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Suicides have a variety of ‘root’ causes. But undoubtedly the most important immediate cause of suicide is untreated depression. Given this fact, the recent spate of suicides in Male has focused attention on the state of mental health care in the Maldives.
There are only 4 psychiatrists working in the Maldives health services –all of them in IGMH working as outpatient doctors each seeing an average of 10 patients per day. There are no other categories of mental health care providers in the country. Now compare this with the need.
While there are many factors leading to severe depression that ends in suicide, the most important factor in the Maldives is drug addiction. If one includes all those who ever experimented with drugs, the number of drug abusers in the Maldives could go up to 30,000. But the number of hard-core drug addicts is much lower by most estimates –perhaps about 5,000. These 5,000 would need psychiatric attention now and then. However, it is fairly obvious that the 4 psychiatrists in IGMH will not be able to cater to such a large number of clients.
Faced with similar dilemma, many countries in Europe have opted for community-based mental health care, which is a low cost alternative to institution-based care, and is recommended by World Health Organization.
Under the community-based model, a range of mental health services can be provided through primary care facilities, backed up by access to specialists for training, consultation, inpatient assessment and specialist treatment. This link to specialists is of particular importance given that most mental health problems will be first seen in primary care, where the detection and management of common mental health problems such as depression remain poor. Effective training for primary care practitioners requires a combination of strategies, including access to information and liaison with and feedback from other health care professionals.
Community mental health teams (CMHTs) provide a range of services (including the contributions of psychiatrists, community psychiatric nurses, social workers, psychologists and occupational therapists), and usually give priority to adults with severe problems. Such teams have been shown to improve the individual’s engagement with services, to increase client satisfaction and improve concordance with treatment. They are also associated with improved continuity of care. At an individual level, case management can be used to coordinate a range of care and other services for an individual that will be provided by the CMHT.
18 comments:
many maldivians still beleive only 'mad' people seek psychiatric help. so very few people go. a lot of awareness needed in this area.
in many countries they have suicide hotlines. many times such hot lines help to prevent suicides.
Again, we have to talk about the re structuring of our social values. The thing is most of us still do not believe that depression is real and that it needs professional help in almost all the cases (unless the individual is very strong and finds alternative by himself).
I admit that i was in profound agony and depression during 2002-2007 a five year period. I have a family breakdown. I did contemplate on suicide once and im really not proud of it, but it is the truth. I tried books, movies, website, forums (since i got the job) and thats when it started to recover. I started traveling finally (which some of my family members and friends and colleaguesstill does not approve) and it helped to recover most if not fully..
The truth is our society has among many things those which really fuel the mental depressions and the lack of activities or entertainment available, youngsters without proper understanding of what they want in their life turn to either Drugs or Extreme religious groups. This is the problem. when we are depressed we are very vulnerable to drugs and extreme ideologies, sometimes to steam off the frustations buildup during those morbid months if not years of depression.
I yearned for a psychiatrists during my day, i simply needed to speak to someone knowing he/she will not judge me and offer me good advice considering i was mentally ill. but all i got was enforcement and anger for my behavior..
I actually never knew there are four shrinks at IGMH.
Things has to change! Xenophobia is not going to solve our problems, but even if some view these developments are western culture its time we set our selves free from such hidebounded concepts and actually start embracing technological and social developments either from West or East. its for our own good and thats what wise ppl do.
No NO.. The Qaaree courses are going to help.
MH
as a recovering addict i can see several things that drive addicts to suicide. loss of self respect and confidence, loss of family support. lack of job and money. hatred from nieghbours etc.
all those who are deprssed, dont lose hope. remember the promise of afterlife.
This is something that can be corrected by a lot of work. See in our education system we don't teach any life skills. We still teach Rannamari and Dhandehelu in our social studies. Isn't this high time for us to change this and start teaching some good social skills. Look at these so called partey. Why did they end up there. Simply because they never had any aim or goal in life. So there is a big role that can be done by the schools and teachers to solve this problem too.
Alif Laamu Gaaf,
ya, why do we keep on teaching our kids bullshit like Rannamaari and Bodu Thakurufaanu cutting through islands? And what's so heroic about Ali Rasgefaanu getting killed while obviously on the run? Funnily in tryng to make the guy a hero the story insults the people of Male who refused to join him in his escape.
young people do have goals. how about winning first prize in annual Quran reciting competition.
public health has designed a mental health policy, n its first priority has given to train primary health care workers in the field of counselling psycology. now what they can do right now is to send psycatrists to islands n attend for the poor patients n activate these few counsellers.
anon 12:36,
there are many projects like this on paper. hope they actually give some service to the patients soon.
How about using fanditha instead of counseliing
Thank you Dr. Waheed for bringing up such a burning topic.
One cause to suicide is as u stressed Drug addiction. I guess the figure you gave (5000) and very well expressed as Hard core addicts are in the suicide row. Its a shame we cant even detox a suffering addict.what more could we do!This a question I ask myself.Most of us seems to sleep over this Just for Today this not viable but in recovery it does work!xoba
holding a couple of emergency meetings every time a person dies is unlikely to solve the problem. Long term measures and services must be started.
Let me ask you, what can be the cause of drug addiction then? you can't say it's just one.it is a cocktail of many social and so many other factors that we have to do urgent research but still we are just talking about it and doing nothing much.
Everybody says something needs to be done. But what can be done? Dr. Waheed tell us, what needs to be done to i)make sure our children (and even adults I must add) do not get seduced by drugs ii) to help those that are addicted to make sure that they have at least some sort of a decent life.
Hope I have an answer Dr. Waheed
To Anonymous 6:27,
I don't claim I have an answer to this difficult problem. However, what works and what does not work in the fight against drugs is fairly well documented. Using those methods most countries have succeeded in limiting the drug menace to accepted levels, though no country has achieved full drug control. It’s not lack of knowledge but lack of effort that is preventing us from reaching the control levels achieved by other countries.
Any person, male, the thought of suicide will never come across his mind, if he does it, it means he found out that the inner himself is actually a secret agent hermaphorite with 6 tits and a dick stuffed in his(its) own twat!
Ladies on the other hand suiside, coz simple they are the weaker sex.
Doctor/Phyciatrist,
anarchyst
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