Tuesday, March 31, 2009
Suicides: The Need for Community-based Mental Health Care
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.