When will our gov­ern­ments take men­tal health se­ri­ously enough to re­visit present bud­getary al­lo­ca­tions?

The Star (St. Lucia) - - LOCAL - By Kayra Wil­liams

Imag­ine look­ing out of your win­dow on an es­pe­cially bright morn­ing to see a head­less body dan­gling from the end of a rope at­tached to a neighbour’s roof. That was the night­mare sev­eral Corinth res­i­dents con­fronted last Sun­day. Place your­self in the shoes of the dead in­di­vid­ual’s im­me­di­ate fam­ily upon dis­cov­er­ing the un­speak­able hor­ror—that the lat­est sui­cide was one of theirs, who had jumped off a sec­ond floor bal­cony, a rope around his neck.

Po­lice ar­rived at the scene at about 7:30 p.m. that evening. The vic­tim was later of­fi­cially iden­ti­fied as 56-yearold Paul Fanus. In­ves­ti­ga­tions con­tinue into the lat­est sui­cide. Mean­while, there are the griev­ing rel­a­tives and friends of three other in­di­vid­u­als who took their own lives just days af­ter the uni­ver­sal ob­ser­vance of Sui­cide Preven­tion Day, on Septem­ber 10. One of the vic­tims was a 16-year-old fe­male.

The cited tragedies put into per­spec­tive the theme of this year’s ob­ser­vance of World Health Day: ‘De­pres­sion, Let’s Talk’. World­wide, dis­cus­sions have per­sisted since the April 7 ob­ser­vance, meant to shed light on de­pres­sion, the lead­ing cause of sui­cide.

On a mis­sion to avoid sen­sa­tion­al­ism, and over­sim­pli­fi­ca­tion of sui­cide and its pos­si­ble causes, the Pan Amer­i­can Health Or­ga­ni­za­tion (PAHO) hosted a we­bi­nar for jour­nal­ists in March. Pre­sen­ters un­der­scored the un­de­ni­able power of the me­dia, es­pe­cially when it came to pre­vent­ing sui­cide.

Con­sid­er­ing the grav­ity of the topic, pre­sen­ters urged jour­nal­ists to talk about sui­cide in a re­spon­si­ble way as, ac­cord­ing to Dr. Dan Rei­den­berg, Ex­ec­u­tive Di­rec­tor of Sui­cide Aware­ness Voices of Ed­u­ca­tion, “Re­spon­si­ble cov­er­age can help pre­vent sui­cide.”

Dévora Kes­tel, Chief of PAHO’s Men­tal Health and Sub­stance Abuse unit ac­knowl­edged that sui­cide was of­ten un­der-re­ported, and that the true fig­ures were some­times much higher.

“This topic mer­its a closer look be­cause de­pres­sion - and peo­ple suf­fer­ing from it are go­ing to have fewer days at work, per­haps pro­duc­tiv­ity will drop off; there will be more ex­penses as­so­ci­ated with that, and this has an over­all ef­fect on a coun­try’s econ­omy,” she said, be­fore of­fer­ing a re­minder that de­pres­sion could be pre­vented, or treated.

Of par­tic­u­lar con­cern was the con­ta­gion ef­fect, also known as copy­cat sui­cide, of­ten oc­cur­ring fol­low­ing sui­cide re­ports that did not fol­low best prac­tices.

Prom­i­nent ex­am­ples in­cluded that of Hol­ly­wood star­let Mar­i­lyn Mon­roe’s demise, and more re­cently, Amer­i­can co­me­dian and ac­tor Robin Wil­liams in 2014. Sui­cide rates in­creased fol­low­ing both of their deaths, and ex­ten­sive me­dia cov­er­age. In light of the re­al­ity of con­ta­gion, Rei­den­berg un­der­scored the sig­nif­i­cance of me­dia guide­lines.

Other rec­om­men­da­tions for com­bat­ting sui­cide in­cluded early iden­ti­fi­ca­tion and treat­ment, train­ing of health work­ers, fol­low-up care and com­mu­nity sup­port, re­strict­ing ac­cess to means, in­clud­ing pes­ti­cides, firearms, sharp ob­jects; in­tro­duc­ing al­co­hol poli­cies, and re­search­ing tech­based so­lu­tions.

The key, ac­cord­ing to pre­sen­ters, was avoid­ing mis­in­for­ma­tion, and of­fer­ing hope.

“It is not just a North Amer­i­can or U.S. or Caribbean prob­lem; stud­ies from around the world have demon­strated that how me­dia re­ports on this topic does make a dif­fer­ence,” Rei­den­berg con­cluded.

Though in some coun­tries, in­clud­ing here in Saint Lu­cia, sui­cide, and aid­ing and abet­ting sui­cide, is con­sid­ered a crime, pre­sen­ters opted to switch the per­spec­tive to “a tragic but highly preva­lent pub­lic health prob­lem”.

For their part, lo­cal po­lice have ex­pressed that in­ci­dents of sui­cide are looked at on a case by case ba­sis, with the un­der­stand­ing of the var­i­ous rea­sons and so­cial is­sues that could lead to a per­son want­ing to take their life. As noted by the po­lice press of­fice: “Po­lice use dis­cre­tion, as charg­ing could lead to more de­pres­sion.”

This is the type of loom­ing de­pres­sion that led many to the Na­tional Men­tal Well­ness Cen­tre, which I vis­ited this week. Af­ter mak­ing it through sev­eral se­cu­rity check points within the state-of-the-art fa­cil­ity, I was face to face with Dr Julius Gil­liard, Con­sul­tant Psy­chi­a­trist at the Well­ness Cen­tre. It was 8:30 a.m. on the dot, and com­pletely im­pos­si­ble not to feel like a pa­tient un­der the dis­cern­ing eyes of the ex­pe­ri­enced psy­chi­a­trist. I con­sid­ered what it might feel like for a per­son strug­gling with men­tal is­sues of any sort, to fi­nally be able to come to a place where their is­sues would be seen as some­thing more than just imag­ined, and in their heads.

We got into con­ver­sa­tion about the ris­ing cases of de­pres­sion, anx­i­ety and other psy­chi­atric mat­ters and, even with those in­creas­ing trends, Gil­liard gave the as­sur­ance that sui­cide was far from be­com­ing an epi­demic in Saint Lu­cia. In his words, “An epi­demic im­plies some­thing that is out of hand. I do not see the sui­cides that are go­ing on now as be­ing out of hand.”

In­stead, he be­lieved that peo­ple sim­ply weren’t aware of the help that was avail­able and, as a con­se­quence, some­times viewed sui­cide as a vi­able al­ter­na­tive when they felt hope­less, or over­whelmed.

A de­tailed look at sui­cide fig­ures shows a de­crease in sui­cides on the is­land from 2015: seven sui­cide-re­lated deaths dur­ing that year, down from a num­ber that fluc­tu­ated between 10-13 deaths an­nu­ally from 2009-2014. No­tably, the Na­tional Sui­cide Helpline was ini­ti­ated in 2015. The fig­ure for 2017 also stands so far at seven.

Though the is­land is not at epi­demic pro­por­tions, as con­firmed also by Min­istry of Health Se­nior Med­i­cal Of­fi­cer Dr Sharon Bel­mar, Gil­liard said it was a prob­lem that was be­ing looked into.

De­vi­at­ing from what could be proven by stud­ies of a health and well­ness na­ture, Gil­liard shared his per­sonal per­spec­tive on the root cause of the spike in de­pres­sion and anx­i­ety. He laid it all at the feet of a lack of hu­man con­nec­tion, which he felt was di­rectly re­lated to the in­creas­ing pop­u­lar­ity of the In­ter­net, and so­cial me­dia. “Be­fore, peo­ple would in­ter­act a lot more, per­son to per­son,” he said. “Right now, ev­ery­thing is so de­per­son­al­ized. So you’d chat with some­one on What’s App, Face­time, and so on; the per­son is not there with you to see your emo­tional re­ac­tions.

“Per­sons now are feel­ing se­cluded. The lone­li­ness comes on a lot faster when this kind of com­mu­ni­ca­tion is the one that’s avail­able. It’s eas­ier for per­sons to be­come de­tached and hope­less, and feel that no­body is there. And I guess sui­cide be­comes at­trac­tive then.”

In or­der to be re­ferred to the Well­ness Cen­tre, a per­son would first have to see an­other doc­tor, whether that be a gen­eral prac­ti­tioner, psy­chol­o­gist, or coun­sel­lor, who would then make a re­fer­ral.

Af­ter con­sul­ta­tions, med­i­cal pro­fes­sion­als would then de­cide, based on the sever­ity of the prob­lem, whether or not there was a need for med­i­ca­tion. Some cases could be man­aged through psy­chother­apy ses­sions with a coun­sel­lor. Oth­ers re­quire both.

Gil­liard spoke di­rectly to the stigma of­ten as­so­ci­ated with health and well­ness is­sues, which ex­isted in all lev­els of so­ci­ety. “Men­tally ill per­sons are of­ten not seen as per­sons,” he said. “Per­sons tend to de­hu­man­ize the men­tally ill, and maybe blame them for what is hap­pen­ing to them. Per­sons in turn be­come fear­ful of those who are men­tally ill, and dis­crim­i­nate against them, which causes them to feel they are not nor­mal, or they are not hu­man, and that may cause a lot of the men­tally ill to look for the at­trac­tive op­tions of sui­cide.”

While some peo­ple tended to view psy­chi­atric is­sues as an in­di­ca­tion that a per­son was “rav­ing mad”, Gil­liard pointed out that de­pres­sion, anx­i­ety, and even drug abuse all fell un­der the same cat­e­gory. PAHO re­ports in­di­cate that 90 per­cent of per­sons who com­mit sui­cide have some form of psy­chi­atric prob­lem, of­ten ex­as­per­ated by ex­ter­nal stres­sors and other life events. Gil­liard con­ceded, adding that a high per­cent­age of per­sons strug­gled with th­ese is­sues in the days and months pre­ced­ing a sui­cide.

“I think be­fore we can do any­thing about bring­ing num­bers down, we need to do some re­search,” he said. “There is a scarcity of re­search in Saint Lu­cia about men­tal health is­sues, and the dif­fer­ent things that af­fect it. We need to find the causes of the men­tal health is­sues we have in Saint Lu­cia and then, depend­ing on the re­sults of the re­search, we can try to im­ple­ment cer­tain mea­sures to ed­u­cate peo­ple more.”

That ed­u­ca­tion and un­der­stand­ing ex­tends to fam­ily and friends of pa­tients, who have a huge role to play in sup­port­ing them through their re­cov­ery, some­thing that ex­tends way beyond forc­ing peo­ple to take med­i­ca­tion and at­tend men­tal health clin­ics.

“In th­ese cases, even though the fam­i­lies see it as get­ting in­volved, the pa­tient feels they are not in con­trol of their ill­ness, and that al­ways has a poor out­come,” he said. “The fam­ily needs to be more un­der­stand­ing, and ed­u­cate them­selves on how they can help with treat­ing those per­sons.”

With only one per­cent of the to­tal health bud­get al­lo­cated to men­tal health is­sues in Saint Lu­cia, the psy­chi­a­trist ad­mit­ted there were chal­lenges faced by the in­sti­tu­tion. The main was staffing, which pre­vented ad­min­is­tra­tion from reach­ing out and be­ing present in the com­mu­nity in a more mean­ing­ful way. Nev­er­the­less, he felt the Well­ness Cen­tre was do­ing an amaz­ing job with the funds they re­ceived.

Dr Gil­liard, the staff at the Well­ness Cen­tre, and other of­fi­cials in­vested in chang­ing peo­ple’s minds about men­tal health have a long way to go but they re­main con­fi­dent in the knowl­edge that ed­u­ca­tion will see a turn­around in at­ti­tudes to­ward men­tal health, which will, un­doubt­edly, help save more lives.

Need help?

Av­enues avail­able for help in­clude the Na­tional Sui­cide Hot­line, which is man­aged by trained pro­fes­sion­als, and can be ac­cessed by di­al­ing 203, 24/hr a day, free of charge. Turn­ing Point, and the Saint Lu­cia Cri­sis Cen­tre also pro­vide free and con­fi­den­tial coun­selling and other op­tions.

Con­sul­tant Psy­chi­a­trist at the Well­ness Cen­tre, Dr Julius Gil­liard.

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