Making the mind a priority

For too long mental health has been demonised and portrayed as negative, bad, violent or scary, and sensationalised with the repetition of horror stories of degrading conditions at the St Ann’s Hospital. But ignorance and intolerance place a huge burden on those who live with mental ill health, so it is time for the discourse to be shifted and taken to another level.

In order to do that, however, there needs to be a clearer understanding of what is mental health because it is often misinterpreted to mean mental illness.

Mental health is defined by the WHO as “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” It is therefore central to everything we do – our sense of agency, and our ability to participate in society, yet it is a topic that most people are uncomfortable discussing unless it is to tell an offensive joke, make a snide remark or a dismissive aside about someone “acting mad” or “crazy”.

Even mental health professionals are not immune to the negative comments – a police officer at the airport scrutinising my immigration form commented “Oh, so you are a shrink dealing up with dem mad psycho people, lady you brave!” The officer equated mental illness with violence, and she is not the only one – that type of thinking permeates throughout society.

But there is significant research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime (Appleby, et al., 2001).

Stigma and discrimination The stark reality is that one in four of us will experience an episode of mental ill health during our lifetime whether it is anxiety, grief, depression, suicidal thoughts, substance misuse or dementia.

Mental illness is the largest cause of disability and is not only disabling and distressing in its own right, but can profoundly impact upon physical health, education, employment and economic well-being. Yet it remains taboo.

The WHO Suicide Report indicates that TT has disproportionately high numbers of suicides, and is ranked 34th in the world based on per 100,000 population size. Globally every 40 seconds someone dies of suicide, and for every person who dies by suicide there are 20 others who have made attempts to take their own lives.

Cast your mind back to the recent reports of suicides in the local papers, where many people were lamenting “Why didn’t they talk about their problems instead of taking their life?” The answer to that question lies in the intractable social ills such as the deep-seated stigma, prejudice and discrimination that prevents open and honest discussions on mental health, and the inequality between physical, and mental health service provision.

Do we expect someone to say they are feeling mentally unwell and experiencing psychological distress when chances are they will become the subject of ridicule, and also have to endure the unnecessary obstacles in navigating in, through and out of the healthcare system? If you go into any public/state sector organisation or school there will most likely be a first aider trained and qualified in administering emergency physical first aid, but no provision will have been made for those who experience emotional crisis, so they often experience pain in silence.

Consequently, until conversations about mental health are normalised and become socially acceptable many people will continue to bear unnecessary suffering.

Mental health matters and needs to be everyone’s business. It can no longer be ignored, so my principal aim for this year’s World Mental Health Day is a call to action for open dialogue. That is a first step in the process for the development and implementation of sustained programmes of culturally appropriate psychological well-being strategies; training and awareness in how to offer reasonable support to distressed individuals, with the same responsiveness as given to physical health; and a human rights approach with adherence to the core values of fairness, respect, equality, dignity and autonomy.

There are already existing frameworks upon which to build a human rights approach. For example, at the UN General Assembly, mental health was set as a Sustainable Development Goals (SDG) stressing the need for world leaders to promote mental health and well-being as a health priority.

In addition, TT has already ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) and that covers people with long-term mental illnesses.

Article 17 of the CRPD is an example which speaks of the “right to respect for physical and mental integrity on an equal basis with others.” So, in keeping with this year’s theme of Dignity in Mental Health my sincerest hope is to see the commencement of widespread transformation in the negative culture of attitudes, systems and services to one that upholds the standards of inherent dignity by which every person should be treated.

Mental health matters to all of us.

Dr Yansie Rolston is a UK-based disability and mental health specialist advisor and a social change trainer and facilitator who works internationally, at various levels of government, business, and civil society


"Making the mind a priority"

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