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Biased focus on physical health
Nothing and no one places a duty on our health ministry to reduce stigma and discrimination for the mentally ill. In fact, for all the years of healthcare in T&T, I cannot recall a T&T prime minister openly making a case for mental health either, nor have I heard a finance minister presenting fiscal policies with adequate resource allocations for mental illness.
And even as Health Minister Terrence Deyalsingh, with pride and pomp, announces a new strategic programme of interventions for non-communicable diseases (NCDs), I am left to wonder what is the level of his ministry’s considerations for the issue of chronic mental illnesses to be counted among the NCDs, as some jurisdictions have done?
The funding for the NCDs intervention is reported to be an IDB loan and I welcome it given the fact that NCDS are at an epidemic state globally and the statistics for T&T are frighteningly dismal. We are ranked fourth in the world for death as a result of diabetes in 2016, and diabetes is listed as our second leading cause of death (http://www.worldlifeexpectancy.com/trinidad-tobago-life-expectancy).
So finding support and having an intervention strategy in T&T for the world’s top NCDs—cardiovascular disease, diabetes, cancer and chronic respiratory disease—is important or in fact, necessary. This more so, since it was our former late prime minister Patrick Manning who initiated the Treaty of Port-of-Spain (2007), the genesis of the current global focus on non-communicable diseases.
Part of the problem with the constant lack of priority is that mostly people think of the issue as mental illness, which concerns only a quarter of our population directly, not recognising that the issue is mental health which is a concern for everyone in our population.
And it is not just a matter of our prime ministers, finance ministers, or health ministers over the years showing ignorance and disregard in fiscal decisions for the mental health of the population, not treating mental health on par with physical health. It is that globally, too, international funding agencies for health research and development, and donors, who make up a large part of global funding for health, also do not treat mental health with similar priority.
Worse than that, I believe, is the fact that as yet the case has not been made strongly enough about the fact that to not treat a country’s mental health with equal status as its physical health is not only foolish but is a contravention of the right of those who live with mental illness where we are entitled to such interventions by the state.
Article 25 of the United Nations’ Universal Declaration of Human Rights (1948) states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
In T&T, this right is not upheld. It cannot be if provisions are not made for an acceptable service for the population for our “health (physical and mental) and wellbeing (physical and mental)”.
But again, stigma, discrimination and ignorance stand in the way of any collective action. Our governments have not had the tolerance for mental illness. They have never exhibited political will for intervention with respect to mental health and much of that is because they do not make the connection to the fact that “there is no health without mental health.”
And too, as a population, those in the constituency needing healthcare and proper interventions for mental illnesses are cowed into quiet and silence because really, our tolerance level is so low that as a citizenry we do not speak about “such matters” publicly, and so we have not as yet impressed upon this society, ergo our government, the need for a serious intervention.
Each day I hope that someone would have a light-bulb moment and realise that the biased focus on physical health is unhealthy for the future of our country. When for example, depression’s true impact on our workforce is taken into consideration we may well find ourselves on the back foot having to produce more expensive interventions.
We may come to know seriously than an ounce of prevention is better than a pound of cure.
The World Health Organization says, “Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world” (http://www.who.int/mediacentre).
The UK Guardian in 2002 carried a feature which highlighted what is and has always been the prevalent attitude of discrimination in T&T.
“Qualitative research from mental health organisations shows that the quality of life of people with mental health problems is diminished by stigmatising attitudes, negative and distorted media coverage, and discrimination (https://www.theguardian.com/society/2000).”
Stigma and obliviousness breed intolerance even among our policy makers and apply a special brand of hurt to those already carrying the burden of difficult illnesses.
I wait in the fires of hope and prayer.
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