Tag Archives: mental health

Suicide – devastating, common and preventable

To mark World Suicide Prevention Day 2018 on 10 September, Dr. Julian Eaton (Senior Mental Health Advisor at CBM) shares his views on a topic that is often taboo, despite desperately needing to be talked about to raise discourse, awareness, recognition and policy priority for suicide, in turn reducing a scourge that affects far too many people.

Picture copyright: Pixabay

 

When I was 21, my thoughtful, caring, talented, beautiful friend, killed herself. I think her funeral was the most upsetting thing I have ever attended, with all of us asking how a person with the world at her feet could feel such despair that this seemed the only solution. Her death left a hole in her family, and our circle of friends still feel the painful gap in the space she used to occupy.

September 10th marks World Suicide Prevention Day, a topic that is increasingly in the news, but that people still find difficult to talk about, though many people are affected. Suicide remains a taboo subject in most parts of the world, often frowned upon by cultural and religious traditions. In fact, the term ‘committing suicide’ refers to the fact that suicide was illegal in many countries. We try to avoid using this terminology, and in countries where suicide remains illegal, it is an advocacy priority to change such laws, as part of the process of challenging stigma, making it easier to talk about the issue, being able to accurately record cases of suicide, and reducing unnecessary additional suffering of families and survivors of attempted suicide.

It is a sad and shocking fact that suicide is the second most common cause of death in young people between 15 and 29 worldwide, and is the leading cause of death among young people in many European countries. In total, almost a million people die by suicide globally each year. It is estimated that for every person who dies by suicide, at least 25 attempt suicide. As well as being an awful situation for the person themselves, a suicide has a devastating effect on friends and family, and it is estimated that typically, over 100 people are effected by a single suicide.

Many people who self-harm do not intend to die, and there are many complex reasons why people do self-harm, but it is also the case that people who self-harm are more likely to go on to kill themselves by suicide, so this is an important warning sign, that should be taken seriously, and lead to support being provided.

Why do people seek to harm themselves, and what can we do to reduce suicide?
Of course suicide is strongly associated with mental ill health, and over half of people of people who die by suicide have a diagnosis of depression at the time of death. People with alcohol and drug problems, psychotic illnesses like schizophrenia, and other mental illnesses are also more likely to self-harm and die by suicide. This means that good mental health services, systems to identify people who are distressed or depressed, and easy access to care are important elements for reducing suicide. Similarly, physical ill health (especially long-term, painful and disabling conditions, including non-communicable diseases (NCDs)) increases risk of suicide, so good care of physical health, as well as recognising a psychological component of such conditions is important.

Relationship problems, bereavement, unemployment, work or educational stress, economic hardship, loneliness, isolation and bullying (often online) increase risk of self-harm and suicide, particularly if they come together. Therefore, a comprehensive approach to addressing risk of suicide is important. The easier it is to access means of self-harm (guns, knives, toxic medicines etc.), the more likely people are to successfully kill themselves, so one of the most effective means of reducing suicide rates is to control access to such means of self-harm. Suicide is often carried out in particular moments of despair, which will almost always pass if a person is not able to find a means of harming themselves. One example is where simple measures to reduce easy access to pesticides, a particularly common cause of death among farmers in India, dramatically reduced suicide rates.

It usually helps to be able to talk to someone, and a listening ear, and supportive friendships can really help when people are feeling hopeless. We can all do what we can to support our own friends, or people we work with who are lonely or distressed, but we can also try to raise awareness of the issue, and advocate for more government and social action to implement the measures we know are effective. Suicide is an essential issue for mental health, and as such closely linked to Non-Communicable Diseases. The High Level Meeting on NCDs at the UN General Assembly is an opportunity to make sure that mental health and suicide are recognised, and we work together as a global health community to reduce the scourge of suicide that affects so many people.

Related links

Innovations:

  • RISING SUN (suicide prevention in the Arctic region) – http://bit.ly/2Np9ntY
  • Giving LIFE a chance – http://bit.ly/2NTie3Z
  • Pesticide Regulation for Suicide Prevention – http://bit.ly/2oIEToO

Toolkit:

  • RISING SUN has produced an online Toolkit on how to measure the impact and effectiveness of suicide prevention in Indigenous groups. 5 levels of intervention a) Family b) Individual c) Clinic d) National/Regional e) Community – http://bit.ly/RISINGSUNTOOLKIT

Resources:

  • Suicide Prevention Webinar from Dr Saxena Shekhar, Director of WHO Department of Mental Health and Substance Abuse – http://bit.ly/2eO6ljx
  • WHO Suicide Prevention Factsheet, available in 6 languages including info on key facts, prevention & control & challenges – http://bit.ly/2oIyREG
  • WHO’s Community Engagement Toolkit – http://bit.ly/2oKVLv1

Mental Health is the centre of attention at the World Bank this year: “Out of the shadows; making mental health a global priority”

Momenta's Project Sierra Leone 2015

The human toll of mental illness has started to be widely recognised for its impact on individuals and families. There is now much more awareness of, for example depression, due to stories in the media about famous people who are talking openly about their problems. Even the once taboo subject of suicide is now more openly acknowledged in society.  When someone like the comedian Robin Williams dies by suicide, it has the effect of reminding us that at least 1,000,000 people die in this way every year around the world. In many countries suicide is one of the top three causes of death in young people, but is often ignored or even denied as an issue.

CBM, along with many other partners in global development have long pointed out that mental illness and psychosocial disability also has an important impact on communities and broader society. Mental illness does not only cause personal suffering, but often results in social exclusion and lack of opportunity for large sectors of the population to contribute to the economy and community development. Since 85% of the people with mental conditions live in the poorest countries in the world, the impact is particularly marked on these fragile economies.

By 2030, depression is expected to become the single largest contributor to disease burden globally, and even today, 350 million people around the world are affected by depression. The sheer scale of this issue, and the well documented impact on people’s ability to work and actively engage in the economic life of a country has led the World Bank to focus on mental illness at their annual Spring Meeting in Washington in April. At last year’s World Economic Forum, careful analysis in a report by a Harvard group resulted in an estimate that the annual global costs of mental illness to the economy was 2.5 trillion dollars in 2010, a staggering number that was expected to rise to 6 trillion dollars by 2030.

The joint meeting, called ‘Out of the shadows, making mental health a global priority’ will be run by the World Bank and WHO, from April 13th to 15th in Washington. It will be a forum to examine how the major financial actors in global development can address this issue. These key funders and politically powerful groups can hopefully start to play their role, joining development organisations like CBM, and other groups like service user organisations and activists, so make more resources available and raise prioritisation of mental health.

CBM will be well represented at the meeting. Carmen Valle will be sharing our experiences of working in Sierra Leone with partners to build resilience and reduce the psychological impact of the Ebola epidemic. This is a part of Disaster Risk Reduction that is often not sufficiently recognised. Information about this project with our partners in Sierra Leone is here. She will also be talking about how our partners ensured that access to important public health messages, for example during an epidemic like the 2014/15 Ebola outbreak, can be accessible to all people, including people with disabilities.

I will be speaking during a panel discussion on the topic of mental health and people with sensory impairments. The main points are that

  • Mental ill health is much more common in people with sensory impairments, but is often not recognised.
  • Mental health components should be integrated into services for people with sensory impairments, for example ensuring that service users themselves, and health and education personnel, are made sensitive to these needs and are aware of how to address them
  • The barriers that people with sensory impairments face should be specifically addressed in messaging relating to mental health by paying attention to accessible formats (as in any other awareness and public health work).

Carmen and Julian will be Tweeting and Blogging from the meeting. Follow our our blog, Twitter and Facebook to get all the latest news about the WHO meetings in Washington DC (the hashtag for this event is #mentalhealthnow). You can also follow Dr. Julian Eaton and Dr. Carmen Valle on Twitter who will be tweeting live from the events.

Additional information on the Innovation Fair can be found here.

 

Julian Eaton

Mental Health Advisor, CBM

The fourth summit of the Movement for Global Mental Health in Mumbai

The Movement for Global Mental Health was founded in 2008 with the aim of mobilising interested actors in a call for human rights for people with psychosocial disabilities, and access to good quality and affordable treatment, especially in the poorer parts of the world.  Since then, the Movement has held a summit every 2 years (previously in Athens, Cape Town and Bangkok) where members have come together to share, celebrate, and plan.

The membership of the Movement is diverse, taking in service users, care providers of all sorts, academics, and others.  The main method of communicating and networking is through a website; www.globalmentalhealth.org ; a good route to join the Movement!

The exciting decision was taken for this year’s summit in India was to focus on service users as a unique and powerful group within the Movement’s membership.  The theme was ‘Nothing about us without us’, and the event was organised by users and their organisations (in India), and had a programme largely devoted to contributions by people with psychosocial disabilities.

Panel Discussion "Nothing About Us Without Us".

Panel Discussion “Nothing about us without us”.

One of the refreshing differences from a typical conference was that there was a larger emphasis on creativity and expression than on academic or scientific activities (though there was scientific content as well).  For two days, we were privileged to hear powerful and inspiring stories from the lives of people with psychosocial disabilities, and those who live and work with them. We watched, and often joined in with, dance, art, drama and provocative discussions.

Forum Theatre by The Banyan

Forum Theatre by The Banyan

The conference organisers The Banyan and Public Health Foundation of India did a wonderful job of welcoming us, with the student volunteers at the venue (the Tata Institute of  Social Sciences) even giving up their own rooms for delegates. There was a positive atmosphere, and a strong sense of purpose, which was translated into the decision taken at the end of the summit to form a local group affiliated to the Global Movement for activities in South Asia.

CBM is proud to have been associated with the Movement since its inception, and will continue to share its aim of providing a strong voice for people with psychosocial disabilities and others committed to realisation of human rights for all.

 

 

You have the will, you have the power

The International Day for Persons with Disabilities is celebrated on Dec 3 every year. This year the theme is Inclusion matters: access and empowerment for people of all abilities, and one of the sub-themes is – Including persons with invisible disabilities in society and development.

 

Often when we think about ‘inclusion’, persons with physical and sensory disabilities come to mind.  We think about making buildings physically accessible for persons who use wheelchairs and printing books in Braille for children with visual impairments.
‘Inclusion matters: access and empowerment for people of all abilities’ is the theme for the 2015 International Day of Persons with Disabilities.  On this day, December 3, we will be called to remember that true inclusion will never occur unless persons with invisible disabilities are included in society and development. But what do we mean by ‘persons with invisible disabilities’?

Mr Kaikai and other service users in a group discussion on the issue of dignity, at the EAMH office in Freetown

Mr Kaikai and other service users in a group discussion on the issue of dignity, at the EAMH office in Freetown

Persons with invisible disabilities include those whose disabilities are not immediately obvious.  It is estimated that worldwide, 1 in 4 persons will experience a mental health condition at some point in their lives.  Despite being extremely common, mental health conditions are some of the most untreated and most stigmatized around the world.  People with psychosocial disabilities are amongst those forgotten and misunderstood because of the ‘invisible’ nature of mental illness, leading to human rights abuses.
As an example, in Sierra Leone, people with psychosocial disabilities have historically been under prioritized, forgotten and abused.  In the national health budget, less than 1% of the budget goes to the Sierra Leone Psychiatric Hospital, and 0% is allocated to other mental health services.  The mental health legislation of Sierra Leone, ‘the Lunacy Act,’ was written in 1902 and is yet to be rewritten or updated.  In addition, a shocking number of human rights abuses take place around the country on a daily basis, including the routine chaining of people with psychosocial disabilities.
Mr Kaikai is the secretary of the Sierra Leone Association of Service Users and Family Support Group, explains: “Thousands of people with mental health conditions around the world are deprived of their human rights. They are not only discriminated against, stigmatised and marginalised, but are also subject to emotional and physical abuse in both mental health facilities and within their communities.”

 

But things in Sierra Leone are slowly changing.  5 years ago, the Enabling Access to Mental Health programme began with the support of CBM and Global Initiative of Psychiatry (GIP) and funded by the European Union.  The aim of the programme was to do exactly what the name suggests: to improve access to mental health care.  A large focus of the programme revolves around mental health advocacy and it was for this reason that the Mental Health Coalition – Sierra Leone was born.

The coalition brought together a broad range of stakeholders: health care providers, teachers, religious leaders, local and international non-government organizations, and many other members interested in mental health.  The Coalition was successful at pushing for changes in mental health in Sierra Leone including launching the National Mental Health Policy and ensuring that patients received food and water during a strike at the psychiatric hospital.  However, until recently, there were very few people with psychosocial disabilities in the Coalition.  Despite having a safe and welcoming environment for people psychosocial disabilities, the Coalition continued to speak on their behalf rather than giving them opportunities to speak for themselves.

 

In 2014, however, a new committee within the Coalition was formed: the Sierra Leone Association of Service Users and Family Support Group. The group has 27 members: mental health service users and their family members. The group meets on a monthly basis with the aim of empowering service users to advocate with their own voice for better medical facilities, medication, social inclusion and respect for the dignity and human right of people with mental disability.

Mr Kaikai, Secretary of the Service Users and Family Members Association, at the beach in Freetown

Mr Kaikai, Secretary of the Service Users and Family Members Association, at the beach in Freetown

Mr. Kaikai highlights the importance of including family members in the group: “Something we will never forget is how much our families have suffered and how positive it was for them to get support from other families in similar situations. And also, even more important, we couldn’t have recovered if the family hadn’t been there with us, helping, understanding, encouraging. Our families own our lives.”

This group was established with 6 goals

  • To know each other better
  • To share views and experiences
  • To mobilise for action
  • To provide a platform for awareness raising on those issues that are crucial to  mental health
  • To minimise the stress and stigma attached to mental illness
  • To express the needs of service users to government and other service providers.

The group is working towards their goals by focussing their meetings on topics that members have decided are important, including: stress management, sharing experiences to offer each other support and group counselling from a qualified counsellor.
As the group continues to grow in empowerment, they continue to set new goals and ambitions.  They hope that group will expand in numbers so that more service users can benefit from their activities and experience an increase in confidence through the peer support that the group offers.

Mr. Kaikai says:  My advice to other service-users would be, don’t ever think you are just mentally ill people with no strength to achieve something great. You might also want to know that there is dignity in mental health, as there is no health without mental health.

In a country where persons with psychosocial disabilities were invisible, service users and their families are learning to take a stand in a united front, to speak loudly and to be seen.

“You have the will, you have the power.
Dignity in mental health.
You own the future.
Long live the Service Users and Family Support Group.”
-Mr. Kaikai, Secretary of the Sierra Leone Association of Service Users and Family Support Group