Tackling Sri Lanka’s Mental Health Crisis
Photo courtesy of Quartz
Sri Lanka has suffered five decades of violent conflict, a tsunami, Covid-19 and an economic crisis, resulting in severe mental health consequences.
According to consultant psychiatrist Dr. Madhushani Dias, about 30% of adults are suffering from mental health issues. Up to 40% of adolescents are grappling with problems like anxiety and depression, often worsened by economic stress and high stigma.
Among students aged 13 to 17, more than one in five reported loneliness while almost 18 percent experienced persistent depression. Fifteen percent had seriously considered attempting suicide during and nearly one in ten reported an actual attempt.
The problems are compounded by underfunding and gaps in accessible, quality mental health services, particularly in rural areas. Approximately 13.3% of people experience untreated mental illness as a result, with many struggling with stress, burnout and lack of support. Only 1.6% of health spending goes to mental health with 94.5% of children with issues not seeking care.
Substance abuse and suicide rates are indicators of mental health problems. Heroin use grew 32% from 2015 to 2019 and 77% of users were dependent on regular doses. Suicide rates increased to 15.6 per 100,000 in 2020-2022 as a result of economic insecurity and availability of pesticides. Youth are especially prone, feeling anxious or lonely due to school pressure and conflict within the family.
“Top priority in the immediate term must be accorded to increasing funding for mental health to 5% of the overall health budget, increasing training for rural primary care teams, and integrating anti-stigma curricula into schools. For sustainable development, there must be a coordinated effort by various sectors to address the causes of mental health problems and not symptoms alone, such as poverty and unemployment, both drivers of heightened substance abuse and hopelessness. Until there is a widespread and radical remaking of the system, the vision of equitable mental care for all remains frustratingly out of reach,” according to Peradeniya University nursing graduate Ishan Dimuthu.
There are several organisations tackling the mental health crisis including Samutthana, the King’s College London Centre for Trauma, Displacement and Mental Health in Colombo, which was established in 2006 following the tsunami to support capacity building in mental health.
A senior academic team in psychology from King’s College is visiting Sri Lanka to explore potential collaborations with local institutions.
Groundviews spoke to Dr Shamil Wanigaratne, Chair of the UK-Sri Lanka Trauma Group (UK-SLTG), Director of Samutthana and Visiting Associate at King’s College London and Dr Isuri Roche Dharmaratne, Acting CEO of Samutthana about the country’s mental health issues and what needs to be done to improve it.
What does Samutthana do in Sri Lanka?
We started in 1996 when the Central Bank bomb happened. A few of us got together and formed an informal group called the UK-Sri Lanka Trauma Group. At that time there was no acknowledgement that there was anything called psychological trauma. We held a conference and for the first time, all the people who were doing psychosocial work came together under one roof and talked about the work they were doing and the trauma they were seeing. That was a watershed moment. We were all volunteers. We travelled to Sri Lanka whenever we could and ran small workshops to educate people, mainly targeting the medical profession as well as teachers and nurses. In 1999, we became a registered UK charity. Then the tsunami happened and all of a sudden everybody was rushing in to do counselling and trauma work. We were there on the frontline. What we saw was total chaos. The WHO was asking where are the psychologists? There were only about six psychologists. When we went back to the UK, we looked for funding to build capacity and train people to deal with disasters. King’s College in London took it on and raised funds with which we opened a centre in Colombo, which is still going on. We had centres in Jaffna, Batticaloa andHambantota where we trained people in psychosocial work and raised awareness. In 2006, we opened Samutthana. We couldn’t sustain the other centres so from Colombo we have been trying to serve the whole country. One of our greatest achievements was to help set up the first clinical psychology training course at the University of Colombo. We have graduated more than 70 clinical psychologists. Most of them remain in the country. We can count up to about 55,000 attendances at our workshops. When the Easter bombing happened, everybody who responded in the frontline psychosocial response had at least attended one workshop at Samuttana, which shows that our capacity building agenda has worked.
What are the main causes of trauma in Sri Lanka?
There are two types of trauma, type one and type two. Type one is single incidents such as traffic accidents, natural disasters androbberies; any time you felt that your life was in danger, that results in trauma. Type two is rape and domestic violence as well as all types of violence. Neglect also causes trauma, as does sexual abuse. These often happen over a period of time and the consequences are mental illness, psychosis, anxiety problems and suicide. The impact of the war has been a major cause of trauma and is closely associated with substance misuse and domestic violence. People use drugs and alcohol to cope with their trauma. Another big trauma is our maids, the mothers, going to abroad to work leaving children without proper care, either a husband who starts to drink or grandparents who are not equipped to handle them. The consequences of leaving children are huge. They become people with problems.
Is there more acceptance of mental illness?
What is a good sign is that society is changing and there is more acceptance of mental illness. People are willing to come out and ask for help, especially young people. They feel that going to a counsellor is not a bad thing. As a plus side of social media, people are sharing information and it becomes acceptable. However in the rural areas stigma is still an issue while the role traditional structures such as temples and churches has deteriorated.
How can people receive treatment when the country faces a dire shortage of psychologists and psychiatrists?
The course that we set up was running without any difficulty because the people who had graduated and others who had returned to Sri Lanka after training abroad kept the course and the curriculum going. During the economic crisis, there was a completeexodus that was quite shocking. Our hope is that the people we are training now will stay or if they go abroad will return. If the economic conditions change, then those who left will come back. Another problem about treating trauma is that in government hospitals, there are only psychiatrists who prescribe medicine. When you have a mental health problem, you don’t take medicine first; you talk to someone. But here when people go to a government hospital, first thing they get is the medicine. Then they get depressed and have other issues. Government hospitals should employ psychologists.
Will Sri Lanka will ever heal from its war trauma when people are denied the truth about what has happened to the dead and disappeared?
The problem of disappeared people is huge. A solution has to come at a policy level. We can do therapy, we can help people to accept it but they don’t. Even five years or ten years after the tsunami, mothers were going to the beach to see if their children would appear. Disappearances cause more than trauma; it is an unresolved bereavement issue. If you know, you can come to terms with it and then part of your mind accepts it. They need to be helped psychologically but also there needs to be some definitive answer from someone. Somebody has to put their neck out and say something that is not popular to address this issue, if not it will just go on.
It is said that government drug treatment centres merely dispense medicine without addressing the causes of addition. Is this correct?
Sri Lanka has a serious drug problem, probably worse than some of the other countries. Prevention of drug use is crucial. Even the most affluent of people take drugs. They are easily available, there is heavy marketing and the new synthetic drugs are easily produced. The most affected are the vulnerable groups. The rehabilitation centres should have treatment that works on motivation and addresses the other mental health issues. Once they are in there, if a good job is done then they won’t go back into that cycle. There are very dedicated people working there. Coming off drugs physically is a short treatment. But real battle is after the detox; how do they deal with the cravings and the risks. That is more of a challenge. In Sri Lanka there are rehabs and some of them have reputations and others are not good. Substance addiction is a disease because the brain changes and you are not in full control of your will power but you can build it. Studies have shown that the brain also changes after psychological treatment.
