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Global development podcast transcript: why care about mental health? Global development podcast transcript: why care about mental health?
(35 minutes later)
VP: Vivienne PerryVP: Vivienne Perry
MF: Dr Michelle FunkMF: Dr Michelle Funk
AG: Ananda GalappattiAG: Ananda Galappatti
VP Sumina lives in the rural southern province of Sri Lanka.VP Sumina lives in the rural southern province of Sri Lanka.
Sumina [Translated] The villagers called us crazies when we walked on the street. They threw stones at us. Once they even approached us with a harvesting knife. My husband ran away and I ran into our house and I locked the door.Sumina [Translated] The villagers called us crazies when we walked on the street. They threw stones at us. Once they even approached us with a harvesting knife. My husband ran away and I ran into our house and I locked the door.
VP Sumina and her husband have been diagnosed with schizophrenia and have been ostracised by their community. More than 450 million people around the world have mental disorders including depression and epilepsy; it's an invisible global issue which for many is a source of stigma and misunderstanding. It can also have a real impact on the lives and livelihoods of those living with them.VP Sumina and her husband have been diagnosed with schizophrenia and have been ostracised by their community. More than 450 million people around the world have mental disorders including depression and epilepsy; it's an invisible global issue which for many is a source of stigma and misunderstanding. It can also have a real impact on the lives and livelihoods of those living with them.
Sumina [Translated] I was suffering from a mental illness. My husband's name is WAK Gunesana, even he suffered from a mental illness. Now we are both much better but we don't have any means of livelihood. I pawned my earrings to hire a vehicle to take him to hospital.Sumina [Translated] I was suffering from a mental illness. My husband's name is WAK Gunesana, even he suffered from a mental illness. Now we are both much better but we don't have any means of livelihood. I pawned my earrings to hire a vehicle to take him to hospital.
VP I am Vivienne Perry and in this Global development podcast I am going to be looking at the impact of poor mental health provision in the developing world, and in particular Sri Lanka; a middle-income country that has historically had, like many other places, a poor track record in mental health treatment.VP I am Vivienne Perry and in this Global development podcast I am going to be looking at the impact of poor mental health provision in the developing world, and in particular Sri Lanka; a middle-income country that has historically had, like many other places, a poor track record in mental health treatment.
But first, the broader picture: Dr Michelle Funk is the World Health Organisation's mental health gap action programme co-ordinator; I asked her how much of a problem mental health issues are in the development world. But first, the broader picture: Dr Michelle Funk is the World Health Organisation's mental health gap action programme co-ordinator; I asked her how much of a problem mental health issues are in the developing world.
MF They are a major problem, mental health issues are a major problem in the developing world as much as they are in the developed world. And I think the best measure that we have at the moment of the extent of the problem comes from the global burden of disease. And the global burden of disease measures are essentially a measure of mortality and disability combined. So if we just focus on that, globally we see that mental disorders account for about 13% of the global burden of disease and that's quite substantial. So that's globally.MF They are a major problem, mental health issues are a major problem in the developing world as much as they are in the developed world. And I think the best measure that we have at the moment of the extent of the problem comes from the global burden of disease. And the global burden of disease measures are essentially a measure of mortality and disability combined. So if we just focus on that, globally we see that mental disorders account for about 13% of the global burden of disease and that's quite substantial. So that's globally.
And if we look at low-income countries and just focus on those countries, mental disorders account for about close to 9% of the total burden of disease; again very substantial.And if we look at low-income countries and just focus on those countries, mental disorders account for about close to 9% of the total burden of disease; again very substantial.
VP When you're talking about a burden of disease, what kind of concrete implications might that have for someone's quality of life, or indeed, for the productivity of the country?VP When you're talking about a burden of disease, what kind of concrete implications might that have for someone's quality of life, or indeed, for the productivity of the country?
MF We are talking about a combined measure of mortality and disability. It essentially means that people are going to die younger or they are going to be suffering from some very disabling consequences of their illness. It means most definitely that productivity is going to be lowered and is going to also lead to higher levels of poverty for those people who are affected. And let me just give you a more concrete example what might happen in terms of someone who develops a mental illness they may not be able to work, for example, because of the illness directly, or because of the significant discrimination associated with having a mental illness. MF We are talking about a combined measure of mortality and disability. It essentially means that people are going to die younger or they are going to be suffering from some very disabling consequences of their illness. It means most definitely that productivity is going to be lowered and is going to also lead to higher levels of poverty for those people who are affected. And let me just give you a more concrete example what might happen in terms of someone who develops a mental illness: they may not be able to work, for example, because of the illness directly, or because of the significant discrimination associated with having a mental illness.
And then there is also another significant factor and that is that not only are there direct consequences in terms of productivity for the individuals, but they extend then to the family, because people who have a mental illness are often going to have to rely on financial support from family members just to meet the very basic living needs, and also to cover the costs of any treatment that they may require. So there are direct impacts at an individual level, at the family level, at the community level which all contribute to costs and reduced productivity for the country as a whole.And then there is also another significant factor and that is that not only are there direct consequences in terms of productivity for the individuals, but they extend then to the family, because people who have a mental illness are often going to have to rely on financial support from family members just to meet the very basic living needs, and also to cover the costs of any treatment that they may require. So there are direct impacts at an individual level, at the family level, at the community level which all contribute to costs and reduced productivity for the country as a whole.
VP Given all of these impacts why do you think so far … I mean in terms of just doing my research for this interview I was looking at the number of NGOs that deal specifically with mental health issues and trying to get a sense of where mental health ranked as a priority; and it seems to be very low. VP Given all of these impacts, why do you think so far … I mean in terms of just doing my research for this interview I was looking at the number of NGOs that deal specifically with mental health issues and trying to get a sense of where mental health ranked as a priority; and it seems to be very low.
MF Right.MF Right.
VP But why do you think that is then?VP But why do you think that is then?
MF It is extremely low for a couple of reasons. Part of the problem is the lack of awareness and knowledge about mental disorders. The lack of knowledge about the extent of the burden and the lack of knowledge that there are cost effective interventions – so that's one reason that explains the low priority given to mental disorders.MF It is extremely low for a couple of reasons. Part of the problem is the lack of awareness and knowledge about mental disorders. The lack of knowledge about the extent of the burden and the lack of knowledge that there are cost effective interventions – so that's one reason that explains the low priority given to mental disorders.
Another very important reason and barrier is just what we were talking about in terms of the stigma associated with having the mental illness and the misconceptions about the causes and the nature of mental health conditions. So all the stigma, the beliefs that people are possessed by supernatural forces, that they're believed to be weak, that they're lazy or dangerous – all these prejudices and false beliefs lead to an under investment in mental health services and strategies, as well as a number of different human rights violations. Another very important reason and barrier is just what we were talking about in terms of the stigma associated with having the mental illness and the misconceptions about the causes and the nature of mental health conditions. So all the stigma, the beliefs that people are possessed by supernatural forces, that they're believed to be weak, that they're lazy or dangerous – all these prejudices and false beliefs lead to an underinvestment in mental health services and strategies, as well as a number of different human rights violations.
VP Sri Lanka is a typical example of what Dr Michelle Funk describes particularly in terms of the stigma attached to mental illness. Ananda Galappatti is a medical anthropologist and practitioner in mental health who's been working in the country for the last 17 years.VP Sri Lanka is a typical example of what Dr Michelle Funk describes particularly in terms of the stigma attached to mental illness. Ananda Galappatti is a medical anthropologist and practitioner in mental health who's been working in the country for the last 17 years.
AG On the whole people with mental illness are quite seriously stigmatised so you would be seen as someone who perhaps someone wouldn't want their son or daughter to marry; or you might not be someone that someone would want to hire and give a job to, and on the whole might be treated badly within your community and viewed with a degree of suspicion. AG On the whole, people with mental illness are quite seriously stigmatised so you would be seen as someone who perhaps someone wouldn't want their son or daughter to marry; or you might not be someone that someone would want to hire and give a job to, and on the whole might be treated badly within your community and viewed with a degree of suspicion.
VP What kind of treatment would someone hope to have?VP What kind of treatment would someone hope to have?
AG A colleague of mine who worked at the large mental asylum said that describing 30 years of work there said all that's changed is that we've had a few different drugs over the years. Any time you have people in an institution where they are constrained, locked up, in long-term care there are always risks of abuse, of violations of different sorts and that certainly has been something that the services have struggled with. I am happy to say that there has been a greater recognition of this and certainly more proactive attempts to address this. But I think this is a fundamental risk of long-term institutionalisation or large scale institutionalisation. And so we need to address that at a societal level and it needs to really be led by an understanding that people with mental illness are entitled to the same rights as any other person in a family or community. AG A colleague of mine who worked at the large mental asylum said that, describing 30 years of work there, said all that's changed is that we've had a few different drugs over the years. Any time you have people in an institution where they are constrained, locked up, in long-term care, there are always risks of abuse, of violations of different sorts, and that certainly has been something that the services have struggled with. I am happy to say that there has been a greater recognition of this and certainly more proactive attempts to address this. But I think this is a fundamental risk of long-term institutionalisation or large-scale institutionalisation. And so we need to address that at a societal level and it needs to really be led by an understanding that people with mental illness are entitled to the same rights as any other person in a family or community.
VP Attitudes to mental health started to change in Sri Lanka during the country's long civil war and in reaction to the tsunami in late 2004. Ananda Galappatti again.VP Attitudes to mental health started to change in Sri Lanka during the country's long civil war and in reaction to the tsunami in late 2004. Ananda Galappatti again.
AG The seeds of change had already, in a sense, been planted in the years prior to the tsunami. There were progressive measures been taken by sometimes health administrators, sometimes senior psychiatrists and other advocates on behalf of people with mental illness. There were attempts to reform both institutional care but also to try and expand services beyond the main urban centres. But I think it really was the tsunami that helped accelerate that process both because of an increased recognition of mental health as a priority area for work; as well as the fact that the tsunami did bring in resources that were primarily targeted towards the tsunami but that also, in some senses, spilled over into general services and that helped really accelerate change. AG The seeds of change had already, in a sense, been planted in the years prior to the tsunami. There were progressive measures being taken by sometimes health administrators, sometimes senior psychiatrists and other advocates on behalf of people with mental illness. There were attempts to reform both institutional care but also to try and expand services beyond the main urban centres. But I think it really was the tsunami that helped accelerate that process both because of an increased recognition of mental health as a priority area for work; as well as the fact that the tsunami did bring in resources that were primarily targeted towards the tsunami but that also, in some senses, spilled over into general services and that helped really accelerate change.
VP So how did you come to be involved in building up those services?VP So how did you come to be involved in building up those services?
AG Well the story goes back about 10 or 12 years actually. I first came into contact with the mental health services in Batticaloa in eastern Sri Lanka when I visited the hospital there to meet the brand new psychiatrist who had taken over and started services. He was the first psychiatrist posted there since the 1970s, and was building services up from scratch. I remember visiting him and being very impressed by his enthusiasm but also recognising that he was really struggling at that point for resources. So he had initially started his ward in the corridor of a hospital building, and then later colonised another slightly rundown ward that was really at the back of the hospital next to the incinerator.AG Well the story goes back about 10 or 12 years actually. I first came into contact with the mental health services in Batticaloa in eastern Sri Lanka when I visited the hospital there to meet the brand new psychiatrist who had taken over and started services. He was the first psychiatrist posted there since the 1970s, and was building services up from scratch. I remember visiting him and being very impressed by his enthusiasm but also recognising that he was really struggling at that point for resources. So he had initially started his ward in the corridor of a hospital building, and then later colonised another slightly rundown ward that was really at the back of the hospital next to the incinerator.
But with the tsunami came a lot of resources, both through the state but also through external agencies; one of the Red Cross organisations helped build a rehabilitation centre which was a place, sort of a half-way community for people with serious mental illness leaving care to gain occupational skills and transition to more independent living. And that was something that was just a dream prior to the tsunami but because of some of the resources that were made available because of the tsunami these sort of facilities became a reality and exist today. But with the tsunami came a lot of resources, both through the state but also through external agencies; one of the Red Cross organisations helped build a rehabilitation centre which was a place, sort of a half-way community, for people with serious mental illness leaving care to gain occupational skills and transition to more independent living. And that was something that was just a dream prior to the tsunami but because of some of the resources that were made available because of the tsunami these sort of facilities became a reality and exist today.
VP So once you have got those resources how did you use them and sustain them because, presumably at some point, that aid money will dry up?VP So once you have got those resources how did you use them and sustain them because, presumably at some point, that aid money will dry up?
AG When creating the system you didn't create a very expensive model. You perhaps rather than hire a number of people for a short period of time to work in the district you would hire one person for every medical administrative unit. For the first time they created a category of community mental health worker who went out from the health facility clinics to communities and helped link people to services, followed up on people when they were not taking their medication or when they were having a problem. AG When creating the system you didn't create a very expensive model. You perhaps, rather than hire a number of people for a short period of time to work in the district, you would hire one person for every medical administrative unit. For the first time they created a category of community mental health worker who went out from the health facility clinics to communities and helped link people to services, followed up on people when they were not taking their medication or when they were having a problem.
The sustaining of those services over time has been more of a challenge. But what has often been attempted is to try and bring in some of these individuals, or at least the model, into the government run health system. So, for example, in eastern Sri Lanka at present there was a surplus of people who were supposed to be working on sanitary … well basically they were sanitary labourers, but there were too many of them. And one of the things that the health administration did was to offer some of the people who were employed in that category to be redeployed temporarily, with a view to perhaps regularising them in the future, to support community mental health work. And this has meant that suddenly you had 40 individuals who are now doing community based work, helping to connect people with existing services. The sustaining of those services over time has been more of a challenge. But what has often been attempted is to try and bring in some of these individuals, or at least the model, into the government-run health system. So, for example, in eastern Sri Lanka at present there was a surplus of people who were supposed to be working on sanitary … well basically they were sanitary labourers, but there were too many of them. And one of the things that the health administration did was to offer some of the people who were employed in that category to be redeployed temporarily, with a view to perhaps regularising them in the future, to support community mental health work. And this has meant that suddenly you had 40 individuals who are now doing community-based work, helping to connect people with existing services.
VP In May 2013 the World Health Organisation launched the mental health gap action programme, a blueprint to scale up services for mental, neurological and substance use disorders especially for low and middle income countries. The broad ranging recommendations include strengthening leadership and governance, comprehensive policies and laws to respect human rights, a focus on empowering people with mental health problems to take their own decisions and to move beyond a medical model of mental health taking treatment out of institutions and into the community. I asked Dr Michelle Funk about the challenge of making mental health a priority for governments with so many other pressing issues. VP In May 2013, the World Health Organisation launched the mental health gap action programme, a blueprint to scale up services for mental, neurological and substance use disorders especially for low- and middle-income countries. The broad-ranging recommendations include strengthening leadership and governance, comprehensive policies and laws to respect human rights, a focus on empowering people with mental health problems to take their own decisions, and to move beyond a medical model of mental health taking treatment out of institutions and into the community. I asked Dr Michelle Funk about the challenge of making mental health a priority for governments with so many other pressing issues.
MF Well the action plan is already a very good example of influencing national agendas. And through the action plan governments have actually made that commitment to put policies and plans in place to address the mental health issues in the country. So basically it has raised the profile of mental health as a key issue that needs to be addressed in countries. And that has been facilitated through all the policy discussions and debates that we have had with member states in the formulation of this action plan. And the action plan itself presents very clear directions and concrete actions that governments need to take and to put in place in their countries. And again they have actually made that commitment to do so by adopting the action plan.MF Well the action plan is already a very good example of influencing national agendas. And through the action plan governments have actually made that commitment to put policies and plans in place to address the mental health issues in the country. So basically it has raised the profile of mental health as a key issue that needs to be addressed in countries. And that has been facilitated through all the policy discussions and debates that we have had with member states in the formulation of this action plan. And the action plan itself presents very clear directions and concrete actions that governments need to take and to put in place in their countries. And again they have actually made that commitment to do so by adopting the action plan.
VP I asked Ananda Galappatti what he made of the mental health action plan.VP I asked Ananda Galappatti what he made of the mental health action plan.
AG The global action plan for mental health is a massive recognition of the need for a concerted effort to develop mental health services globally and as such, is a good thing. However, these sorts of global plans do not mean much unless they are reflected in the actions of governments and health services in every country in the world. And as such I see there being quite a lot of work to be done perhaps using the global action plan as a tool with which to advocate with our respective governments to allocate more resources to addressing mental health issues. AG The global action plan for mental health is a massive recognition of the need for a concerted effort to develop mental health services globally and, as such, is a good thing. However, these sorts of global plans do not mean much unless they are reflected in the actions of governments and health services in every country in the world. And as such I see there being quite a lot of work to be done, perhaps using the global action plan as a tool with which to advocate with our respective governments to allocate more resources to addressing mental health issues.
I think there are many positive things about the action plan certainly around the promotion of services in community settings and the involvement of service users and their families in the development and delivery of services. But these are things that are often easier said than done. And so there needs to be quite considerable interpretation of those plans and elaboration of methods for making those aspirations a reality. I think there are many positive things about the action plan, certainly around the promotion of services in community settings and the involvement of service users and their families in the development and delivery of services. But these are things that are often easier said than done. And so there needs to be quite considerable interpretation of those plans and elaboration of methods for making those aspirations a reality.
VP Earlier this year Ananda Galappatti organised a mental health professional conference in Sri Lanka's capital Colombo. Delegates came from around the world to share some of the real challenges they are facing especially in countries where the population is suffering from the effects of conflict or natural disaster. VP Earlier this year Ananda Galappatti organised a mental health professional conference in Sri Lanka's capital Colombo. Delegates came from around the world to share some of the real challenges they are facing, especially in countries where the population is suffering from the effects of conflict or natural disaster.
"I'm a psychiatrist from Egypt. There is acceptable international evidence that people after exposure to such adverse events people would be affected; people with pre-existing mental health problems, their problems can be exaggerated because when emergencies happen these people may not have access to medication or lost their access to the regular health facilities. But there is another group of people who will have what professionals would differentiate from mental illness who will have emotional stressors and that would be the majority of the population. And we know that the majority of the population will be able to resilience mechanism to overcome such events. But there will still be a small percentage of population that if we look into large countries in respect of numbers this small percentage which can be about 20% of the population which will have mild to moderate mental illness, and a population which would have severe mental illness would raise up to 4% after an emergency. This can include depression, this can be anxiety, substance misuse disorders and many other forms of mental illness that would increase after such emergencies."
"I'm a psychiatrist from Egypt. There is acceptable international evidence that people, after exposure to such adverse events people would be affected; people with pre-existing mental health problems, their problems can be exaggerated because when emergencies happen these people may not have access to medication or lost their access to the regular health facilities. But there is another group of people who will have what professionals would differentiate from mental illness, who will have emotional stressors and that would be the majority of the population. And we know that the majority of the population will be able to [have a] resilience mechanism to overcome such events. But there will still be a small percentage of population, that if we look into large countries in respect of numbers this small percentage which can be about 20% of the population, which will have mild to moderate mental illness, and a population which would have severe mental illness would raise up to 4% after an emergency. This can include depression, this can be anxiety, substance misuse disorders and many other forms of mental illness that would increase after such emergencies."
"My name is Emmanuel, I am coming from Belgium. Working in emergency operation, small scale and large scale emergency operation. And the main challenge we have is communication between people who try to help. You have lots of people coming with the good will, good faith and they try to help after an emergency, but they all try to do the same thing in the same place and usually they arrive with poor information about the local situation."
"My name is Emmanuel, I am coming from Belgium. Working in emergency operation, small-scale and large-scale emergency operation. And the main challenge we have is communication between people who try to help. You have lots of people coming with the good will, good faith, and they try to help after an emergency, but they all try to do the same thing in the same place and usually they arrive with poor information about the local situation."
"It's like any new technology you don't know how to use it and then once you start using it you start to see the benefit. But it requires somebody…"
"It's like any new technology you don't know how to use it and then once you start using it you start to see the benefit. But it requires somebody…"
VP Ananda Galappatti has also launched a website for professionals around the globe to share their knowledge and skills.VP Ananda Galappatti has also launched a website for professionals around the globe to share their knowledge and skills.
AG The website MHPSS.net, or the Mental Health and Psychosocial Support Network, really represents an opportunity to connect the field that is both fragmented geographically, I mean there are practitioners throughout the world who are working in very difficult circumstances who often don't have access to resources or peers who have been through similar experiences, and are very much on their own figuring things out from first principles. So the website serves as a kind of platform that can help connect people individuals and groups working in situations of crisis as well as act in a sense as a repository for manuals, reports. AG The website MHPSS.net, or the Mental Health and Psychosocial Support Network, really represents an opportunity to connect the field that is both fragmented geographically, I mean there are practitioners throughout the world who are working in very difficult circumstances who often don't have access to resources or peers who have been through similar experiences, and are very much on their own figuring things out from first principles. So the website serves as a kind of platform that can help connect people, individuals and groups working in situations of crisis as well as act in a sense as a repository for manuals, reports.
And I think what is so exciting about having something online is that it is possible for practitioners in lower resource settings, perhaps in Cote d'Ivoire and Sri Lanka and Cambodia to connect with one another directly; instead of, as in the past, having to rely on the mediation of perhaps knowledge centres in western Europe or North America to collect those lessons and disseminate them around the world. And I think what is so exciting about having something online is that it is possible for practitioners in lower resource settings, perhaps in Cote d'Ivoire and Sri Lanka and Cambodia, to connect with one another directly; instead of, as in the past, having to rely on the mediation of perhaps knowledge centres in western Europe or North America to collect those lessons and disseminate them around the world.
I mean cost per access is … I'll tell you something quite exciting which is that I looked at the website to see how many resources had been downloaded; in the last two years alone over 145,000 downloads had taken place from the website, which is quite remarkable. And around 35,000 people had accessed the website, which exceeds my expectations by several degrees I think.I mean cost per access is … I'll tell you something quite exciting which is that I looked at the website to see how many resources had been downloaded; in the last two years alone over 145,000 downloads had taken place from the website, which is quite remarkable. And around 35,000 people had accessed the website, which exceeds my expectations by several degrees I think.
"And then there were people saying that you know it's good the network because you ask questions and people answer you. And somebody said, it was somebody called Emmanuelle who answered me and I was next to her. And I say, 'It's me!'"
"And then there were people saying that you know it's good the network because you ask questions and people answer you. And somebody said, it was somebody called Emmanuelle who answered me and I was next to her. And I say, 'It's me!'"
VP Back in the conference the value of the website is obvious for practitioners and mental health experts.VP Back in the conference the value of the website is obvious for practitioners and mental health experts.
"Well for me directly it's very useful because when there is an emergency I can go on the website look what is happening in this country, learn a lot of information, being in touch with people who are already in the country, contact them directly, getting information and see if I could contribute or not. And then when I arrive in the country I can use the website just to upload document, instead of sending emails to everybody, I simply upload a document and I tell everybody to go to the website and then you will have the information. So it's really a link between people on the field and people not on the field."
"Well for me directly it's very useful because when there is an emergency I can go on the website, look [at] what is happening in this country, learn a lot of information, being in touch with people who are already in the country, contact them directly, getting information and see if I could contribute or not. And then when I arrive in the country I can use the website just to upload documents, instead of sending emails to everybody, I simply upload a document and I tell everybody to go to the website and then you will have the information. So it's really a link between people on the field and people not on the field."
VP What's the vision for the future in terms of tackling mental health particularly in the developing world? Dr Michelle Funk. VP What's the vision for the future in terms of tackling mental health, particularly in the developing world? Dr Michelle Funk.
MF We need to start by having a greater investment in mental health. It is very important. I think it would be misleading to say that you can run good, high quality mental health services with a zero investment. In ten years' time if the attitudinal change whereby people with mental disabilities are seen as individuals with capacity, with potential who have the ability to make core decisions about their personal and financial affairs and their treatment, if that attitudinal change occurs many other things are going to change. MF We need to start by having a greater investment in mental health. It is very important. I think it would be misleading to say that you can run good, high-quality mental health services with a zero investment. In 10 years' time if the attitudinal change whereby people with mental disabilities are seen as individuals with capacity, with potential who have the ability to make core decisions about their personal and financial affairs and their treatment, if that attitudinal change occurs many other things are going to change.
VP Ananda Galappatti has already seen things start to change. Has he noticed a shift in attitudes to mental health problems?VP Ananda Galappatti has already seen things start to change. Has he noticed a shift in attitudes to mental health problems?
AG I would say that on a local level where services really work for people with mental illness and their families, where people can see that people go in for treatment and then they come out and that they are better, they are able to function in communities and that they don't need to be locked up and they don't need to be viewed with view of suspicion or don't need to be restricted in different ways because you are afraid of them either getting into trouble or creating problems at a societal level. Then stigma is reduced and people are able to see people as being much more just like them, you know, as they are. AG I would say that, on a local level, where services really work for people with mental illness and their families, where people can see that people go in for treatment and then they come out and that they are better, they are able to function in communities and that they don't need to be locked up and they don't need to be viewed with suspicion or don't need to be restricted in different ways because you are afraid of them either getting into trouble or creating problems at a societal level. Then stigma is reduced and people are able to see people as being much more just like them, you know, as they are.
But also you see situations where sometimes services themselves become less stigmatised. So families that have been successful in accessing services and have seen the evidence of their family members who have mental illness getting better, are often the very people who refer others to those services. So I would say that part of the challenge of addressing stigma is really in providing respectful, caring services that actually work to improve people's mental health and address mental illness. And without that it is probably difficult to bring about any sort of change.But also you see situations where sometimes services themselves become less stigmatised. So families that have been successful in accessing services and have seen the evidence of their family members who have mental illness getting better, are often the very people who refer others to those services. So I would say that part of the challenge of addressing stigma is really in providing respectful, caring services that actually work to improve people's mental health and address mental illness. And without that it is probably difficult to bring about any sort of change.
VP And Sumina is hopeful.VP And Sumina is hopeful.
Sumina [Translated] Being a mental patient is no reason to be ostracised. You can get the medication you need these days and you can even become financially independent. We are normal now and can do anything you can do.Sumina [Translated] Being a mental patient is no reason to be ostracised. You can get the medication you need these days and you can even become financially independent. We are normal now and can do anything you can do.
VP That's all for this week's development podcast. For more ongoing coverage of development issues visit guardian.co.uk/globaldevelopment. My thanks to Ananda Galappatti, Dr Michelle Funk and the delegates at the MHPSS Conference for their contributions. Thanks also to Azzam Ameen and Basic Needs for their help gathering interviews. VP That's all for this week's development podcast. For more ongoing coverage of development issues visit guardian.co.uk/global-development. My thanks to Ananda Galappatti, Dr Michelle Funk and the delegates at the MHPSS Conference for their contributions. Thanks also to Azzam Ameen and Basic Needs for their help gathering interviews.
This podcast was presented and produced by me, Vivienne Perry.This podcast was presented and produced by me, Vivienne Perry.
Do you work for a charity that strives to improve social wellbeing in the UK? The Guardian Charity Awards are now open for entries. For 21 years the awards have been recognising and rewarding excellence shown by small to medium sized charities in the UK. This is a chance for charities, with an income of less than 1.5 million sterling, to raise their profile, get priceless consultation from sector experts and also a share of the £25,000 sterling winner's prize. Prove that small charities can make a big impact, enter now. Visit guardian.co.uk/charity-awards – the deadline is the 19th July 2013 and terms and conditions apply. Do you work for a charity that strives to improve social wellbeing in the UK? The Guardian Charity Awards are now open for entries. For 21 years the awards have been recognising and rewarding excellence shown by small- to medium-sized charities in the UK. This is a chance for charities, with an income of less than £1.5m, to raise their profile, get priceless consultation from sector experts and also a share of the £25,000 winner's prize. Prove that small charities can make a big impact, enter now. Visit guardian.co.uk/charity-awards – the deadline is the 19th July 2013 and terms and conditions apply.
For more great downloads go to guardian.co.uk/audio.For more great downloads go to guardian.co.uk/audio.