By Dr Ramli Hassan, Specialist & Head of Psychiatric Services (Taken from Borneo Bulletin Weekend 22nd October 2011)
World Mental Health Day is celebrated throughout the world on October 10 of every year.
For 2011, the theme chosen by the World Federation of Mental Health (WFMH) is "The Great Push:
Investing in Mental Health". This theme emphasises the importance of mental health at all levels of society
and the importance of investing resources to ensure the maintenance of optimal mental health in all the
members of a society.
The number of people suffering from mental illness in the community is large. In general, the rate of mental
illness is higher in the more developed and urbanised societies as compared with the developing and less
urbanised societies.
For example, in the United States, Europe and Japan, one in every four adults has some form of mental
illness requiring treatment. This rate is lower in the less developed societies such as Malaysia where 11 per
cent of the adult population suffer from some kind of mental illness. The prevalence rate of mental illness in
Brunei is not known as no epidemiological study has been done on the subject.
However, a rough conservative estimate used for the purpose of planning of services is about 10 per cent,
which means that of the 400,000 Brunei population, about 10 per cent or 40,000 suffer from some form of
mental illness requiring treatment.
Fortunately, most of the 40,000 mentally ill individuals do not have a serious mental illness. It is estimated
that only 2-3 per cent of the population suffer from a severe mental disorder that would fit the lay concept
of madness or "gila". They are the ones who can be seen to be talking or laughing to themselves, talking
incoherently or irrelevantly, experiencing severe and rapid mood changes, hearing and often responding to
imaginary voices, as well as seeing visions that are not experienced by others. Such severely mentally ill
people often are seen to be abnormal in their behaviour, unable to function in their usual roles and even
unable to take care of their own needs and personal hygiene.
Unfortunately, these severely mentally ill individuals are brought to hospital very late and often have been
ill for several years before treatment is initiated. One reason for this delay in starting treatment is the fact
that the patient himself/herself does not know he/she is mentally ill and often resists attempts by the family
members to bring them to the medical doctor at the clinic or hospital for treatment.
Another common reason for the delay is the family's belief regarding what causes the mental illness.
Among the local Malay community, the idea of illness, especially mental illness, being due to supernatural
causes is still very prevalent and strong. The mentally ill patient is considered to be possessed by evil spirits
or to have been charmed by people known to them due to various reasons such as jealousy or revenge.
Because of these beliefs, the patient is often brought for treatment very late, often after they have become
unmanageable or too disturbed to be cared for at home. Very often, this is too late as the response to
treatment and the recovery will be limited.
An increasingly important cause of mental illness in Brunei is the use of illicit drugs such as
methylamphetamine or "syabu". Syabu can result in a mental illness very similar to a severe mental illness
called Schizophrenia, but unlike the real illness, this drug-induced psychosis usually lasts only a few days
and disappear completely within a week.
However, prolonged and chronic use of syabu can result in Schizophrenia and the patient would continue to
have symptoms even when drug use has stopped unless given the proper treatment with medication. For
this reason, the use of such illicit substances should be avoided altogether by our teenagers and young
adults.
Brunei has good facilities, as well as trained personnel for the care, treatment and rehabilitation of people
with mental illness.
For the majority with mild mental disorder, treatment as an outpatient, using counselling, psychological
therapy or medication is usually enough.
However, for the two to three per cent of the population with severe mental disorder, in-patient admission is
necessary, usually for two to three weeks, after which the patient can be discharged and followed up in the
clinic as an outpatient. Some of them may need to continue treatment as a day-patient, either in the ward
itself or at a nearby day-centre where they are involved in activities designed to facilitate their recovery as
much as possible. Some of these patients have been able to regain a good level of functioning and have
been able to return to their previous jobs or find new ones.
In recent years, the field of Community Psychiatry has expanded
greatly. The goal of Community
Psychiatry is to treat the mentally ill patient and his family at home
as much as possible, thus avoiding the
separation of the patient from his family and to reduce the financial
costs and emotional trauma of in-patient admission as much as possible.
Doctors and nurses visit patients in their homes or workplace,
examine and treat them there. Sometimes, patient admission is still
necessary if the patient is too ill or too
disturbed to be managed at home.
Of course, prevention is better than cure. The investment in mental health is not only to provide staff and
facilities to identify and treat those who are mentally ill, as early as possible, but also to prevent those who
are healthy mentally from developing mental illness. The need to curtail the use of illicit substances that can
cause mental illness such as syabu is obvious.
A lot of chronic suffering and financial costs can be avoided if our teenagers and young adults can be
prevented from abusing such drugs as the mental illness, once started, continues life-long.
Equally important is the effort to strengthen the individual's ability to cope with the stresses and challenges
of daily life by enhancing religious beliefs and practices, providing skills in the recognition and
management of stress and strengthen the role of social support systems such as the family and friends as
well as the local mosque committee in helping the individual cope with the stresses such as the death of a
loved one, loss of a job, marital problems or family problems.
The Ministry of Health is playing an active role in holding "Stress Management Workshops" for various
groups all over the country in order to help the participants to recognise stress early, manage it as much as
possible, and if necessary, to seek professional help from a counsellor, psychologist or medical doctor.
The Ministry of Health has also set up a Counselling Unit to provide counselling services for distressed
staff of the various government ministries, who are occasionally referred to the specialist psychiatrist in the
hospital if further assessment and treatment is required, especially medication.
Talks and workshops are also held in schools for parents, teachers and secondary school students in order to
help improve parenting skills; to improve the recognition by teachers of students with behaviour or
emotional problems who will benefit from specialist help and to help students cope with the stress of
studies and examinations effectively.
In conjunction with World Mental Health Day 2011, various events will be organised.
These include a Walkathon, a Forum for community leaders, poster exhibitions at strategic sites as well as
dissemination of information on mental health, mental illness and the facilities available for their treatment
via the print and electronic media.
The goal of all these activities are to increase the understanding and knowledge of the community regarding
the importance of maintaining good mental health, prevention of mental illness as well as the early
detection and treatment of these illnesses; to increase public awareness regarding the services and facilities
available locally for the maintenance of good mental health as well as the treatment and rehabilitation of
those who are mentally ill; to educate the public regarding the emotional, social and financial costs of
mental illness to the patient, the family, the organisation, the community and the Government.
In order to achieve these goals, the involvement of members of the community is essential in the different
activities that have been organised.
Only in this way can the message be spread far and wide across the nation: "There is no health without
mental health and taking care of our mental health is as important as taking care of our physical health.
"Mental illness can be treated effectively in Brunei, the earlier the better".
(Ministry of Health Public Awareness Programme)
