Community destruction: mental illness in PNG
Wednesday, July 15, 2009, 12:51 pm
“Mental health care is too expensive and health care resources are limited in PNG,” Dr Moses Bagou.
That’s the general verdict by just about everybody you talk to in the government or health care industry.
Because of the lack of resources, mental illness, very serious though it is, does not get much recognition in communities.
People in villages are mostly not aware of the psychological impacts of drugs, before trouble strikes.
Drug induced psychoses, anxiety and depression are common; and mental illness gets very little attention in the news media — contributing to the problem.
“Staff agree they don’t have enough money or other resources for psychiatric care and treatment of mental illness, or to support patients,” says Dr Bargou, Director of Medical Services the Madang’s Modilon General Hospital.
Even in the way mental health services are managed, he says there’s too much separation from the general health system.
He concedes the hospital’s small psychiatric clinic is too isolated from other wards, and he should have more staff to do rounds within the hospital and identify patients in need of support.
“There was a program aimed at educating people about mental health awareness and care programs called Mental Health Watch, but this became too expensive and patients needed to be repatriated back to their families”, he said during a tour with visiting journalists.
Priorities of a cash-strapped developing country too often would block any progress.
“The government does not provide much financial assistance for mental health, as it is second in priority to educating people about disease prevention and vaccines.”
Susan Baniau is the head psychiatric nurse at Modilon General; she carries out home visits to educate families about mental health and counsels patients referred to the hospital by their families – though she does not have time or resources to get out into the field for long enough.
She says there are many people in rural or semi-rural areas suffering psychosis from drug and alcohol abuse, and the best hope is to get them referred by families, or through local clinics.
“The young people make home brews which are very high in alcohol; these give them high blood pressure and make them physically and mentally ill.
“The most commonly diagnosed problems are anxiety and post-marijuana psychosis leading to schizophrenia, and the schizophrenic patients go on and off treatment all of the time…
“We are trained at Modilon Hospital to interview, diagnose and treat each patient and if they improve we continue to treat them,” said Nurse Baniau.
In just the one provincial hospital in PNG, three to five patients are referred per day, with a average ages between 18-25, young people often beginning to use drugs as early as grade six.
The drug taking is linked also to the prevalence of violence within many communities.
Nurse Baniau a psychiatric nurse for twelve years sees her speciality ranked low in recognition against the critical problems being experienced with malaria, tuberculosis, malnutrition and pneumonia.
There are social problems with it as well, like the feeling stigma associated with mental disorders.
“Within the community those who are mentally ill are called ‘long long’ in Tok-Pisin and members do not want to care for them.
“We educate the community to care for them because when they behave abnormally in public they are not cared for and roam the streets; if we receive better funding we will be able to go out into the streets and work with them more regularly.”
Despite very steep increases in numbers of patients each year, Nurse Baniau’s department has no accommodation so patients all have to go home after treatment sessions.
The very small building is run down; only three staff work in psychiatric care, and there is no transport available to them to do their outreach work, going to homes and schools.
They say big savings could actually be made in they could treat severe, hospitalised cases, instead of having to send them to the capital city.
Dr Bargou says PNG has only six psychiatrists, all in Port Moresby; and he’d greatly like to see them more dispersed, to help support those suffering from trauma, drug and alcohol abuse and mental illness.
He says medical students have little motivation to specialise in psychiatric care, going more towards other priority areas like pediatrics.
In one important case, an organisation called the Foundation for People and Community Development (FPCD) has stepped in with moneyh and training, following concern over growing numbers of out-of school and unemployed youths, severe unemployment and the related problem of increasing violence, crime and mental illness.
The project is funded by New Zealand Aid and carried out in partnership with the support Foundations based in Fiji.
It’s campaigning for funds to back up social workers, counselors and mental health care providers in PNG.