Mental health care for all: Let’s make it a reality

HEALTH

By UMA AMBI
MY dear fellow citizens,
One of the primary goals of our national Mental Health Policy is to mitigate the number of people who became ill, and die from mental illness, through protection and promotion of mental health and social well-being, prevention of substance abuse, access to quality care and effective rehabilitation within our chosen environment.
Harassment of basic human rights at work places is unjustifiable. These incidents are preventable and reversible with positive involvements. We must stand tough for anyone who is a victim as they could be our partners or loved ones. As the rugby slogan goes “Strong men do not victimise women.”
The Mental Health Act 2015 was passed by Parliament to addresses these actions. It is unmistakable that Mental Health Act 2015 would stimulate and initiate many kinds of activities with result driven implementations.
Mental health promotion, prevention awareness and education is essential to inform people how to identify stress, mental health problems, to know where to seek medical attention and for those in the community to know where to refer those who need social and mental health services. Access to such support will go some way to reduce the tragedies of trauma, relieve stresses on individuals, communities and protect the lives of people from harming themselves and others.
The World Federation for Mental Health (WFMH) President Dr Ingrid Daniels has announced the theme for World Mental Health Day 2021 (Oct 10) which is ‘Mental health in an unequal world’.
This theme was chosen by a global vote of members, stakeholders and supporters because the world is increasingly polarised, with the very wealthy becoming wealthier, and the number of people living in poverty still far too high. In the previous year it was highlighted that inequalities due to race and ethnicity, sexual orientation and gender identity, and the lack of respect for human rights in many countries, including for people living with mental health conditions. Such inequalities have an impact on people’s mental health.
Hence WFMH had the theme, chosen for 2021, will highlight that access to mental health services remains unequal, with between 75 per cent to 95 per cent of people with mental disorders in low- and middle-income countries unable to access mental health services at all, and access in high income countries is not much better. Lack of investment in mental health unequal to the overall health budget contributes to the mental health treatment gap.
Many people with a mental illness do not receive the treatment that they are eligible to and deserve and together with their families and carers continue to experience stigma and discrimination. The gap between the ‘haves’ and the ‘have not’s grows ever wider and there is continuing unmet need in the care of people with a mental health problem.
Research evidence shows that there is a deficiency in the quality of care provided to people with a mental health problem. It can take up to 15 years before medical, social and psychological treatments for mental illness that have been shown to work in good quality research studies are delivered to the patients that need them in everyday practice.
The stigma and discrimination experienced by people who experience mental ill health not only affects that persons physical and mental health, stigma also affects their educational opportunities, current and future earning and job prospects, and also affects their families and loved ones.  This inequality needs to be addressed because it should not be allowed to continue. We all have a role to play to address these disparities and ensure that people with lived experience of mental health are fully integrated in all aspects of life.
People who experience physical illness also often experience psychological distress and mental health difficulties. An example is visual impairment. Over 2.2 billion people have visual impairment worldwide, and the majority also experience anxiety and/ or depression and this is worsened for visually impaired people who experience adverse social and economic circumstances.
The Covid-19 pandemic has further highlighted the effects of inequality on health outcomes and no nation, however rich, has been fully prepared for this.  The pandemic has and will continue to affect people, of all ages, in many ways: through infection and illness, sometimes resulting in death bringing bereavement to surviving family members; through the economic impact, with job losses and continued job insecurity; and with the physical distancing that can lead to social isolation.
We need to act, and act urgently.
The 2021 World Mental Health Day campaign ‘Mental Health in an unequal world’ will enable us to focus on the issues that perpetuate mental health inequality locally and globally. We want to support civil societies to play an active role in tackling inequality in their local areas. We want to encourage researchers to share what they know about mental health inequality including practical ideas about how to tackle this.
When WFMH was formed in 1948 the world had emerged from war and was in major crisis and much of this was tackled by collaboration between WFMH, WHO, UN, UNESCO and other global stakeholders and citizens with an interest in mental health wellbeing.
We are again in the midst of another global crisis that is resulting in widening health, economic and social inequalities. The 2021 World Mental Health Day campaign provides an opportunity for us to come together and act together to highlight how inequality can be addressed to ensure people are able to enjoy good mental health.
Be a partner; be an advocate is the call from the Professor Gabriel Ivbijaro, the WFMH secretary-general. And I attest that we have similar sentiments in PNG with this call.

Is mental illness a lifelong condition?
Each person experiences mental illness differently. For one person, it may occur, stop and re-occur, while another might recover completely. There are a range of treatments available that enable many people with mental illness to function successfully in their private and work lives.

World Mental Health Day (Oct 10) message from the PNG Psychiatric Association

Is mental illness a disability?
The impact of mental illness on a person’s life determines whether it becomes a disability for them and whether it is a permanent or temporary disability. A person may experience one event of mental illness in their lifetime and completely recover, while another may have to manage their illness for the rest of their life. The definition of ‘disability’ is broad and includes both permanent and temporary mental illness.

Facts about mental illness
Mental illness can cause misunderstanding, confusion and sometimes fear. As an employer, you may have fixed views about employing or working with people with mental illness. Here are a number of facts about mental illness:
Fact 1: People with mental illness can and do work
People with mental illness successfully work across the full range of workplaces.
Some people disclose their mental illness and some do not. Most importantly, people with mental illness can succeed or fail, just like any other worker.
Fact 2: Mental illness is treatable
Mental illness can be treated. This means that many people who have mental illness, and are being treated, recover well or even completely. However, because there are many different factors contributing to the development of each illness, it can sometimes be difficult to predict how, when, or to what degree someone is going to get better.
Fact 3: The vast majority of people with mental illness are not risky
It is far more likely that people with mental illness are victims of violence rather than being violent themselves. Only a small number of people with mental illness are violent and this tends to be when they are experiencing an untreated psychotic episode. This behaviour can be managed through the use of medication.
Fact 4: People with mental illness live and work in our communities
People with mental illness do live and work in our communities. The majority of people successfully manage their illness without it greatly impacting on their

Steps to dealing with mental health in difficult times like the present.
home and work life, while others may require support to minimize its impact.
Fact 5: People with mental illness have the same rational ability as anyone else
Having mental illness does not necessarily imply any loss of rational functioning. Some symptoms and medications associated with mental illness may affect a person’s ability to think, process, or remember information.
Fact 6: People with schizophrenia do not have multiple personalities
People with schizophrenia experience changes in their mental functioning where thoughts and views become inaccurate and are often ‘split’ from reality. Schizophrenia is not about having ‘split or multiple personalities’, as is often shown in the media.

Education
Our government and the National Capital District have included material about educating the public on mental and behavioral disorders to encourage a better understanding of these disorders. As you and I are aware, there is good continuous educational propaganda via “Beautiful Mind” and “Healthy Mind” weekly TV programmes. In addition to this, the newspaper column titled “Mind-Watch” has certainly synergised our thoughts on what good mental health elements are.

The time to change is now— make it happen
This kind of campaign helps to eradicate the stigma and taboo which for centuries have surrounded mental illness and so helped to create profound discrimination against those who suffer mental ill health.
We are still a million miles away from the parity of esteem between physical and mental health. Imagine lying in a ditch after a road traffic accident and being told that the ambulance would be along in a couple of weeks. Yet for severe mental illness, that long and much worse is taken for granted. We all have a role to play in breaking down the walls of stigma and taboo
I bid you all every success.

• Dr Uma Ambi, OBE , is president of the PNG Psychiatric Association and a consultant psychiatrist.