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Stigma in developing countries-Sri Lanka
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Lalith A Kuruppuarachchi MD, MRCPsych(UK), Professor of Psychiatry Faculty of Medicine,University of Kelaniya,Ragama,Sri Lanka,tel:0094112958219, Therese S. Lawrence MBBS,Lecturer,Faculty of Medicine,University of Kelaniya,Ragama,Sri Lanka
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lalithkuruppu{at}lycos.com Lalith A Kuruppuarachchi MD, MRCPsych(UK), et al.
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Sir: our accolades to the authors of the paper ‘community study of knowledge of and attitude to mental illness in Nigeria’ (1). Though it is said that stigmatisation of the mentally ill is less in developing countries as compared to the west, there is a lack of large scale community studies to substantiate this claim. Denial of its existence and downplaying its importance would only hamper efforts to de-stigmatise mental illnesses. Stigmatising attitudes may be encountered even amongst educated groups of people. For instance, a cross sectional study done amongst the academic and nonacademic staff of the Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka showed that though prejudice and misconceptions toward completely recovered mentally ill patients was less, the social acceptance of incompletely recovered patients was low. This was seen more markedly with psychotic illnesses than with neurosis. (More details are available from the authors on request). Murthy highlighted an important point when he stressed that the local experience has to be considered due to differing types and areas of stigma such as men experiencing greater discrimination in the job area and women, more in the family and social area which was demonstrated in a WPA stigma project from India(2). In Sri Lanka, in certain rural communities, it may be more culturally acceptable to say that one was possessed by a supernatural power than to admit to being psychiatrically ill. Interestingly, in Gureje et al’s paper, the second most commonly reported cause of mental illness was possession by evil spirits. In addition, most of our patients belong to extended families and though there are advantages in closely-knit families such as care and warmth, lack of privacy and confidentiality may lead to problems. Furthermore, health care providers seem to be paying less attention to mental health problems in developing countries and one might argue that this is a form of ‘stigma’ towards the mentally ill. For instance in Sri Lanka, only 1% of the overall health budget is allocated to mental hospitals while individual general hospitals have to meet their own mental health care expenses (3). We believe that stigmatisation of the mentally ill is still a very pertinent issue that has to be addressed worldwide and more community based research needs to be done. Only then can anti-stigmatisation interventions, which are culture appropriate, be applied. Media coverage of ‘anti-stigma’ interventions is essential to disseminate positive mental health messages while dispelling misconceptions (4). It would be interesting to see in the future if the wide publicity and open discussions regarding psychiatric illness, which we saw in the post- tsunami period in Sri Lanka, has changed the public’s perception of the mentally ill. Reference: 1. Gureje O, Lasebikan VO, Ephraim-Oluwanuga O et al. (2005) Community study of knowledge of and attitude to mental illness in Nigeria. British Journal of Psychiatry 186,436-441. 2. Murthy RS. (2002) Stigma is universal but experiences are local. World Psychiatry 1, 28. 3. Mendis N. (2004) Mental health services in Sri Lanka. International Psychiatry 3, 10-12. 4. Byrne P. (2000) Stigma of mental illness and ways of diminishing it. Advances in Psychiatric treatment 6, 65-72. Declaration of interest- None |
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