There are two consultants, eight registrars and a pool of nurses who are qualified to care for psychiatric patients at Suva's Saint Giles Hospital.
Presenter: Geraldine Coutts
Speaker: Fiji's Minister for Health, Dr Neil Sharma
SHARMA: If you look at what's happening globally, mental health would be a major NCD item in the 10, 15 years. And when you look at the Pacific, we are very poorly served as far as mental health services go. And if you look at a lot of the countries, there's not even a trained nurse to look after mental illness. And the models which have been set, have been set on schizophrenic individuals, but there's a lot more depression and anxiety in the communities now with all the changes taking place, climate change and NCDs and premature deaths and mobility. So what happens is somebody needs to address this and in the last four years in Fiji, we have modernised our laws, our laws which are over 65 years old have been modernised. And with the modernisation of the mental health laws, we have decentralised our mainstream mental health or psychiatric services into from the institution to the divisional hospitals and then down to the subdivisional and with satellite health facilities now for mental health patients.
So with the decentralisation, we're able to pick up a lot more anxiety and depression and, of course, as you know, we have a high incidence of suicide and para-suicide developing in younger people. So that is the strategy. And then, of course, we started developing a post-diplomat program in mental health for our individuals and last year, six individuals graduated after that class and this year we have seven registrars from Fiji and we have three registrars from the Region, we have mostly just students from Palau, from Vanuatu and from Kiribatis, studying here to be able to go home after one year of post-graduate exposure, to be able to provide service to their communities.
With that in mind, we have had a fairly extensive discussion with the various ministers of health in Honiara two years ago and at the recent Pacific ministers of health meeting in Apia, where there was wide support and endorsement that we should look at developing a facility, a Pacific facility, for mental health and Suva would probably be a good choice, because we have a university here, we have volume of people and a range of diseases. We would be able to provide a teaching service and sector facilities for our research facility. So that needs to be undertaken and we need to move out of our institutions so that it has become rather stigmatised. So we are looking at an alternate project site and with that in mind, we have taken this up with the international global organisations, and they are the interested parties if we can offer this for the region.
So with that setting, we are looking ahead. Back in the not too distant future, there would be a mental health institute here, training and undertaking research on Pacific issues on mental health or psychiatric diseases.
COUTTS: Now the regional side of it Dr Sharma, will you be accepting patients from outside of Fiji. There are obviously going to be residential, so are we assuming then the cases that are in more need of treatment and long-term treatment than others who might be able to be treated at home more easily?
SHARMA: Yeah well, I think at this point in time, we don't want to be transplanting patients from one country to the other. I'm quite sure with the training that we will provide, that treatment would be available to those patients in their home country. But the purpose is to train our people, our nurses, our doctors and our paramedical people to be able to recognise mental illness at a much earlier stage to be able to intervene and be able to bring quality of life to our people in the region.
COUTTS: It's interesting that you've described it as an NCD. I've never had mental health included, but, of course, it makes sense. So the rates of mental health disease, is that been tracked and is there a data base on it. Do we know which ones are more prevalent in the communities than others?
SHARMA: Well, if we look at mental health disease, the World Health Assembly, (inaudible) ... very important NCD and if you look at the range of diseases, it varies from country to country and from region to region and it has a wide range from anxiety to depression and depression is a leading cause of problems, generally. Then you have schizophrenia personality disorders and adolescent and mental health disorders and that's becoming a lot more pronounced problem in younger people when they're striving and they're not achieving or there's inadequate employment in their own countries, the incidence, the availability of marijuana and glue, these sort of things, and binge drinking, all that contributes to illnesses happening in younger people in the Region.
COUTTS: And do we know the rate of suicide. You mentioned suicides are on the increase in Suva. Has that been calculated, do we know to what extent it's an issue?
SHARMA: Well, all I'm saying it's being reported a lot more, because there's a lot more civil society organisations and mental organisations working with the state and the ministry of health now. So we're picking up a lot of this and people are becoming a lot more clued into the numbers. I'm not saying that it has increased in anyway, but the figures do indicate that there's a need to be able to look at these issues and a lot of young people are finding it difficult to cope with circumstances, the modern way of living and sort of losing hope and taking such measures which are probably not as responsible as you and I would look on it.
COUTTS: Now, when do you expect the regional mental health facility to be in place?
SHARMA: Well, that''s a subtle issue that we need to try to address, international agencies of governments. We've done our ground work, we've had our ground work ready for a year now and we'll leave it to the other parts of government to take forward to the international agencies and if we had our way, I'd probably have that tomorrow, but that may not be the case in sort of low developed, income countries, or mid-level countries where these resources are restrained.