Tuesday, May 12, 2009



The journey in helping the mentally ill begins with small steps

By Dianne Silva

A certain comic strip relates how this little boy is told to go and sit in a corner by his mother. The boy goes to this corner but chooses to stand instead of sitting down, much to his mother’s annoyance. In the next frame the mother physically makes him to sit down. The final frame shows the boy saying; “I might be sitting on the outside but I’m standing on the inside!”

The strip more or less depicts our ability as human beings to outwardly portray an image that is in stark contrast to what actually lies beneath. We are all able to show the world that things are all ‘honky-dory’ when in reality they are not. In a society that quickly sweeps mental health problems under the rug we are expected to deal with our problems internally and not make a scene about these problems we, supposedly, brought on ourselves. However, living in a world where the deaths of children caused by the faults of their parents are becoming increasingly frequent -- suicide is becoming the easiest means of solving problems. This trend reflects the emergence of a post-conflict society and this phenomenon seems more pertinent now more than ever before a situation demanding the focus on this area of health which has thus far been stigmatised by society.

Escalation of the incidence of mental illness

According to a study by VSO (an international development charity that works through volunteers and promotes volunteering to fight global poverty and disadvantage), between 5% and 10% of people in Sri Lanka are known to suffer from mental health problems. The organisation attributes the deterioration of the mental health of the population to the Tsunami of December 2004, which is estimated to have affected some 400,000 people. Together with the conflict in the North, it has made a significant impact on the mental health of the population. Further the finds that the post-traumatic stress caused by both the ongoing conflict and the tsunami has an impact on people’s ability to earn a living and participate fully in their communities.

Despite being ranked 93rd among developing countries in the Human Development Index (2005), the mental health of our people has been ignored to a great extent due to the stigma that surrounds the subject. The VSO through their studies identified three main areas that were leading to the marginalization of mentally ill persons.

(a) Social discrimination - people with mental health problems are frequently ostracized from society due to ignorance, myths, false beliefs and lack of awareness of their rights.

(b) Inadequate access to mental health services, resulting in lack of treatment and rehabilitation. Mental health services which exist are concentrated in urban areas with little or no services in rural areas, while specialized services for the elderly and children are extremely limited

(c) Economic barriers - families of people with mental health problems are often poor and are not provided with welfare benefits to address their psycho-social needs. This type of mental illness often leads to suicide or other acts of violence which have been evident in the past with many affected people resorting to heinous crimes that escape all reason.

Coping with life’s challenges

According to the experience of experts on the area, having good decision making skills and coping skills will help an individual to have greater self confidence to face the day to day challenges of life, keeping them from being lured by undesirable compulsions such as, tobacco, alcohol, drugs, premarital/ extra marital sex etc. all of which can lead to emotional problems.

The Director of the Suicide Prevention Programme conducted by the Colombo South branch of Sri Lanka Sumithrayo, Surakshi Siriwardena believes that this can be avoided if people are given the resources to cope with their problems and more importantly their emotions instead of resorting to acts of violence. “We have identified that befriending is of utmost importance and the benefits of decision making skills are being imparted to our society to reach all walks of life” she said.

Since the increase in the number of suicides is identified with the consumption of pesticides, some authorities have been discussing the possibility of eradicating such potential materials of self destruction. However, the Sumithrayo concept differs from this. “There have been many discussions and workshops on suicide prevention and controlling of the sale and use of pesticides among farmers in rural societies. Instead we are focused on empowering the various groups of persons through emotional support to enable them to develop coping skills and not reach a point of suicide.” Ms.Siriwardena said.

Ms.Siriwardena also explains that persons need to realise the significant roles they play in the lives of others and that one moment spent to ask someone else how they are feeling could possibly save their lives. “We very rarely ask the question ‘are you feeling suicidal?’ If someone asked me that I would say no, but if you ask someone who has been considering it then they could break down and pour their heart out to you which could make the difference between their taking that decision to end their lives or not. Yet we are so fearful of asking that question,” she explains.

Peer support for the mentally ill

The Director explained that small steps however insignificant they may appear to be, have to be taken in order to make great successes in this area. The Chinese Philosopher Lao Pzu said ‘the journey of a thousand miles begins with one step.’ Taking this idea further the American politician Adlai Stevenson said that the journey of a thousand leagues begins with a single step. So we must never neglect any work within our reach however small it is,” she said. Experts stress the importance of having a good group of peers for support and the importance of women especially not confining themselves to the company of their family. Surakshi Siriwardena says one should remove themselves even for a brief period from the sources that cause them stress or displeasure and thus need a source to run to when such pressures come from within the family.

For those who find themselves alone and isolated from such situations are requested to contact the Sri Lankan Sumithrayo who are always willing to listen on their hotline - 4401094.

How to help outside your circle: Colombo South, Sumithrayo

The Colombo South Branch of the Sri Lanka Sumithrayo are calling for volunteers willing to help ‘the suicidal and despairing’ by giving their time, commitment and a listening ear. A training programme is conducted by the Colombo South centre for volunteers after which, they are trained for a short period and then allocated a weekly four hour shift.

The initial training is a two day programme and gives participants all the knowledge needed to befriend suicidal persons. The programme focuses on training in listening to the emotions of those in despair instead of focusing on their problems and trying to solve them.

Training batches of police personnel, school children and hospital staff have been conducted to befriend those in their own environment. The objective of the organisation is to reach out to a considerable number of persons at an early age by creating an awareness of suicide prevention and recourse they would have in case of suicidal feelings. Further, to make society and peers aware of how to identify another person with suicidal feelings or early depressive feelings. The organisation also hopes to make persons aware of what steps are available and what could be done in order to prevent a potential suicidal person taking his or her life.

In an attempt to reach outside of the Colombo circle the Colombo South branch has established outreach centres in Arachchikattuwa and Pambala as part of their expansion programme. They hope to establish more centres around the country beginning with their next one in Galle.

With this in mind the group held an all island essay competition for school children in collaboration with the Ministry of Education on the topic, “The Importance of developing decision making skills and coping skills amongst schoolchildren”. This was completed in March of 2009 and the winners were gifted 16 computers. Trophies and 240 merit certificates were also awarded. The branch also carried out a quiz on world children’s day where over 1100 students participated and the winners were given certificates and 425 book vouchers. Further, a free health camp at Lunugamvehera was held to reach out to over 600 needy persons.

About depression

Most people feel depressed at some stage of their lives; but for some the feelings are more intense and last longer. This type of depression doesn't just ‘go away', and telling the person to ‘cheer up' or ‘pull yourself together' doesn't help. It's not that simple. But there is hope. Depression is a medical condition that can usually be treated. A doctor may prescribe medication or therapy - or a combination of the two. The important point is to seek help. If someone you know suffers from depression that lingers encourage him or her to see a doctor or healthcare professional

Symptoms to look out for:

Depressed mood - most of the day, every day

Mood swings - one minute high, next minute low

Lack of energy and loss of interest in life

Irritability and restlessness

Disturbed sleep patterns - sleeping too much or too little

Significant weight loss or gain

Feelings of worthlessness and guilt

Difficulty in concentrating and thinking clearly

Thoughts about death and the option of suicide
Helping a suicidal friend or relative

Be quiet and listen! If someone is feeling depressed or suicidal, our first response is to try to help. We offer advice, share our own experiences, try to find solutions. We'd do better to be quiet and listen. People who feel suicidal don't want answers or solutions. They want a safe place to express their fears and anxieties, to be themselves. Listening - really listening - is not easy. We must control the urge to say something - to make a comment, add to a story or offer advice. We need to listen not just to the facts that the person is telling us but to the feelings that lie behind them. We need to understand things from their perspective, not ours.

What do people who feel suicidal want?

Someone to listen. Someone who will take time to really listen to them. Someone who won't judge, or give advice or opinions, but will give their undivided attention.

Someone to trust. Someone who will respect them and won't try to take charge. Someone who will treat everything in complete confidence.

Someone to care. Someone who will make themselves available, put the person at ease and speak calmly. Someone who will reassure, accept and believe. Someone who will say, "I care."

What do people who feel suicidal not want?

To be alone. Rejection can make the problem seem ten times worse. Having someone to turn to makes all the difference. Just listen.

To be advised. Lectures don't help. Nor does a suggestion to "cheer up", or an easy assurance that "everything will be okay." Don't analyze, compare, categorize or criticize. Just listen.

To be interrogated. Don't change the subject, don't pity or patronize. Talking about feelings is difficult. People who feel suicidal don't want to be rushed or put on the defensive. Just listen.


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