Dare to care

  • Health
  • Sunday, 23 Mar 2003

For the best possible outcome in the treatment of those living with mental disorders, family support, in collaboration with mental health professionals, is crucial, reports PAUL YEO

IT’S a testament to life in the 21st century – the World Health Organisation (WHO) estimates that about 400 million people across the world suffer from mental disorders. The numbers are expected to surge over the next 20 years.  

In fact, according to the WHO, five of the 10 leading causes of disabilities worldwide are mental disorders. They include depression, substance abuse, bipolar disorder (manic depression), schizophrenia and obsessive-compulsive disorder. This is no “mean feat” because of the prevalence of the “big guns of disease” such as heart disease, stroke, cancers, high blood pressure and so on. The increasing incidence of mental disorders could be a reflection of the stressful lifestyles that prevail in the new millennium, as well as the high incidence of poverty and violence. 

The facts certainly do not paint an optimistic picture. In 2001, WHO revealed: 

Families offer crucial support to the person who has to live with a mental illness.

  • Twenty percent of people in the Western Pacific Region and worldwide who seek medical attention, have anxiety or depression or another mental disorder; in only half of these cases is the disorder recognised, and in only half of these is some form of appropriate treatment offered. 

  • Mental health problems are dramatically increasing. However, the majority of governments in the Western Pacific Region spend less than 1 % on mental health within their national health budgets. Australia and Malaysia are the only two countries in the region spending between 5 % and 10 % of their health budget on mental health. 

  • In Japan, there are 10,000 psychiatrists serving a population of 126 million. In Australia, population 19 million, 2,057 psychiatrists and 10,000 psychiatric nurses are practising.  

  • In the Philippines, there are 322 psychiatrists practising in the country with a population approaching 76 million people. There are approximately 723,000 seriously mentally ill Filipinos needing hospitalisation (one out of 100 population). The doctor-patient ratio is 1: 9,562. It would take 1.5 years for each psychiatrist to talk for 10 minutes each to his or her 9,652 patients, with the psychiatrist spending four clinic hours a day, five days a week. 

    WFSAD president JIm Crowe . . . 'The effect of mental illness on the family is one of loss and grief.

    According to World Fellow of Schizophrenia and Allied Disorders (WFSAD) president Jim Crowe, mental illness can affect anyone, regardless of age, culture, income or gender. In other words, all of us are at risk. “There’s so little difference between us and those who’re mentally ill,” he emphasises. “All those violent and creepy portrayals of the mentally ill are so distorted. We have thousands of positive stories about people living with mental disorders.” 

    Crowe was in Kuala Lumpur recently for the inaugural national Family Support Group Conference themed Towards a National Alliance of Family Support Groups for Carers of the Mentally Ill organised by the Malaysian Mental Health Association (MMHA) and the Ministry of Health, sponsored by Eli Lilly Malaysia.  

    Mental disorders include a whole list of illnesses ranging from schizophrenia and depression to bipolar disorders and even Alzheimer’s disease.  



    But the signs are encouraging that the world is not sweeping the issue of mental health disorders under the carpet. In 2001, the WHO launched a campaign called: Stop exclusion – Dare to care, which aimed to remove the stigma from mental illness.  

    Then there are organisations such as WFSAD that continue to provide support to those living with mental disorders and their families. Crowe says that such support is crucial because often, the families of those with mental disorders become secondarily ill because of the burden of the disease. “There’s shock, bewilderment, guilt and blame when these families try to rationalise an irrational illness. 

    “The effect on the person is devastating,” he notes, “while the effect on the whole family is one of loss and grief. Unfortunately, the discrimination and stigma of the mental disorder affects the whole family. 

    “It is not only the person affected by a mental illness who is both stigmatised and discriminated against, it also happens to the family. We need to remember that mental illness can be treated, but discrimination goes on,” he adds.  

    Crowe notes that discrimination happens because people do not understand mental illness, and there’s a fear of the unknown. “People with mental illness are no more prone to violence than anyone else in the community. However, when there’s an incidence of violence, the reports will blare out ‘Mentally ill man runs riot’. If it’s a man with heart disease or asthma or whatever, it just reads ‘Man runs riot’. Why the discrimination? 

    “In fact, statistics show that only 0.9% of those living with mental disorders may turn violent. That’s much lower than the incidence of violence in the normal population,” he says. 


    Myths and preconceptions 

    Crowe lists out a few myths about mental illness, and urges every one to understand the disease a little bit better so that such myths do not linger. Some of the myths that he lists out include: 

    Myth 1: People who need psychiatric care should be locked away in institutions. 

    Fact: The notion that all people with mental illness should be institutionalised is a thing of the past. Today, there are a variety of programmes and medications that allow people to lead productive lives within their communities. 

    Myth 2: Families cause mental illness. 

    Fact: It must be stated that in no way or shape or form are families to blame. This unfortunately has been an enduring myth, which causes so much distress to many families. Such a myth must be destroyed.  

    Myth 3: A person who has had a mental illness can never be normal.  

    Fact: Mental illness is often a temporary condition. A previously well-adjusted person may have an episode of illness lasting weeks or months, without further difficulty. To label a person who’s recovered as “abnormal” is both unfair and very discriminatory. 

    Hence, Crowe advises to always put the person before the illness. He stresses that people with a mental illness are ordinary people, and anyone can get a mental illness. “Your attitude can make a difference,” he emphasises. 


    Education and training 

    Crowe advises families to try and accept the illness and seek help as soon as possible. He stresses that the family should be there for the person, and they have to be calm and acknowledge how the affected person is feeling. He put forward some practical suggestions for families: education about the disorder for the whole family; learn coping strategies; and carer’s need to look after themselves first so that they can look after their loved one. 

    Crowe says that these are important practical considerations because research has shown that people who experience mental illness have fewer relapses when their family, friends and other support systems become involved in their care and treatments. “If family and friends are knowledgeable and informed, they are in a better position to support their relative or friend,” he notes. 

    According to Crowe, families are the biggest resource of information and support to mental health services in any country. They have lived the experience, and sometimes they have resources that they are not even aware of because they have been living and coping on their own despite tremendous pressures. “Their ‘lived experience’ can offer insights into the patterns of illness, and with the support, understanding and advice from professionals, it can make a difference to the outcomes of treatment,” he says. 

    Fortunately, research is bringing about a new era in treatment as well as understanding of these disorders. With treatment, opportunities for rehabilitation, and the support of family and friends, these diagnoses need not be as feared as they were in the past. 

    For example, the treatment success rate for schizophrenia is now about 60%; for bipolar disorders, it is 80% to 90%; for panic disorder, it is 70% to 90%; for obsessive-compulsive disorder, it is 75%; for depression, it is 70% to 80%. 

    Crowe is all for advocacy to bring about a change in attitudes about mental disorders. “For those with a mental illness, their families speaking out is one of the most powerful images that can be portrayed. In fact, New Zealand now has a consumer network which has caused adverts about mental illness to be shown on all national TV stations. That’s a powerful voice,” he observes.  

    So where do we go from here, and how can we set up support for families in Malaysia living with mental disorders? There are family support groups in existence, but these are limited to a few centres. 

    According to Dr Abdul Kadir, a consultant psychiatrist, the solution may lie in the formation of a non-governmental organisation family support group. “Family support groups have a strong primary care involvement. They can become equal partners in care delivery, and should aim towards promotive, preventive and recovery oriented care. This can bring about best practices in care of those living with mental disorders.” 

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