World first initiative improves global mental health

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"The health systems in low and middle income countries are hugely under-funded often resulting in enormous neglect and abuse of the human rights of people with mental illness," said Associate Professor Harry Minas, Director of the University's Centre for International Mental Health, who has led the initiative.

Human rights abuse includes the restraining of mentally ill people in shackles, or stocks, in a practice known as Pasung, which is still active in Indonesia and many other low income countries.

One hundred and twenty cases of Pasung have been identified as part of the University of Melbourne community mental health development program in Aceh.

A less visible but no less important human rights abuse was the lack of mental health services even for people with severe and disabling mental disorders.

Dr Minas says that 80 - 90 percent of schizophrenia patients in low income countries receive little or no treatment. In addition mental disorders are responsible globally for 35 percent of all years lived with a disability.

The first of its kind in mental health, the observatory will develop research, monitoring and evaluation programs at national and district level.

It will rely on the establishment of strong partnerships with key stakeholders, including Ministries of Health, university research groups, local and international NGOs, professional associations and mental health practitioners.

The observatory will begin its work in Asia and the Pacific region, where Dr Harry Minas and his team have been working for more than 10 years.

Dr Minas' team has been very active in the tsunami and conflict affected region of Aceh, and in the Southern Province of Sri Lanka, where he says there was "virtually no attention to mental health."

"Poor facilities and lack of skilled mental health workers lead to poor or harmful treatment for those in need," he said.

For 21 years, a 56 year old Indonesian man suffering mental illness was restrained in inhuman wooden stocks in the custom known as Pasung. It was the desperate measure of his family who consider they had no other course of action other than to rely on physical restraint.

His family had sought many forms of treatment for the man who at one stage had lived in the forests wandering without food or clothing. He had had several bouts of medical treatment and hospitalization. After his release from hospital, he became violent and erratic causing his family to resort to restraining him by Pasung.

He stayed in this incarceration for 21 years until the Indonesian mental health team, trained as part of the University of Melbourne program, discovered him.

"The good news is that our mental health programs have made an impact in Indonesia and in Sri Lanka and raised the awareness of the need for change, "Dr Minas said.

"Aceh and the Southern province of Sri Lanka now have functioning community mental health services with trained nurses and GPs and village volunteers. Many thousands of people have received treatment."

"The Aceh Government has acknowledged the mental health development work that has been done in the region and has committed to eradicating the practice of Pasung. The Sri Lankan Government has requested that the mental health development program be extended to other parts of the country, particularly where the recent conflict has been so devastating."

Dr Minas says that mental illness is unfortunately absent from the UN Millennium Development Goals, which is an initiative to end global poverty by 2015.

"Without investment in developing a skilled workforce, medical treatments and social support, there is not going to be a functioning mental health system, and it is impossible to protect the human rights of people with mental illness."

"The observatory will improve the human rights of people with mental illness and promote the scaling up of effective mental health services in low and middle income countries around the world."

University of Melbourne