is compounded in a world which is becoming increasingly polarized, points out Dr. Fernando. “The gap between the haves and have-nots is widening each day and the inequality is more prominent when it comes to mental health. Lack of investment in mental health disproportionate to the overall health budget contributes to the mental health treatment gap.”

People with mental disorders experience disproportionately higher rates of disability and mortality proving that ‘there is no health without mental health.’ According to WHO, persons with major depression and schizophrenia have a 40% to 60% greater chance of dying prematurely than the general population, owing to physical health problems that are often left unattended (such as cancers, cardiovascular diseases, diabetes and HIV infection) and suicide. Suicide is the second most common cause of death among young people worldwide. Yet, health systems have not yet adequately responded to the burden of mental disorders.

As a result, the gap between the need for treatment and its provision is large all over the world, notes the WHO’s Mental Health Action Plan 2013-2030. ‘Between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries; the corresponding range for high-income countries is also high: between 35% and 50%. A further compounding problem is the poor quality of care for those receiving treatment.’

One in every four persons develops a mental illness says Dr. Neil Fernando. “Yet the annual investment in mental health is less than US$ 2 per person. In low income countries, it is less than US$ 0.25. In 2019, WHO pointed out that for every dollar spent on mental health, there is a return of four dollars from improved health and productivity.” Although it is accepted that large hospitals are not the best of places for people with mental disorders, 67% of financial resources are allocated to mental hospitals,” notes the psychiatrist who goes onto add that mental hospitals often restrain people unnecessarily resulting in abuse, poor health outcomes and human rights violations.

The tragic story of P.P. James who was confined to the asylum in Angoda for 50 years is one of the worst violations of human rights resulting in restricted hospitalization. Arrested on a charge of killing his father late one night in 1958, James was ruled mentally ill by a judge and was committed to the asylum for the criminally insane and was forgotten for 50 years, never having stood trial. Worst, the father he was charged for having killed was actually alive and died only 23 years after James’ arrest for ‘his murder’. A half a century after his arrest, his case was dismissed and James was finally free. “Although James had recovered decades ago and the courts were informed, there was no response as his file had been lost,” recollects Dr. Fernando who was serving in the hospital’s criminal ward at that time.

The absence of mental health legislation in the country to suit the present day needs is also cited by the senior consultant as a drawback in realizing mental health from a human rights perspective. The proposed Mental Health Act has remained only a ‘draft’ for decades, he says.

Stigma and discrimination, very often within families of patients (even after recovery) compounds the unequal access to mental health care and impedes the quality of their lives. Problems of knowledge, attitude and behaviour contribute to stigma. Many people even after recovery are abandoned by their families and are often deprived of their rightful inheritance.

In our setting, the stigma is even extended to the very locality where the hospital for the mentally ill stands- commonly referred to as pissan kotuwa in derogatory terms. When posted to Angoda as a young psychiatrist in 1984, Dr. Fernando took the bus from Kandy to Fort and from there to Angoda. “As the bus approached Angoda, the conductor was shouting Pissan kotuwa bahinna- pissan kotuwa bahinna and nobody got down from the bus. At the next bus halt half the passengers got off the bus and opted to walk back,” he recollects. The hesitancy of residents from the area to be identified with a hospital, drove authorities to rename the areas as ‘Mulleriyawa New Town.’ Angoda Mental Hospital was renamed ‘National Institute of Mental Health.’

Migration of qualified psychiatric specialists to other countries is another challenge points out Dr. Fernando. Sri Lanka’s failure to deliver mental health care services to a larger population is attributed to four broad reasons by Dr. Fernando:

1. The centralized services limited to large hospitals

“We need to decentralize mental health care and take it to primary health care or to the village level and integrate it to normal health care services.”

2. Services are all hospital-based

“The majority of people who need mental health services do not come to hospitals, hence the treatment gap is further widened,” remarks the senior consultant who calls for a ‘complementary community-based’ system. “Like in the case of maternal health, we can develop a system where patients are seen at home. We already have psychiatric nurses and this cadre can be further strengthened.”

3. The treatment is largely disease-based

“Instead of looking only at the disease, we should have a patient-friendly service which looks at a person holistically addressing his/her other needs as well.”

4. Services are delivered on one-to-one basis

“When we know that one in four people will be affected by a mental health problem during his/her lifetime, one-to-one delivery will not be adequate,” says Dr. Fernando who says the involvement of patients as well as their care givers in mental health services is essential. The effort could make them active partners in the process, so that they too can be empowered to take ownership to the delivery of care, he says.

All News Advertisement

Features

The challenge of keeping value-based politics alive

Published

12 hours ago

2026/05/28

Sahan Weerasooriya

Anti-migrant protests in Durban, South Africa. BBC

The current outbreak of anti-immigrant protests in Durban, South Africa is bound to have taken many a subscriber to value-based politics or political idealism quite by surprise. After all, this is evidence that despite the historic accomplishments of nation-builders of the stature of the late President Nelson Mandela it cannot be taken for granted that identity politics, including racism in its worst forms, is no more in South Africa.

At the time of this writing details are scarce on the substantive root causes of the protests but it could very well be that economic grievances, particularly on the part of the majority community in South Africa, are contributing considerably to the disaffection. Shrinking employment and material prospects are likely to figure majorly among the factors igniting the unrest.

Fortunately, the local authorities in Durban are losing no time in calling for peaceful co-existence among the relevant communities and are pointing to the vital importance of stepping-up national integration processes. Apparently, immigrants in sizable numbers from neighbouring countries are present in Durban. However, international TV footage of the protests quoted some local authorities as saying that the majority of the immigrants in some centres that housed them were not illegal migrants and had the documents that entitle them to be in Durban.

In the Durban protests the world has fresh proof of the socially divisive consequences of the gathering globe-wide economic disaffection, touched off particularly by the continuing crisis in West Asia. Going ahead, the world would need to brace for increasing identity-based unrest of the kind it is just witnessing in South Africa.

Considering that the material lot of ordinary people everywhere could only aggravate progressively, with the US and Iran showing no signs of negotiating an end to their confrontation any time soon, it will be left to the more democratic and progressive sections of the world community to initiate positive measures collectively to bring a measure of relief to the discontented.

The swiftness with which such relief will be provided would depend crucially on the importance those sections taking up these undertakings attach to value-based politics as opposed to Realpolitik of power politics.

Going by these yardsticks, Italy could be considered to be moving in the right direction. Recently Italy came to the fore in initiating the collective named, ‘Rome Coalition for Food Security and Access to Fertilizer’, which has as one of its aims the swift provision of fertilizer to economically weak African countries.

In a recent statement Italian Minister of Foreign Affairs and International Cooperation, Antonio Tajani, said that a principal aim of the project was to ensure that the farmers of Africa gained easy access to fertilizer, considering that food security is a growing concern among some of Africa’s economically vulnerable countries.

The statement went on to mention that some 30 countries hailing from the Mediterranean region, the Middle East, the Balkans as well as the FAO had been invited to join the coalition. The venture is far-seeing in that food security is main among the reasons for social discontent which in turn could degenerate into endemic political turmoil and bloodshed. Separatist violence and geographical fragmentation of countries wouldn’t be too far behind these developments, as Africa itself has often proved.

It is hoped that more G7 countries would take the cue from Italy and do what they could to ease the hardships of economically distressed countries, particularly of the global South. In these efforts they would need to break rank with the US, which is today brutally indifferent to the consequences of its policy of making ‘America First’, come what may.

Going by current developments, the Trump administration seems to be blithely oblivious to the wider, deleterious effects of its policy course in West Asia. Besides rendering Iran militarily and otherwise impotent nothing else seems to matter to Washington, as regards West Asia. This is policy short-sightedness of an extreme kind. After all, right now West Asia could be said to be sitting on the proverbial powder keg.

On the other hand, Iran is not giving the world the impression that it is doing anything constructive to get out of the policy straitjacket that it wove for itself decades ago. Rather than enter into a policy of ‘live and let live’ in relation to Israel in particular and initiate a process of reconciliation with the latter, it has chosen to operate within policy parameters that continue to damn Israel. This has put Israel always on the ‘defensive’ so to speak and prevented the opening up of space for meaningful dialogue.

That said, Israel is obliged to explore the possibilities of entering into a negotiatory process with the Arab-Islamic world that could lead to a de-escalation of tensions and bloodshed. It cannot continue to look at its neighbours through lenses that distort them as archetypal enemies who should be ‘wiped off completely from the face of the earth.’

In other words, the need is urgent for Realpolitik to give way to value-based politicks. Italy is beginning to prove that the latter approach could be pursued with some success. May be the EU and the UK could throw their weight behind these initiatives as well and establish that international politics could be refashioned on the basis of humane, civilized norms. The UN would need to be fully supportive of these moves and prove an organizational nucleus of the operations that follow.

In fact the time is ripe for people of conscience to collectively stand up on the side of peace and say ‘No’ to war and violence. Organizations such as the ICRC, the WHO and Medicines Sans Frontiers have already taken up this call. Referring to the widespread destruction of health facilities and their dehumanizing results these organizations have said, among other things, that ‘This is not a failure of the law. It is a failure of political will.’

True, ‘failure of political will’ among those powers that matter accounts for the runaway, uncontrollable nature of war and destruction in contemporary times, but more fundamentally it is a failure of the human conscience. It could very well be that the phenomenal levels to which violence and war have been unleashed today have had the effect of deadening consciences. This is a matter for urgent study and wide discussion.

Features

Vesak celebrations … with Cuteefly

Published

12 hours ago

2026/05/28

Sahan Weerasooriya

Perfect for celebrations, gifts, and meaningful occasions // Gift pack

I would describe Indunil Kaushalya Dissanayaka as innovative and creative, and she operates under the name of Cuteefly.

Indunil always comes up with something novel to celebrate special occasions, and she does it with candles … and that’s her profession.

She was in the spotlight when she created a happening scene, with candles, for Christmas, Sinhala and Tamil New Year, and Valentine’s Day.

As lanterns light up Sri Lanka for Vesak, the Colombo-based candle maker is quietly turning wax and wick into little pieces of the festival.

Candles reflecting Vesak themes

Her candles reflect Vesak themes – light, peace, remembrance, giving, etc., to enable you to fill your Vesak celebration with devotion and beauty.

Among her Vesak creations is a lotus-shaped soy candle, scented with sandalwood, lavender, etc., meant to burn during this Vesak Poya Day.

Indunil Kaushalya Dissanayaka: Customers
praise her for her creativity

These handcrafted Vesak candles are perfect for offering at the temple, she says.

What makes her creations so novel is that they come in different shapes, scents, themes, and all are handmade.

What’s more, her customers have heaped praise on her for her creativity.

According to Indunil, her creations are perfect as a thoughtful gift … to bring beauty, unity, and light into every moment.

Says Indunil: “Our beautifully handcrafted Unity candles are designed with premium detail and love, making them perfect for celebrations, gifts, and meaningful occasions.”

Cuteefly, says Indunil, is available online.

Readers could contact Indunil on 0778506066 for more details.

He Facebook Page is: Cuteefly.

Handmade with love

Features

Dark Spots …

Published

12 hours ago

2026/05/28

Sahan Weerasooriya

Yes, dark spots do crop up on the skin, especially with sun exposure and, of course, as the skin ages.

However, these tips should be of immense benefit to those who are faced with dark spots.

* Lemon and Honey Glow Mask:

You will need 01 teaspoon lemon juice and 01 teaspoon honey.

Mix the lemon juice and honey well and then apply this mixture, only on the dark spots.

Leave for 10–15 minutes and then rinse with cool water.

Benefits:

Lemon helps brighten pigmentation.

Honey moisturises and heals skin.

Gives a natural glow.

* Aloe Vera Gel Treatment:

All you need is fresh aloe vera gel.

Apply the gel apply on dark spots, before going to bed.

Leave overnight and wash in the morning.

Benefits:

Reduces acne marks and pigmentation.

Soothes irritated skin.

Helps skin repair naturally.

* Turmeric and Yoghurt Paste:

You will need 01 teaspoon yoghurt and a pinch of turmeric

Mix the yoghurt and turmeric into a smooth paste and apply on affected areas.

Leave for 15 minutes and then wash gently with lukewarm water.

Benefits:

Turmeric brightens skin naturally.

Yoghurt removes dead skin cells.

Helps fade dark spots gradually.

Use these packs 02-03 times a week as results are generally seen over time.

You can also try this out: Mix a ripe papaya into a smooth paste and apply to the face, or directly on to the dark spots. Leave for 15-20 minutes and then wash with lukewarm water.