Mental health services in Fiji have had a long interesting history. From its beginnings, in 1884, as a single ward catering to the mentally ill expatriate population it has evolved into a 136-bed psychiatric facility with links to the community through a well-established public health system. However, there is a need to further expand mental health care services and development.
One of the biggest hurdles facing mental health development in Fiji is the stigma not only associated with mental illness but also with St. Giles Hospital itself.
This stigma has fostered a very tragic catch-22 scenario whereby people are reluctant to seek assistance for mental health problems while their conditions worsen, sometimes resulting in them being brought to St. Giles Hospital forcibly, adding again to the stigma associated with being mentally unwell.
Also associated with the stigma surrounding mental illness are the many misconceptions, myths and traditional beliefs linked to the development of mental illness which prevent people from seeking appropriate assistance and turning to alternative means of treatment.
There is a dire need to educate the public and promote community awareness on mental health issues.
Other challenges include the limited resources available, both financial and human; the lack of trained mental health professionals and allied mental health professionals; limited community mental health and psychosocial rehabilitative services; archaic infrastructure and the need for new legislation which is in line with the modern practice of psychiatry.
However, this is not to say that Fiji's mental health services have not continued to develop and evolve despite the challenges and shortcomings.
An expansion of community mental health services in the Western and Northern divisions of the country has been funded for the period 2006-2008 from the Fiji Health Sector Improvement Program (FHSIP).
This is being achieved through the provision of Mental Health Project Officers in those divisions to promote and advocate for mental health in the community and through capacity building and training of public health nurses in mental health. This has been boosted by the allocation of additional funds for a divisional Mental Health Project Officer in the CentEast division in 2007.
The Fiji School of Nursing has just started its first post-basic nursing program in mental health, which started on September 25, 2006.
The formation of the national Committee on the Prevention of Suicide (NCOPS) in 2001 to address the issue of suicidal behaviours has also been another milestone in the evolution of mental health services in Fiji.
Also, after a long delay, a review of the current mental health legislation has commenced in the last quarter of 2006.
This is a very important event as that legislation, along with the current mental health plan will form the basis of and provide direction for the further development of mental health care in Fiji.
Fiji is also participating in two regional initiatives: the START (Suicide Trends in At-Risk Countries and Territories) study, A WHO study on suicide behaviour in the Western Pacific region; and is a member of the newly formed Pacific Island Mental Health Network (PIMHNet) which will be officially launched in April 2007.
So for a small developing country like Fiji, what is the way forward for mental health? With limited resources and competing health needs, which are seemingly more urgent, how do we progress?
I would like to reiterate that there is a fundamental need in the wider community for greater awareness of the importance of mental health and need for greater understanding of mental illness.
It is unfortunate that through lack of knowledge and awareness, we have treated mental health as a luxury item that we can do without, rather than as the vital basic necessity it is and often do not realize its importance or value until it is no longer there: be it through having to nurse a parent with dementia, or care for an intellectually disabled child or having experienced an episode of depression.
There must also be a commitment to improve the delivery of mental health care services through its integration with primary health care.
Advocacy and promotion of mental health should be strengthened through the development and implementation of policies and legislation, not only in the realm of health, but in other spheres such as education, housing, social welfare and employment opportunities, that will positively impact on the mentally ill and mental health care services.
Mental health must be made a priority and the realization of its importance in every aspect of our lives needs to be recognized and transformed to legislative and political commitment and funding.
However, we cannot depend solely on government to supply all our needs. We must also involve our communities and establish services and programs that will allow mental health care consumers to access help where they live in the least restrictive environment and without fear of stigmatization. There is a need to promote partnerships with the private sector to address shortcomings in the current delivery of mental health care (e.g. drug rehabilitation facilities, psychiatric respite and residential facilities, advocacy, mental health awareness, support groups, etc.). Consumers of mental health services should also be empowered and be given the opportunity to actively participate in the development of legislation, services, plans and policies related to mental health.
As a developing country with limited resources available, it is important to make use of the resources accessible at present. Mental health should be integrated into the general medical and public health arenas. Medical and nursing personnel, in both the private and public sectors, should be adequately trained to care and manage consumers with mental health concerns and community psychosocial and rehabilitative and support systems in place.
I envisage a future where people with mental health concerns can be assessed and managed in their communities at their local health centers and hospitals; that St. Giles Hospital will cease to exist in its current form and be a much smaller psychiatric facility attending to subspecialties in the field; with mental health care supported by a private sector based Mental Health Fund; and that the stigma attached to mental ill health and its treatment will be a thing of the pastâ€¦.does it sound too imaginative and far-fetched?
Probably. But with mental health one has to be visionary and ever hopeful that the value of mental health and the moral obligation we have to addressing mental health issues will one day be recognized.
Because we must remember: "There is no health without mental health".
(Guest Editorial: Fiji General Practitioner, Volume 15, Number 2 (June 2007)p 4-5)
nDr. Odille Chang, then Acting Medical Superintendent, St. Giles Hospital is currently Senior Lecturer in Psychiatry/Consultant Psychiatrist, College of Medicine, Nursing and Health Sciences, Fiji National University and President of Fiji Alliance for Mental Health (FAMH))
nThis article is taken from the guest editorial by Dr. Chang in the June 2007 edition of the Fiji General Practitioner Journal. Since the publication of this editorial it should be noted that Fiji now has new mental health legislation (Mental Health Decree, 2010) more in line with the modern practice of psychiatry, emphasizing consumer rights, community mental health, psychosocial and rehabilitative services. There are also plans to build a new subspecialist psychiatric facility with clinical, research, training and educational capabilities.