Don’t make the mental hospital a prison again As discussions continue on administrative reforms at the National Institute of Mental Health (NIMH), which was once known as the Angoda Mental Hospital, a public dialogue on the role this hospital plays in the development of mental health services in the country has become imperative. This hospital [...]

The Sundaytimes Sri Lanka

Letters to the Editor


Don’t make the mental hospital a prison again

As discussions continue on administrative reforms at the National Institute of Mental Health (NIMH), which was once known as the Angoda Mental Hospital, a public dialogue on the role this hospital plays in the development of mental health services in the country has become imperative.

This hospital was once an asylum where the law and the public dumped mentally ill patients and purged them out of society. Towering walls and strong Victorian buildings made sure that no patient escaped from this medical Bastille. Administrators, who had no understanding of psychiatry saw the symptomatic behaviours of helpless patients as bad acts and punished them. Life inside the hospital for most patients was worse than being inside a prison and their suffering went unnoticed.

The picture changed dramatically over the past ten years after a psychiatrist was appointed as the administrator of the hospital. Advanced psychiatric therapies like rehabilitation therapy, horticulture therapy and community treatment were adopted in patient management. The hospital began to monitor treatments through regular audits and research. The Mental Hospital Angoda does not resemble a prison any longer. In keeping with its new name ‘the National Institute of Mental Health’, the hospital is now equipped with lecture halls, a library, a research centre, an Intensive Care Unit and a training unit.

The hospital has also developed direct links with many prestigious international psychiatric bodies and local institutions in scaling up its services. Several international conferences are held annually at the hospital premises. With these improvements, it is not surprising that the hospital has won several health excellence awards in the recent past. Its achievements were largely due to the commitment of its staff with every unit being an equal partner of a team dedicated to serve the patients better.

But now the time has come to view the future role of NIMH. In the “Mental Health Policy of Sri Lanka”, NIMH is assigned the duties of development of special expertise in mental health care, and the provision of training and research.

Though Sri Lanka has achieved high standards in many fields of medicine, the same cannot be said about its mental health services. We still have a high suicide rate and a high alcohol consumption rate. The people’s understanding of mental illness still remains poor. Though one in four people develop a mental illness during their lifetime, many do not seek treatment. Some of those who seek treatment are not properly diagnosed due to some medical officers’ lack of proper understanding of psychiatric conditions.

There are two important aspects of modern psychiatric treatment. One is that the greater part of the treatment is carried out in the community. The other is that treatment has to be carried out by a team including doctors, nurses, psychiatric social workers and psychologists. These methods are now being adopted at central and district levels.

Despite these positive developments, NIMH remains an asylum by concept. Much of the mental health budget of the country is spent on maintenance. The time has come for NIMH to decentralise its services and consolidate its lead role in developing mental health services, especially in the development of expertise, training and research. To achieve this, the institution should move forward further with calculated changes. The staff of the hospital should continue to work as a team. Any hierarchical splitting will hinder further development. Any move in the opposite direction at this juncture will be a lost opportunity.

Decision makers should understand the crucial role NIMH has to play. In most parts of the world, the administration of psychiatric institutions is handled by professionals in psychiatry. The administrators appointed to NIMH should have a thorough understanding of modern psychiatry. Sadly we have to accept the fact that only the psychiatrists have this understanding and capacity at present in Sri Lanka. One may argue that a person with an administration qualification can liaise with psychiatrists and other staff to do the same job. However, this does not work in practice. For any endeavour to be successful the leader should have the vision and capacity. If the paths of the leader and those under him or her run into conflicts the institution suffers. The stakes are too high to take such a risk at a highly specified and important institution like the NIMH.

Stakeholders who wish for a qualitative mental health service development in the country do not wish the NIMH to become a prison again.

Dr. Prabath Wickrama, Acting Psychiatrist  General Hospital Trincomalee

Old pensioners seek justice before death

In the not so distant past, public servants were regarded as crystal wheels of the state administration with the authorities depending heavily on them to deliver the goods.

However with retirement, true to the law of impermanency, they have become a nonentity with the state sidetracking the pressing issues of those pensioners, especially those who retired before 2006.

Most pensioners in this category are likely to die within the next five years. It is indeed a crime that parliamentarians get an inflated pension, sitting in a palatial building and enjoying many hidden benefits unlike the miserable pensioner, who has laboured eight hours a day for some 35 years. The grant of pension to an army of parliamentarians is a clear exploitation of the rate-payer.

The sad state of affairs is that the President has to look into even minor issues like pension anomalies while those responsible at the Treasury and the Pension Department are in slumber.

Susantha S. Edirimuni, Ratmalana

To extend or not to extend retirement age

The suggestion by the Central Bank to extend the retirement age has many facets to it. Yes, employees nearing retirement have a lot of experience which will be valuable to our country. These older staff are probably dreading life after retirement on a reduced income, with the cost of living going up daily.

However, by extending the retirement age, a whole stream of their juniors will be deprived of promotions and an increase in pay and perks.

What about the thousands of young people looking for jobs? These are blocked by those staying on after the retirement age.
Which is the fairer option? To extend or not to extend? That is the question!

Dr. Asoka Thenabadu, Colombo

Anti-Muslim campaign harmful to Sri Lanka

What is the motive of those who are behind the Anti-Muslim campaign in Sri Lanka? Since the campaign began just before the Sri Lanka issue being taken up at the United Nations Human Rights Council sessions in Geneva, the question that arises is: Was it to deprive Sri Lanka of the votes of the Muslim countries?

The Government should find out who is financing this movement. I urge the President to check on this and take necessary action.
I feel that the aim of these groups is not only to deprive us of those the vote but also the remittance from our workers employed in West Asia. If the West Asian countries decide to close doors on Sri Lankan workers, what will be the fate of our economy?
Therefore, the authorities should nip the anti-Muslim campaign in the bud. Otherwise, all of us will suffer.

S.G. Gunawardene

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