The current state of mental welfare

Maldivians live in a close-knit community, where everyone seems to know everyone else. The culture and beliefs are on the same spectrum, if not the same frequency, and the same taboos resonate across the country. Mental health is one such taboo. COVID-19, however, has blown the lid off this stigma most violently.

The biggest drawback faced by anyone wanting to assess the situation in the Maldives with regard to most social issues would be the lack of literature or statistics on these subjects. One major reason for this would be how certain social and personal issues are considered taboos; and mental health takes top spot behind substance abuse. The consequence of this is that these problems then continue unchecked, until one day, in one way or the other, it might just be too late.

It is important to understand a few things regarding mental health and its importance. Mental health is one of the main dimensions of health and is defined by the World Health Organisation (WHO) as: 

The lack of attention to the mental welfare of a society has been shown to be a huge risk factor in rising rates of crime, unemployment, and domestic violence. It also has a detrimental effect on the overall education system. It is rightfully so to assume that this issue, while not causative entirely, is a highly correlated factor that needs severe attention for a society to prosper sustainably.

In 2015, a long-delayed first step on the issue was taken with the publication of the National Mental Health Policy, 2015-2025. This was not unprecedented at a technical level though; work had begun all the way back in 2006, yet it was never given the priority it deserved. It was only in 2019 that, under the Solih Administration, the Centre for Mental Health was established at the state hospital, IGMH. It led the charge to fix this very serious, and almost crippling, epidemic that was mental disease, and its policy was based on these key objectives.

It has been six years since the National Mental Health Policy was announced, and there has been notable advancements in this endeavour that deserve mention. The discussion on mental health has been started, most definitely, and society is slowly opening up in that regard. Specific numbers are not easy to come by given the many private and non-governmental institutions offering mental health services, but this alone is an indicator that the public is taking the issue more seriously than they did before. The Centre at IGMH has seen a rise in the number of patients obtaining their services since it opened as well. However, these advancements are barely making a dent in the problem. On top of that, COVID-19 has made it worse.

There has been a major spike in mental health issues since the pandemic reached our shores. While the many risk factors that contributed to high mental health issues, such as congestion in the city, the rise in income disparity due to rampant capitalism, and even religious extremism, were bad enough already, the pandemic accelerated the deterioration. Once again, while exact numbers are yet unavailable, the trend is obvious to everyone. At the time of writing, even a member of our team had first-hand experience of the state of matters, and the simplest explanation is a lack of human capacity.

Staffed with four full time psychiatrists and a handful of assistants, the Centre has been overwhelmed. Getting upwards of hundreds of new patients each month, the hardworking staff there are working double-time especially now that COVID-19 has brought about so much more mental stress on the populace. Loss of jobs, the absolutely devastated economy, added on to the rise in adolescent mental health issues (WHO has made it clear that closed schools and continued states of lock down has been having huge detrimental effects on growing youngsters and youth) in the Maldives as well, has been a challenge they were not equipped to face.

Some of the psychiatric medications required are, understandably, controlled drugs. This means a written prescription with the correct dosage need to be on a signed paper to be accepted by the state pharmacy and other distributors. STO pharmacy refuses to accept prescriptions that do not list medications very specifically (i.e., a dosage of 100mg cannot be substituted with two 50mg pills) and too many times the patients have had to shuffle between the Centre and the pharmacy over this. On top of this, the medicines are not even available throughout the nation. In this instance, these are medication that would cause severe withdrawal symptoms if not administered correctly. 

Furthermore, due to being understaffed, consultations are delayed, sometimes cancelled, and more often than not, after weeks and months of delays (as without a consultation it is not easy to get the prescriptions renewed or updated) the patients are forced to go to the ER, only to be turned away at times. While an increase in patients does mean more awareness in society for mental health disorders, and also gives early diagnosis a chance, the waitlist is long. People requiring more urgent attention, however, ends up being added to this same waitlist, since there is no way to distinguish between patients without a prior diagnosis, which could worsen their illness. The situation is dire and needs a complete reassessment.

COVID-19 has brought about a new normal that the nation is still not ready to adapt to. While many jobs are now carried out remotely, new employment opportunities are opening up and lifestyles are changing, there are a lot facets of the nation’s infrastructure that needs reevaluation. As mentioned earlier, mental welfare is crucial for a society as closely knit as the Maldives. Much work needs to be done under the National Mental Health Policy. 

While it is cause for celebration that the people do not entirely demonise mental health issues now, the country, and her people, still have a long way to go to create an inclusive, healthy, and nurturing environment for everyone.