Mental illness disproportionately affects people living in poverty and hardship, yet as many as nine in 10 people in developing countries go without the mental health care they need. Volunteer Service Abroad (VSA) volunteers work throughout the Pacific with local organisations to lift the stigma and provide support.
Until 2014, the psychiatric hospital in South Tarawa, Kiribati, was known as “The Mental”. The 60-bed hospital was built in British colonial days and is, like so many health facilities in the Pacific, under resourced, even as mental illness in Kiribati becomes more common.
On World Mental Health Day (October 10) in 2014, “The Mental” became “Te Meeria”, I-Kiribati for Frangipani. The name was suggested by one of the hospital’s patients, and marked the start of a campaign of community outreach.
VSA volunteer Andrew Raven, who worked with Te Meeria Mental Health as a psychologist trainer, says “it’s a really exciting time to be involved in mental health in Kiribati, and for me as a volunteer it’s been really satisfying.”
Information about the rates of mental illness in the Pacific is hard to come by, with few countries reporting patient data, but its global impact is better understood. In 2010, the World Bank and World Health Organisation (WHO) estimated that depression alone cost US$800 billion in lost economic output, “a sum expected to more than double by 2030.”
Andrew says that there are far too many people going without support. “The WHO did a review of mental health in Kiribati in 2013, as they’ve done in a few other Pacific Island countries. Based on Kiribati’s population of 100,000, they estimated 1,500 people have mental health problems. We’re seeing maybe 200 of them, so that’s a significant number of people not getting the help they need.”
Mental health was not included in the Millennium Development Goals at all, despite three of those eight goals focusing on health generally, and mental illness falling under the UN’s convention on the rights of persons with disability. It has some more visibility in the Sustainable Development Goals (SDGs), under SDG 3: “ensure healthy lives and promote well-being”. But international specialist on mental health law Laura Davidson writes “mental health has never had parity with physical health. Despite compelling economic arguments for investing in mental health, stigma perpetuates the lack of resources.”
And yet, Andrew says, mental health isn’t resource-hungry. “You don’t need a lot of stainless steel – you don’t need operating theatres and x-ray machines. You need good people, a regular supply of appropriate medication, and humane facilities.” The change in Kiribati has been largely driven by Dr. Mireta Noere, an I-Kiribati women who trained as a psychiatrist in Fiji and returned to her home country. “In her ambition and desire to improve things for local people, she has set about creating a community mental health service, which has occupied my time. We’ve got a home visiting service going.”
Recently, Andrew and the home-visit team have been working with Anna Maria, a young woman with a diagnosis of schizophrenia. “I first met Anna Maria when she failed to attend her outpatient appointment.” Sitting on pandanus mats in the home she shares with her parents, sisters and their husbands, Anna Maria explained that she was pregnant and had thrown away her medication out of concern for her baby.
Andrew says further discussion lead to her accepting that a full relapse of her illness was not good for her, her baby or her family. “We restarted her on a small dose of medication, talked with her attentive and concerned mother about support with antenatal care and asked the family to come to the next outpatient clinic. Evening cool had set in as we returned to the hospital, sharing concern for this lovely young woman and her baby.”
Anna Maria still takes medication, but decided against an increased dose as she felt she had learnt enough about her mental health, was active around her home and at peace with family.
Andrew says, “Sixteen months ago, the mental health service would not have been able to visit her at home, with a high likelihood that Anna Maria would have experienced a relapse of her schizophrenia, possible hospitalisation and increased risk for her baby.
“Anna Maria faces many obstacles over the coming years, but I will be returning to New Zealand knowing that this family have experienced good mental health service input, staff are motivated and more skilled to continue this work and a child will come into the world in better health than might have occurred previously.”
A significant part of Andrew’s work has been initiating a review of the Kiribati Mental Health Act. “These acts need to be kept up to date,” Andrew says, “This one has not been reviewed for 40 years.” Mental health acts, Andrew says, shape not only clinical practice, but philosophy and thinking around mental illness. “If they have a very strong focus on institutional care, which the old acts tend to do, then people will get institutionalised. If there’s a focus on less restrictive environments, then then more patients can stay home with appropriate treatment and support.
“The process of shaping a mental health act is, in itself, an education for the community, especially a small community.”
While they’re raising awareness, Andrew says they know there are some big issues still to be faced: “Big issues include increasing drug and alcohol abuse, and Kiribati’s young population (half the population is under the age of 25) having high rates of unemployment and higher levels of addiction. Young people are very vulnerable to impulsive acts of self-harm, and sometimes that’s lethal.”
The final draft of the national mental health policy submitted by the Te Meeria team would pull Kiribati into line with modern practice, and empower Te Meeria and other agencies to work with those going without support now. Andrew says, “we’ve put mental health on the map.”
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