Wednesday 31 December 2008
Tuesday 30 December 2008
'2579' arrested on drug related charges this year? What does this mean!!
Exactly, what is the significance of this ? If the police media officials have stated that 2,579 people were arrested on drug related offenses, what we are seing here is the tip of the iceberg.
I will easily hypothesize that for every arrest, there will be 10 hidden users, so let us multiply the 2579 by 10, so we may have a hidden population of atleast 25,790 drug users atleast in the country....the numbers may infact be much more.
There have been reports which have also suggested that over 80 % of our prison population may be drug addicts, over 75% of our youth population may be drug addicts....and yet only 400 or so is the bed capacity for drug rehabilitation...with just over 5 counsellors to carry on the drug rehabilitation programme....which is now run based on the therapeutic community model( by ex addicts,read further from this link;http://abdullahwaheedsblog.blogspot.com/2008/12/reaching-out.html).
So the picture we see is gloomy. Police also seems to be adament on creating awareness that more and more drug users are minors.....all this is just so alarming...so pathetic.
We have to crack down on the drug pushers, drug dealers and drug lords in the country and break the interactions between the drug mafia between the countries....of the region. We have to reject the wealth that makes the wealthy wealthier and the poor rich by selling drugs. The people of the country must start a silent movement against the sale of drugs, criminalisation of drug addicts and stand up to the atrocities committed by the drug dealers who are pushing our children to take the path of drugs.
Some thing more has to happen.....some thing more than criminalising these youngsters and sending them to prison....we all have to really become proactive.
Who are the other 10 people who are using drugs silently without being caught? Can we help them before its too late?!!!!
I will easily hypothesize that for every arrest, there will be 10 hidden users, so let us multiply the 2579 by 10, so we may have a hidden population of atleast 25,790 drug users atleast in the country....the numbers may infact be much more.
There have been reports which have also suggested that over 80 % of our prison population may be drug addicts, over 75% of our youth population may be drug addicts....and yet only 400 or so is the bed capacity for drug rehabilitation...with just over 5 counsellors to carry on the drug rehabilitation programme....which is now run based on the therapeutic community model( by ex addicts,read further from this link;http://abdullahwaheedsblog.blogspot.com/2008/12/reaching-out.html).
So the picture we see is gloomy. Police also seems to be adament on creating awareness that more and more drug users are minors.....all this is just so alarming...so pathetic.
We have to crack down on the drug pushers, drug dealers and drug lords in the country and break the interactions between the drug mafia between the countries....of the region. We have to reject the wealth that makes the wealthy wealthier and the poor rich by selling drugs. The people of the country must start a silent movement against the sale of drugs, criminalisation of drug addicts and stand up to the atrocities committed by the drug dealers who are pushing our children to take the path of drugs.
Some thing more has to happen.....some thing more than criminalising these youngsters and sending them to prison....we all have to really become proactive.
Who are the other 10 people who are using drugs silently without being caught? Can we help them before its too late?!!!!
How can sexual violence be prevented?
Can we prevent rape and do rape prevention programmes exist? Well! In fact such programmes are conducted in other parts of the world. The objectives of these programmes vary and are targeted at different audiences. I was therefore wondering if it is perhaps time to introduce such programmes in the Maldives. But, who will be our target audiences? What would be the objectives? Who could conduct them?
Several thoughts bombard my mind as I bang on the keys of this laptop.
If I can have my way, I will focus such programmes at two different levels.
Level one.
In this level I will begin by introducing several short term awareness programmes targeting the following audiences.
1. Prisoners.
I think rape awareness programmes must be initiated in prison (some people will regard this as crazy, but I feel this will be the right place to start such a programme)
But we must acknowledge the challenges involved in introducing any programme to the prisons of Maldives and must first go into a dialogue with the prisoners, as for me, the prison now appears to be an institute which has also produced numerous people with PhD’s (people with ‘permanent head damage’ and they have later graduated to become the drug lords, gang leaders…street soldiers of our country). We must all acknowledge the significance of the role prisoners play in our lives and we cannot dispute that prison history is of amazing relevance…as it has also emerged as the institute of reform process in the country over the years. It is now regarded(ahem!!!) as the place where fight for democracy and human rights originated in the Maldives and so it may be sensible to start any programme of this nature from these prisons.
Returning to the topic, unfortunately prison behaviour in the Maldives has never been scientifically researched so we don’t really know anything about the prison subcultures. Do prison rapes occur between inmates? What is the prevalence of these occurrences? I wonder about the extent of this subculture in our prisons. Does it happen frequently and if so is this behaviour getting generalized?
Perhaps, rape awareness programmes can be initiated in prisons following a small study to examine the prevalence of these behaviours in the prison.
I have a feeling that prison rapes between inmates may be a predominant culture, because I remember seeing such behaviours among the inmates at some of my visits to the prison. I have seen some inmates who put white powder on their face, presumably to signify the female roles they may have adopted (these boys who had tiny physiques had taken this role in comparison to the more masculine stronger males). Perhaps these roles were adopted by the inmates in order to survive in the prison. We must all be aware that various things of this sort can happen in prison.
However, the inmates also have a right to be protected from other prisoners who may sexually violate them in the prison and we must provide them with this security. There is research, which shows the viciousness of the cycle of violence. We must do our best to prevent such rape from happening within the prison and thus prevent it from spreading to the community once these people are released into the society.
NGO’s who are working for the rights of prisoners, or against violence in general can initiate rape awareness programmes with a focus on providing information on sexually transmitted diseases/HIV/AIDS, information on the physical, psychological and legal consequences associated with rape whether in prison or outside. Such awareness programmes should also focus on rehabilitating individuals with skills to break the cycle of violence, and help them foster the belief that violence cannot be a solution to any problem.
2. Women.
Women should be made aware that rape is something which happens in our society and no one is immune to this. It can happen to anyone and while there is no guarantee that it can be prevented even if you follow all the do’s and don’ts that we may specify in a rape prevention programme, by virtue of being given a gender, women will always remain vulnerable to such extreme forms of violence. However, women should be taught to take certain precautions.
Things like going out by themselves to places that are not familiar to themselves, to isolated or abandoned spots should be avoided. From the recent reports of gang rapes what we realize is that girls must not go alone to places where strangers have invited them under suspicious circumstances, especially if the friend or ex friend you are visiting is high on drugs or have a history of drug abuse or history of violence or crime. This should give you all the more reason to take extra caution, if at all, go to these places in the company of responsible adults. Further, if the so called friend has ever treated you or your body with disrespect, or has been violent towards you, it is better to not get further entangled in such relationships.
If at any point of the relationship you have been sexually violated, please do not tolerate such violence. It cannot happen under the garb of love. Do not stay in a violent relationship, because the person who inflicts such violence is just not going to change overnight for the sake of you or because of your tolerance of this violence. Violence and love are not the same.
Seek help. I am sure there are people in the family or among friends who can guide you to safety.
3. Men
It has been reported by several studies that majority of sexual violence is committed by men. In the Maldives, through my practice I have come across several women who have narrated stories of unbearable physical and sexual violence on them. This has happened to them while some were in boy friend girl friend status of the relationship. Many girls have reported being sexually coerced to give in to the sexual exploits of their so called boy friends. Distress, guilt, fear and powerlessness have often kept these girls in some of these pathological relationships. Sometimes, extreme forms of sexual violence have been reported by married women who had endured this, because the man who inflicts this violence is also the provider of the family, the father of the kids, and the women tolerate this sexual violence just to keep the family together.
I think that men in our society should be taught to become more humane. Coercing naïve girls into sexual behaviours they don’t want cannot be a sign of manhood or something to gloat about. We have to start re-educating our youth to accept a more civilized form of courtship, let there be consent, respect the feelings of the girl too. She may love you but do not force her to give up her virtues to prove her love for the man, unless that is what she wishes. Women should learn that good men, are not sexually violent, they don’t force you to sex under any circumstance. Our youth must be taught this.
Further, drug abuse is associated with moments of complete insanity and an addict may be sexually violent under intoxication. Be careful, when you are in a relationship with an addict, just don’t do anything which you will regret later.
Level two.
This level will focus on achieving long term outcomes. Ideas like respecting the human body of oneself and of others can be introduced into school curricula. Children can be taught values such as the need to have a proper belief system, religious values, moral values, etc, and this would be a long term developmental plan.
Several thoughts bombard my mind as I bang on the keys of this laptop.
If I can have my way, I will focus such programmes at two different levels.
Level one.
In this level I will begin by introducing several short term awareness programmes targeting the following audiences.
1. Prisoners.
I think rape awareness programmes must be initiated in prison (some people will regard this as crazy, but I feel this will be the right place to start such a programme)
But we must acknowledge the challenges involved in introducing any programme to the prisons of Maldives and must first go into a dialogue with the prisoners, as for me, the prison now appears to be an institute which has also produced numerous people with PhD’s (people with ‘permanent head damage’ and they have later graduated to become the drug lords, gang leaders…street soldiers of our country). We must all acknowledge the significance of the role prisoners play in our lives and we cannot dispute that prison history is of amazing relevance…as it has also emerged as the institute of reform process in the country over the years. It is now regarded(ahem!!!) as the place where fight for democracy and human rights originated in the Maldives and so it may be sensible to start any programme of this nature from these prisons.
Returning to the topic, unfortunately prison behaviour in the Maldives has never been scientifically researched so we don’t really know anything about the prison subcultures. Do prison rapes occur between inmates? What is the prevalence of these occurrences? I wonder about the extent of this subculture in our prisons. Does it happen frequently and if so is this behaviour getting generalized?
Perhaps, rape awareness programmes can be initiated in prisons following a small study to examine the prevalence of these behaviours in the prison.
I have a feeling that prison rapes between inmates may be a predominant culture, because I remember seeing such behaviours among the inmates at some of my visits to the prison. I have seen some inmates who put white powder on their face, presumably to signify the female roles they may have adopted (these boys who had tiny physiques had taken this role in comparison to the more masculine stronger males). Perhaps these roles were adopted by the inmates in order to survive in the prison. We must all be aware that various things of this sort can happen in prison.
However, the inmates also have a right to be protected from other prisoners who may sexually violate them in the prison and we must provide them with this security. There is research, which shows the viciousness of the cycle of violence. We must do our best to prevent such rape from happening within the prison and thus prevent it from spreading to the community once these people are released into the society.
NGO’s who are working for the rights of prisoners, or against violence in general can initiate rape awareness programmes with a focus on providing information on sexually transmitted diseases/HIV/AIDS, information on the physical, psychological and legal consequences associated with rape whether in prison or outside. Such awareness programmes should also focus on rehabilitating individuals with skills to break the cycle of violence, and help them foster the belief that violence cannot be a solution to any problem.
2. Women.
Women should be made aware that rape is something which happens in our society and no one is immune to this. It can happen to anyone and while there is no guarantee that it can be prevented even if you follow all the do’s and don’ts that we may specify in a rape prevention programme, by virtue of being given a gender, women will always remain vulnerable to such extreme forms of violence. However, women should be taught to take certain precautions.
Things like going out by themselves to places that are not familiar to themselves, to isolated or abandoned spots should be avoided. From the recent reports of gang rapes what we realize is that girls must not go alone to places where strangers have invited them under suspicious circumstances, especially if the friend or ex friend you are visiting is high on drugs or have a history of drug abuse or history of violence or crime. This should give you all the more reason to take extra caution, if at all, go to these places in the company of responsible adults. Further, if the so called friend has ever treated you or your body with disrespect, or has been violent towards you, it is better to not get further entangled in such relationships.
If at any point of the relationship you have been sexually violated, please do not tolerate such violence. It cannot happen under the garb of love. Do not stay in a violent relationship, because the person who inflicts such violence is just not going to change overnight for the sake of you or because of your tolerance of this violence. Violence and love are not the same.
Seek help. I am sure there are people in the family or among friends who can guide you to safety.
3. Men
It has been reported by several studies that majority of sexual violence is committed by men. In the Maldives, through my practice I have come across several women who have narrated stories of unbearable physical and sexual violence on them. This has happened to them while some were in boy friend girl friend status of the relationship. Many girls have reported being sexually coerced to give in to the sexual exploits of their so called boy friends. Distress, guilt, fear and powerlessness have often kept these girls in some of these pathological relationships. Sometimes, extreme forms of sexual violence have been reported by married women who had endured this, because the man who inflicts this violence is also the provider of the family, the father of the kids, and the women tolerate this sexual violence just to keep the family together.
I think that men in our society should be taught to become more humane. Coercing naïve girls into sexual behaviours they don’t want cannot be a sign of manhood or something to gloat about. We have to start re-educating our youth to accept a more civilized form of courtship, let there be consent, respect the feelings of the girl too. She may love you but do not force her to give up her virtues to prove her love for the man, unless that is what she wishes. Women should learn that good men, are not sexually violent, they don’t force you to sex under any circumstance. Our youth must be taught this.
Further, drug abuse is associated with moments of complete insanity and an addict may be sexually violent under intoxication. Be careful, when you are in a relationship with an addict, just don’t do anything which you will regret later.
Level two.
This level will focus on achieving long term outcomes. Ideas like respecting the human body of oneself and of others can be introduced into school curricula. Children can be taught values such as the need to have a proper belief system, religious values, moral values, etc, and this would be a long term developmental plan.
Saturday 27 December 2008
Victims of gang rape in Maldives.. need psychological support too
I have been reading the news reports about how some girls have recently been gang raped and my heart goes out to the victims who have suffered this terrible ordeal.
I hope they and their family members get the courage to cope with this extremely difficult moment. I also hope they get justice and that those who did this be given the necessary punishments. They must not be allowed to roam free on our streets after having done what they have done to these young and naïve girls.
Yes. I know rape, violence against women these things happen in every society and will continue to happen. But what has bewildered me is, that this time, the rapists appear very organized, they seem to have a particular modus operandi and this seems to indicate something more sinister is going on behind these acts. Are these people individuals with past criminal records? Are they people who abuse drugs? Do they belong to different gangs?? Are these acts of revenge? Do these people belong to the group that have been recently released from parole? I think the public has a right to know these answers and I think the news reporters must ask the police these questions in the next briefing. I think the police must keep the public informed as they are doing now on who these people are, and when the time comes let us see their photographs so that we will know to protect our daughters from the claws of these horrible people.
Rape is a word that immediately sends shivers down the spine of any one and it is difficult to fathom both physical and psychological pain that victims must forever endure once they have been victimized. Research studies show that victims of rape develop several symptoms of Post Traumatic Stress Disorder (PTSD) such as fear, anxiety, flashbacks etc following rape and almost one-third (31%) of all rape victims developed PTSD sometime during their lifetime; and more than one in ten rape victims (11%) still has PTSD today. Further, 30% of rape victims experience at least one major depressive episode in their lifetime and some go on to develop more life threatening problems such as attempting suicide with reports stating that they were 13 times more likely than non-crime victims to have attempted suicide (13% Vs 1%). Further some studies have also shown that the incidence of substance abuse was significantly higher among victims of rape with reports that among rape victims there was a 26 times more likelihood to have two or more major serious drug abuse problems.
The trauma associated with rape can occur in several phases.
In the acute phase which usually last from a few days to a few weeks after the attack survivors experience a disruption of their lives, they live in fear may cry, shout, swear, laugh nervously, or sit calmly. They may either openly show their emotions or they may contain the emotions by controlling their composure. They may sit calmly, respond to questions in a detached, logical way, and downplay their fear, sadness, anger, and anxiety
What one has to understand at this point of time is that the survivor of rape is in a deep state of shock, and disbelief. What has happened to her is not acceptable; it is a terrifying, brutal experience. There is anger, and often the survivor feel dirty, and cheap and often can feel as if he or she has committed a sin. The humiliation can be deep and lifelong and yet at the same time there could be that sense of relief for having survived the attack.
Following such an attack the survivor can report general soreness of the body, may have difficulty with sleep the appetite may be disrupted and may also report nightmares and flashbacks.
The survivor then enters the reorganization phase following rape and this phase may last from few weeks to several years. During this phase, it is important that the survivors utilize their coping skills to move ahead in life, they need the emotional support of family and friends and it is important that the loved ones offer their empathy and unconditional support to the survivors for effective healing to take place. Further, if they have other comorbid problems such as drug abuse, these must be addressed too.
In this phase the individual is trying to bounce back to life may they still have residues of the sexual attack. They may still show mood changes, may break up into tears easily , may not like to be left alone, may feel too ashamed to go back to their place of work and may generally feel a loss of control over their life. Like in this case where the survivors were gang raped they may even develop a fear to go outside and mingle with society again.
The survivors of rape often find it difficult to accept, like with any victim of violence, that this has really happened to them. Thus, denial can be commonly seen among the victims and this is an emotion that must be dealt with sooner or later by the victim as denial that lasts longer than a few hours or days, is detrimental to their recovery.
Depression, guilt, and a general loss of self-esteem are also common psychological reactions and these symptoms suggest that the survivor have turned their anger inward, and that they have unresolved fears.
This is where friend and family can step in and let the survivors know that they are in no way responsible for this and that the anger and negative feelings must be directed outwards. If the survivors still go on to develop panic attacks, anxiety and fear reactions with PTSD, therapy is highly recommended.
Following rape, the sexual life of the survivor can also get disrupted as the otherwise pleasurable experience has been used to cause pain, humiliation and punish.
Therefore, victims of rape may often report physical pain during sex, have difficulty relaxing, show indifference to sex or some victims have on the other hand desire sex all the time. Thus, their behaviors may fall between these two extremes. If the survivor was a virgin at the time of the assault, they may have a heightened fear of their first consensual sexual encounter.
Many survivors also develop fear of having contacted STD’S or HIV/AIDS, or fear that they may have conceived following a rape. Thus, it may be worthwhile to test the survivor for these at the earliest such that the next necessary steps could be taken.
Further, some studies also report that following rape, victims are stigmatized for life and they may even lose the love of their life.
So , at this moment while the media is focusing on the story side of these gang rapes, let us , the so called responsible citizens of the country, take a second to empathize with the young victims of this recent rape and do what ever is possible to offer our support to the families and victims who have had to endure this violence and let us hope that those who caused this violence is brought to book at the earliest.
I hope they and their family members get the courage to cope with this extremely difficult moment. I also hope they get justice and that those who did this be given the necessary punishments. They must not be allowed to roam free on our streets after having done what they have done to these young and naïve girls.
Yes. I know rape, violence against women these things happen in every society and will continue to happen. But what has bewildered me is, that this time, the rapists appear very organized, they seem to have a particular modus operandi and this seems to indicate something more sinister is going on behind these acts. Are these people individuals with past criminal records? Are they people who abuse drugs? Do they belong to different gangs?? Are these acts of revenge? Do these people belong to the group that have been recently released from parole? I think the public has a right to know these answers and I think the news reporters must ask the police these questions in the next briefing. I think the police must keep the public informed as they are doing now on who these people are, and when the time comes let us see their photographs so that we will know to protect our daughters from the claws of these horrible people.
Rape is a word that immediately sends shivers down the spine of any one and it is difficult to fathom both physical and psychological pain that victims must forever endure once they have been victimized. Research studies show that victims of rape develop several symptoms of Post Traumatic Stress Disorder (PTSD) such as fear, anxiety, flashbacks etc following rape and almost one-third (31%) of all rape victims developed PTSD sometime during their lifetime; and more than one in ten rape victims (11%) still has PTSD today. Further, 30% of rape victims experience at least one major depressive episode in their lifetime and some go on to develop more life threatening problems such as attempting suicide with reports stating that they were 13 times more likely than non-crime victims to have attempted suicide (13% Vs 1%). Further some studies have also shown that the incidence of substance abuse was significantly higher among victims of rape with reports that among rape victims there was a 26 times more likelihood to have two or more major serious drug abuse problems.
The trauma associated with rape can occur in several phases.
In the acute phase which usually last from a few days to a few weeks after the attack survivors experience a disruption of their lives, they live in fear may cry, shout, swear, laugh nervously, or sit calmly. They may either openly show their emotions or they may contain the emotions by controlling their composure. They may sit calmly, respond to questions in a detached, logical way, and downplay their fear, sadness, anger, and anxiety
What one has to understand at this point of time is that the survivor of rape is in a deep state of shock, and disbelief. What has happened to her is not acceptable; it is a terrifying, brutal experience. There is anger, and often the survivor feel dirty, and cheap and often can feel as if he or she has committed a sin. The humiliation can be deep and lifelong and yet at the same time there could be that sense of relief for having survived the attack.
Following such an attack the survivor can report general soreness of the body, may have difficulty with sleep the appetite may be disrupted and may also report nightmares and flashbacks.
The survivor then enters the reorganization phase following rape and this phase may last from few weeks to several years. During this phase, it is important that the survivors utilize their coping skills to move ahead in life, they need the emotional support of family and friends and it is important that the loved ones offer their empathy and unconditional support to the survivors for effective healing to take place. Further, if they have other comorbid problems such as drug abuse, these must be addressed too.
In this phase the individual is trying to bounce back to life may they still have residues of the sexual attack. They may still show mood changes, may break up into tears easily , may not like to be left alone, may feel too ashamed to go back to their place of work and may generally feel a loss of control over their life. Like in this case where the survivors were gang raped they may even develop a fear to go outside and mingle with society again.
The survivors of rape often find it difficult to accept, like with any victim of violence, that this has really happened to them. Thus, denial can be commonly seen among the victims and this is an emotion that must be dealt with sooner or later by the victim as denial that lasts longer than a few hours or days, is detrimental to their recovery.
Depression, guilt, and a general loss of self-esteem are also common psychological reactions and these symptoms suggest that the survivor have turned their anger inward, and that they have unresolved fears.
This is where friend and family can step in and let the survivors know that they are in no way responsible for this and that the anger and negative feelings must be directed outwards. If the survivors still go on to develop panic attacks, anxiety and fear reactions with PTSD, therapy is highly recommended.
Following rape, the sexual life of the survivor can also get disrupted as the otherwise pleasurable experience has been used to cause pain, humiliation and punish.
Therefore, victims of rape may often report physical pain during sex, have difficulty relaxing, show indifference to sex or some victims have on the other hand desire sex all the time. Thus, their behaviors may fall between these two extremes. If the survivor was a virgin at the time of the assault, they may have a heightened fear of their first consensual sexual encounter.
Many survivors also develop fear of having contacted STD’S or HIV/AIDS, or fear that they may have conceived following a rape. Thus, it may be worthwhile to test the survivor for these at the earliest such that the next necessary steps could be taken.
Further, some studies also report that following rape, victims are stigmatized for life and they may even lose the love of their life.
So , at this moment while the media is focusing on the story side of these gang rapes, let us , the so called responsible citizens of the country, take a second to empathize with the young victims of this recent rape and do what ever is possible to offer our support to the families and victims who have had to endure this violence and let us hope that those who caused this violence is brought to book at the earliest.
Friday 26 December 2008
Neglecting those with mental illness
Does a societies interpretation of mental illness play any role on how its people depict their symptoms and therefore on how they treat it?
If a society attaches some stigma to mental illness does it tell anyone, anything about that particular society? What does it tell about the value system of those people?
If a society ignores its most vulnerable people or if a nation of people fails to attend to the most vulnerable of its people, because their voices are faint against the noisier larger, stronger frame work of individuals, what does it tell one of those societies?
Who cares if Maldives does not have enough mental health professionals?
Who cares if Maldives does not have a mental health legislature and its parliamentarians are too busy to handle an issue of this nature at this juncture of its political history.
Who cares if Maldives does not have a national mental health policy or programme?
It’s not a bloodline of a country we are talking about here.
Its just about forlorn, depressed patients, lost somewhere under the label of a ‘lazy person’…its just about schizophrenic patients who needs to be sent away to Guraidu…its just about drug addicts who has a comorbid antisocial personality disorder who just needs to be kept behind bars in a prison, its about people like these….who matter not at all. Perhaps some antipsychotics will do the trick. Perhaps a visit to the psychiatrist is just the answer
Is that the cultural understanding we have of mental illness??
Then why …why is it that Maldivians with mental illness, travel to India, Srilanka, Malaysia…different countries of the world….in search of therapy, in search of proper treatment. Why is it that while I live here in UK, I still receive calls from distressed patients or their relatives, asking for the addresses and contact numbers of mental health professionals in Asia…where they can go and seek help for their loved ones. Why is it that people call me to ask me when I will return to Maldives…..
I can’t help so many people. I can’t make the difference all alone. If others cannot care…..why can’t I too slumber to a state of lethargy and say just this.
Who cares?
It is because you and I together have a responsibility towards the most vulnerable of our people. It is because creating awareness about mental illness can reduce the stigma that is prevalent towards those with mental illness. It is because early intervention and eclectic treatment approaches can help reduce the distress associated with mental illness.
It is because we can inform the parliamentarians that we need to have a proper system of care established towards the mentally ill, and for that we need a mental health legislature and policy and programme.
We have moved ahead in many other areas of development and the time has now come for people like us to start voicing our concerns. This is the way forward, for a country which is definitely burdened with a multitude of mental health problems we just cannot afford to neglect those with mental illness any longer.
If a society attaches some stigma to mental illness does it tell anyone, anything about that particular society? What does it tell about the value system of those people?
If a society ignores its most vulnerable people or if a nation of people fails to attend to the most vulnerable of its people, because their voices are faint against the noisier larger, stronger frame work of individuals, what does it tell one of those societies?
Who cares if Maldives does not have enough mental health professionals?
Who cares if Maldives does not have a mental health legislature and its parliamentarians are too busy to handle an issue of this nature at this juncture of its political history.
Who cares if Maldives does not have a national mental health policy or programme?
It’s not a bloodline of a country we are talking about here.
Its just about forlorn, depressed patients, lost somewhere under the label of a ‘lazy person’…its just about schizophrenic patients who needs to be sent away to Guraidu…its just about drug addicts who has a comorbid antisocial personality disorder who just needs to be kept behind bars in a prison, its about people like these….who matter not at all. Perhaps some antipsychotics will do the trick. Perhaps a visit to the psychiatrist is just the answer
Is that the cultural understanding we have of mental illness??
Then why …why is it that Maldivians with mental illness, travel to India, Srilanka, Malaysia…different countries of the world….in search of therapy, in search of proper treatment. Why is it that while I live here in UK, I still receive calls from distressed patients or their relatives, asking for the addresses and contact numbers of mental health professionals in Asia…where they can go and seek help for their loved ones. Why is it that people call me to ask me when I will return to Maldives…..
I can’t help so many people. I can’t make the difference all alone. If others cannot care…..why can’t I too slumber to a state of lethargy and say just this.
Who cares?
It is because you and I together have a responsibility towards the most vulnerable of our people. It is because creating awareness about mental illness can reduce the stigma that is prevalent towards those with mental illness. It is because early intervention and eclectic treatment approaches can help reduce the distress associated with mental illness.
It is because we can inform the parliamentarians that we need to have a proper system of care established towards the mentally ill, and for that we need a mental health legislature and policy and programme.
We have moved ahead in many other areas of development and the time has now come for people like us to start voicing our concerns. This is the way forward, for a country which is definitely burdened with a multitude of mental health problems we just cannot afford to neglect those with mental illness any longer.
Monday 22 December 2008
A focus on the issues underlying cases XY and P !
Let’s have a look at madam X’s case.
How was she before the incident/s?
She was an apparently healthy, happy woman without any eccentric behaviours.
Did something happen to her?
Physical abuse, sexual abuse in other words, she was subjected to rape several times.
What help did she receive?
None. There was no one to offer her help.
How did she cope?
I don’t think she was able to cope with these incidents. She had to mimic ‘MAD’ behaviours as understood by the people of our society so that they will be so scared of her that people will not dare to come close to her….this was the only way she thought she could cope with.
So what are the issues involved?
There are several issues involved here. First, victims of rape, sexual abuse, incest, domestic violence, find it hard to come and report it to the concerned authorities. But we find that our law enforcement agencies and media are much more sensitive to these issues than it was before, perhaps this was not the case at the time when it happened to Madam X. However, I think the NGO’S and the government agencies involved can increase the level of psychological support that is provided to these victims. Early intervention is necessary and victims need to have greater access to these NGO’S through 24 hr helpline etc,
Another issue which is briefly reflected through this case is that we are yet to understand the level of stigma and discrimination attached to mental illness in the Maldives. I also feel we have our own cultural interpretation or understanding of ‘mental illnesses. There is a need to do research in the area of mental health in the Maldives. There is a need to create awareness about mental illness in the Maldives.
Let’s have a look at master Y’s case.
How was he before the incident/s? He was a normal, happy boy.
Did something happen to him?
Yes. Sexual abuse, repeatedly. We also had to examine whether he suffered from psychotic symptoms as he could have been reporting these behaviours due to early onset of a psychotic illness.
What help did he receive? Early intervention in the form of psychotherapy and supportive work for family. He did not receive any medication at any point of time in treatment.
How did he cope after the intervention? He appears to be coping fairly well.
So what are the issues involved?
Luckily, our government and NGO’S are very active in this area now and there are several ‘rights’ organisations working at different levels to deal with this problem and all that’s really very welcoming.
Master Y’s case also highlights several important underlying social issues.
Why did the mother have to come to Male? Need for better education, better health, better life which she believed she can get only if she came to Male. This is a core issue.
She and her son had to live like domestic slaves in a jammed room. The child was made a forced partner in the sexual behaviours of irresponsible adults with whom they were forced to live with. Housing problem is the other core issue here.
The mother was a single parent who had no one to assist her financially or otherwise. What sort of help is offered to women in her position by the state? She had to leave her minor in such an environment and take up/ one / two jobs to get enough to eat and have a roof over her head. Poverty is the other issue here, lack of adequate support to women in her situation is a core issue here.
Further, due to the lack of mental health experts in the country (even I am still undergoing training and still have a long way to go…at least that’s what I believe) the interventions made in the country, often produces little result. We need properly trained experts who are specialised in this area to deal with problems such as this.
Let’s have a look at master P’s case.
Master P’s case is different from the previous two cases.
However, like in Master Y’s case I can see the colours of poverty and housing issues along with some more worrying phenomena.
As far as I believe they are in a way the street children of Maldives. They wake up to go to school, come back from school and live on the streets until nightfall and go back home only to sleep. They are exposed to the evils of the streets and have become street smart. Yet, they are children , minors, the “vultures’ can attack them at any time, they are easy prey. If we wish drug abuse to stop from spreading the way it is now, we have to nip things in the bud. We have to have programmes (not mere slogans to shout and t shirts to wear, ) to deal with these significant issues. For example, we have to take these kids off the streets, we have to help them have a family life, their mother to cook healthy meals, offer them tender loving care etc…so much more…!We have to address the bigger issues such as housing, overcrowding in Male', poverty,..etc stigma towards the mentally ill and those who return from drug rehabilitation, discrimination..etc etc....and unless this is done it will indeed be very difficult to see any quality in the average Maldivians life in decades to come.
How was she before the incident/s?
She was an apparently healthy, happy woman without any eccentric behaviours.
Did something happen to her?
Physical abuse, sexual abuse in other words, she was subjected to rape several times.
What help did she receive?
None. There was no one to offer her help.
How did she cope?
I don’t think she was able to cope with these incidents. She had to mimic ‘MAD’ behaviours as understood by the people of our society so that they will be so scared of her that people will not dare to come close to her….this was the only way she thought she could cope with.
So what are the issues involved?
There are several issues involved here. First, victims of rape, sexual abuse, incest, domestic violence, find it hard to come and report it to the concerned authorities. But we find that our law enforcement agencies and media are much more sensitive to these issues than it was before, perhaps this was not the case at the time when it happened to Madam X. However, I think the NGO’S and the government agencies involved can increase the level of psychological support that is provided to these victims. Early intervention is necessary and victims need to have greater access to these NGO’S through 24 hr helpline etc,
Another issue which is briefly reflected through this case is that we are yet to understand the level of stigma and discrimination attached to mental illness in the Maldives. I also feel we have our own cultural interpretation or understanding of ‘mental illnesses. There is a need to do research in the area of mental health in the Maldives. There is a need to create awareness about mental illness in the Maldives.
Let’s have a look at master Y’s case.
How was he before the incident/s? He was a normal, happy boy.
Did something happen to him?
Yes. Sexual abuse, repeatedly. We also had to examine whether he suffered from psychotic symptoms as he could have been reporting these behaviours due to early onset of a psychotic illness.
What help did he receive? Early intervention in the form of psychotherapy and supportive work for family. He did not receive any medication at any point of time in treatment.
How did he cope after the intervention? He appears to be coping fairly well.
So what are the issues involved?
Luckily, our government and NGO’S are very active in this area now and there are several ‘rights’ organisations working at different levels to deal with this problem and all that’s really very welcoming.
Master Y’s case also highlights several important underlying social issues.
Why did the mother have to come to Male? Need for better education, better health, better life which she believed she can get only if she came to Male. This is a core issue.
She and her son had to live like domestic slaves in a jammed room. The child was made a forced partner in the sexual behaviours of irresponsible adults with whom they were forced to live with. Housing problem is the other core issue here.
The mother was a single parent who had no one to assist her financially or otherwise. What sort of help is offered to women in her position by the state? She had to leave her minor in such an environment and take up/ one / two jobs to get enough to eat and have a roof over her head. Poverty is the other issue here, lack of adequate support to women in her situation is a core issue here.
Further, due to the lack of mental health experts in the country (even I am still undergoing training and still have a long way to go…at least that’s what I believe) the interventions made in the country, often produces little result. We need properly trained experts who are specialised in this area to deal with problems such as this.
Let’s have a look at master P’s case.
Master P’s case is different from the previous two cases.
However, like in Master Y’s case I can see the colours of poverty and housing issues along with some more worrying phenomena.
As far as I believe they are in a way the street children of Maldives. They wake up to go to school, come back from school and live on the streets until nightfall and go back home only to sleep. They are exposed to the evils of the streets and have become street smart. Yet, they are children , minors, the “vultures’ can attack them at any time, they are easy prey. If we wish drug abuse to stop from spreading the way it is now, we have to nip things in the bud. We have to have programmes (not mere slogans to shout and t shirts to wear, ) to deal with these significant issues. For example, we have to take these kids off the streets, we have to help them have a family life, their mother to cook healthy meals, offer them tender loving care etc…so much more…!We have to address the bigger issues such as housing, overcrowding in Male', poverty,..etc stigma towards the mentally ill and those who return from drug rehabilitation, discrimination..etc etc....and unless this is done it will indeed be very difficult to see any quality in the average Maldivians life in decades to come.
Saturday 20 December 2008
My Deviations from Professional Boundaries; The story of P
I had gone to a restaurant at artifical beach with my friend to have a quick snack and as we started eating a small boy,lets call him Master P, came towards us and asked me whether we could give him one Rufiyaa. This had never happened to me before and I was surprised and curious.
I think the staff saw the boy approaching as one of them started to gesture at the boy to move out. But before I could say anything , the boy said he was just very hungry and he wanted to go to the shop and buy something.
I felt uncomfortable to just offer him money but it was also not possible to eat in front of this small boy. I then realised that the boy kept looking at a particular direction so I followed his gaze and my eyes fell on three more little boys , aged around 9-10 years.
At this point I said, ' if you are hungry you can sit at this table , I will buy you something to eat'
But he shook his head and said, ' my friends want something to eat too', so I extended my invitation.
The waiter gave me a dirty look as he took the order.
What did they want? All four of them wanted 'chocolate milkshakes'
Meanwhile, I asked them why they were on the streets like this and why they were begging.
Master P, I guess who was the leader of the group spoke up.
He said, ' Mummy goes to work immediately after we come back from school and there was noone at home to give us any food' but hesitatingly he added,' not really, there is garudhiya and bai, everyday and we like to eat something different'
I asked whether they begged frequently like this.
Apparently begging was not frequent, but they spent most of their time loitering at artifical beach. I wanted to know more so I asked them about their families.
According to Master P, one of the other boys in the group was his brother and they lived in this single room. Mother had to earn money, so she had to go out frequently and she had said that they can eat and go out to play afterwards. The other boys had similar things to tell.
I asked them what people did when they approached them for money. Apparently, one of the boys who was now sitting very queitly had been taken to childrens unit because someone reported it.
As small as they were, they had their own views about this experience and the boy said,' we dont have a choice, we cant stay inside the house all the time, anyway mummy says to go out, so we are not doing anything wrong........'
I asked them how many hours per day they spent like this at the beach. ' atleast 7 to 8 hours' was the answer. And to my question on the type of experiences they have had,
' lot of other boys here knows us, even the big boys..but we are good even if they offer us cigarettes we don't use it, we just play around'
By now the milkshakes were brought and I watched as the boys gulped it down.
And while they were drinking it I saw this ghastly scar on Master P's upper arm.
I could not help but ask him what it was, he said reluctantly, ' my mother burnt me with the iron because one day I did not listen to her'
The moment they finished their milkshake they just wanted to run away and they did.
I was at a complete loss for what to do. I asked my friend to report about the boys to the concerned authorities.
Traumatised, hungry, neglected minors, vulnerable to the vultures who were selling drugs and other evils lurking at every street corner of Male'...
I felt angry with the parents, with the society and also with myself.
I knew what I had done here was wrong. Buying them a milkshake was not the thing to do. I did it becuase I could not take mine watching the thirst on their faces..and reporting to the units....was this a solution or a 'bolun nattaalun'???
I was not in a position to follow up on the boys either and now its nearly 4 years since that day, I still remember the look on Master P's face when he said ....he was hungry, I have frequently wondered about where they may be in life now....
Yes. We can spend thousands of Rufiyaa on shouting 'wake up' on the streets, we can conduct awareness programmes all over the country and politicians to win our votes say holding loud speakers ,' we will eradicate the drug problem in the country....'
I often feel like saying just this.
' bull'
(to continue...analysing the core issues underlying stories of XYP...will welcome your contributions..)
I think the staff saw the boy approaching as one of them started to gesture at the boy to move out. But before I could say anything , the boy said he was just very hungry and he wanted to go to the shop and buy something.
I felt uncomfortable to just offer him money but it was also not possible to eat in front of this small boy. I then realised that the boy kept looking at a particular direction so I followed his gaze and my eyes fell on three more little boys , aged around 9-10 years.
At this point I said, ' if you are hungry you can sit at this table , I will buy you something to eat'
But he shook his head and said, ' my friends want something to eat too', so I extended my invitation.
The waiter gave me a dirty look as he took the order.
What did they want? All four of them wanted 'chocolate milkshakes'
Meanwhile, I asked them why they were on the streets like this and why they were begging.
Master P, I guess who was the leader of the group spoke up.
He said, ' Mummy goes to work immediately after we come back from school and there was noone at home to give us any food' but hesitatingly he added,' not really, there is garudhiya and bai, everyday and we like to eat something different'
I asked whether they begged frequently like this.
Apparently begging was not frequent, but they spent most of their time loitering at artifical beach. I wanted to know more so I asked them about their families.
According to Master P, one of the other boys in the group was his brother and they lived in this single room. Mother had to earn money, so she had to go out frequently and she had said that they can eat and go out to play afterwards. The other boys had similar things to tell.
I asked them what people did when they approached them for money. Apparently, one of the boys who was now sitting very queitly had been taken to childrens unit because someone reported it.
As small as they were, they had their own views about this experience and the boy said,' we dont have a choice, we cant stay inside the house all the time, anyway mummy says to go out, so we are not doing anything wrong........'
I asked them how many hours per day they spent like this at the beach. ' atleast 7 to 8 hours' was the answer. And to my question on the type of experiences they have had,
' lot of other boys here knows us, even the big boys..but we are good even if they offer us cigarettes we don't use it, we just play around'
By now the milkshakes were brought and I watched as the boys gulped it down.
And while they were drinking it I saw this ghastly scar on Master P's upper arm.
I could not help but ask him what it was, he said reluctantly, ' my mother burnt me with the iron because one day I did not listen to her'
The moment they finished their milkshake they just wanted to run away and they did.
I was at a complete loss for what to do. I asked my friend to report about the boys to the concerned authorities.
Traumatised, hungry, neglected minors, vulnerable to the vultures who were selling drugs and other evils lurking at every street corner of Male'...
I felt angry with the parents, with the society and also with myself.
I knew what I had done here was wrong. Buying them a milkshake was not the thing to do. I did it becuase I could not take mine watching the thirst on their faces..and reporting to the units....was this a solution or a 'bolun nattaalun'???
I was not in a position to follow up on the boys either and now its nearly 4 years since that day, I still remember the look on Master P's face when he said ....he was hungry, I have frequently wondered about where they may be in life now....
Yes. We can spend thousands of Rufiyaa on shouting 'wake up' on the streets, we can conduct awareness programmes all over the country and politicians to win our votes say holding loud speakers ,' we will eradicate the drug problem in the country....'
I often feel like saying just this.
' bull'
(to continue...analysing the core issues underlying stories of XYP...will welcome your contributions..)
My Deviations from Professional Boundaries; The story of Y
Some people still believed in walking that extra mile for the sake of another. I would have never met Master Y, if not for such a person.
I remember the day she walked into my clinic and told me, that this particular boy needed my help, but she was not in a position to offer me any money in return for my time or work, and said that his family was too poor to afford my sessions. She requested her visit to remain confidential.
Well. Behind her was this extraordinarily calm chap, not bothered about the interactions between us.
She told me about the problems Master Y suffered, and knew that I had to offer my help.
I could not promise that he would overcome the problems that were being reported, but I told this girl, that I would work on him and she need not to be bothered about the fees.
He had been flushing fish from the fish tank down the commode, had killed a cat, been catching and killing lizards and rats. If confronted about these behaviours he would not reply and chose to remain silent and he also had difficulty with sleep.
It took me time to build rapport with him and soon I started psychological testing. He was cooperative and during the phase of testing he narrated on how this small boy was being given pain 'down there' by an uncle and had even watched when uncle and aunt did things in the same room (as this was a single room unit) , and also when mummy went to work, uncle even brought his friends and they all did this thing together. He told me this little boy cannot do anything, because they were grown ups, and when he went to sleep he dreamt they were going to come and do the same to him. He did not wish mummy to know.
I left him in the play area during this phase with stuffed toys and he would meticulously tear the animals from the underside and re- stuff the same thing and put it back in the same spot. He would get so abosrbed in the task that he would be unaware of my presence.
My impression, as you may have all guessed by now was that this boy was living in an environment of continuous sexual abuse.
I was left with the task of informing the mother, who appeared to be the only support this boy had. In the presence of the lady who introduced me to Master Y, I narrated this to the mother, who did not wish the extended family to be harmed because of them, and in a way they survived under the mercy of these people. We emphasized the importance of reporting the incident to the necessary authorities and also the need to give her son a safe environment.
The mother was a teary eyed middle aged single woman, who was just literate and had moved to Male’ in the hope of giving her son a better life. She sobbed and broke down saying she just did not have enough money, that she loved her son dearly and would do anything to help him. She told us, that she worked as a ‘massakathu meeha’ and after she returned home she did the household chores for these people.
After much time and talk, she decided to move to another place and she also took a second job. Prior to making this decision, she spied on these people and was able to confirm the going ons.....but she chose not to inform the authorities, despite our repeated advise to do so.
I held my sessions with Master Y, phased at different levels over a long period.
He began to sleep well, he was studying well, he was behaving well, he was taking care of plants and now preferred to repair broken stuff instead.
That's when I had to close the clinic and leave the country.
I had visited Male’ last year and as I stood on Fareedhee Magu, I saw a lady hurrying towards me. Before I knew what was happening she was hugging me, sobbing, wiping her tears and saying,' thank you….my son is now earning, he has done a vocational training course and is earning enough to take care of both of us’
The lady was caressing my face, totally unaware that we were in the middle of the road and all she could say was thank you repeatedly.
But my mind was somewhere else; I felt someone else deserved this gratitude, someone who dared to approach another professional without feeling ashamed for requesting help despite possible disapproval from colleagues.
I will at this point admit that I needed supervision to handle Master Y and it took me at least 3 trips to my mentors in India to present his case and receive further inputs to continue therapy. There was no one in Maldives who could offer me such help.
Collaboration and teamwork among the few people who work in this field in our country is still very rare, and often even taking supervision or feedback from another is considered to be a failure and a 'not to be done thing'.
Note; I have been given permission by the concerned people to share these experiences.
I remember the day she walked into my clinic and told me, that this particular boy needed my help, but she was not in a position to offer me any money in return for my time or work, and said that his family was too poor to afford my sessions. She requested her visit to remain confidential.
Well. Behind her was this extraordinarily calm chap, not bothered about the interactions between us.
She told me about the problems Master Y suffered, and knew that I had to offer my help.
I could not promise that he would overcome the problems that were being reported, but I told this girl, that I would work on him and she need not to be bothered about the fees.
He had been flushing fish from the fish tank down the commode, had killed a cat, been catching and killing lizards and rats. If confronted about these behaviours he would not reply and chose to remain silent and he also had difficulty with sleep.
It took me time to build rapport with him and soon I started psychological testing. He was cooperative and during the phase of testing he narrated on how this small boy was being given pain 'down there' by an uncle and had even watched when uncle and aunt did things in the same room (as this was a single room unit) , and also when mummy went to work, uncle even brought his friends and they all did this thing together. He told me this little boy cannot do anything, because they were grown ups, and when he went to sleep he dreamt they were going to come and do the same to him. He did not wish mummy to know.
I left him in the play area during this phase with stuffed toys and he would meticulously tear the animals from the underside and re- stuff the same thing and put it back in the same spot. He would get so abosrbed in the task that he would be unaware of my presence.
My impression, as you may have all guessed by now was that this boy was living in an environment of continuous sexual abuse.
I was left with the task of informing the mother, who appeared to be the only support this boy had. In the presence of the lady who introduced me to Master Y, I narrated this to the mother, who did not wish the extended family to be harmed because of them, and in a way they survived under the mercy of these people. We emphasized the importance of reporting the incident to the necessary authorities and also the need to give her son a safe environment.
The mother was a teary eyed middle aged single woman, who was just literate and had moved to Male’ in the hope of giving her son a better life. She sobbed and broke down saying she just did not have enough money, that she loved her son dearly and would do anything to help him. She told us, that she worked as a ‘massakathu meeha’ and after she returned home she did the household chores for these people.
After much time and talk, she decided to move to another place and she also took a second job. Prior to making this decision, she spied on these people and was able to confirm the going ons.....but she chose not to inform the authorities, despite our repeated advise to do so.
I held my sessions with Master Y, phased at different levels over a long period.
He began to sleep well, he was studying well, he was behaving well, he was taking care of plants and now preferred to repair broken stuff instead.
That's when I had to close the clinic and leave the country.
I had visited Male’ last year and as I stood on Fareedhee Magu, I saw a lady hurrying towards me. Before I knew what was happening she was hugging me, sobbing, wiping her tears and saying,' thank you….my son is now earning, he has done a vocational training course and is earning enough to take care of both of us’
The lady was caressing my face, totally unaware that we were in the middle of the road and all she could say was thank you repeatedly.
But my mind was somewhere else; I felt someone else deserved this gratitude, someone who dared to approach another professional without feeling ashamed for requesting help despite possible disapproval from colleagues.
I will at this point admit that I needed supervision to handle Master Y and it took me at least 3 trips to my mentors in India to present his case and receive further inputs to continue therapy. There was no one in Maldives who could offer me such help.
Collaboration and teamwork among the few people who work in this field in our country is still very rare, and often even taking supervision or feedback from another is considered to be a failure and a 'not to be done thing'.
Note; I have been given permission by the concerned people to share these experiences.
Friday 19 December 2008
My deviations from professional boundaries; the stories of XYP
I have always wondered since childhood, why a particular lady, let us call her lady X at this instance, known to me and you created such fear in me. Her appearance on the lane would often freeze me and if anyone, said her name she would respond with fear inducing gestures.
With a qualification in my pocket which gave me the right to diagnose mental illness, I wanted to diagnose her and of course was intent on helping her to change.
But this was all in the back of my mind, and did not trigger until I saw her near henveyru boalhadhandhu one fine day.
I now knew which ever mental illness she suffered from, there was no need to have any fear, people with mental illness were just very vulnerable people who needed our helping hands.
So I began to follow her around the boalhadhandhu and soon she realised this, and started calling me names and gesturing at me. But I walked behind her with a smile on my face, and she started to run. Well, I think that was one of the most hilarious moments of my life. My secretary who was watching this said afterwards,' that was just so funny’. Well, I ran behind her (and we both ran for some time ) until I finally caught up with her and said,
‘I just wish to talk to you, would it be possible for you to walk up with me to the place I work?’
She looked at me rather suspiciously and said;' are you not afraid of me?’.
Well, I replied, ‘not at all, and infact would like to be your friend’
Perhaps she has never been in a situation like this and did not know what to do, so just walked with me to my clinic.
When I entered, I offered her one of the big relaxing chairs to sit immediately she looked at me and said,
‘I cannot sit on a nice looking chair like that, if I did sit on it then noone else can sit on it, I have never sat on a nice chair like that’
I shook my head and said, ‘but that is where I think you should sit’
She sat down and began to feel the chair. I gave her time to enjoy this moment and once she settled down I began to communicate with her. I explained that I worked with the so called people with mental illness, and I would like to ask her a some questions.
I was shocked with her response. Her eyes immediately became filled with tears and asked me whether she could say a thing or two first. She told me that in her case being mad was a mechanism for survival. And then she told me tragic tales of her life, stories of limitless levels of abuse and explained to me that this behaviour of hers was based on a need for her to protect herself from further abuse, now she terrorise others before others could, and gradually all this has become a habit and this was her identity now and she no longer wished to come out of this state.
At that moment I realised that she did not suffer from any mental illness, she was one of the most intelligent and sane women I have ever met and there was nothing I could do to help her.
She smiled at me and said, she would leave now, but she was so happy that someone at least bothered to treat her like a human being and listened to her story. Perhaps she wanted me to tell the world about her life, she shook hands with me and said, she will never repeat this story, the real story to anyone. It was far too late for her to change now.
I watched her walk away. I had a heavy heart as I thought about the high prevalence rate of abuse of all forms in our society.
I felt very guilty, for having had a secure and protected life, felt guilty that I too had called her names, once upon a time and knew people will never know this side of her....and the sadest thing was there was absolutely nothing I could do to help her
(to continue..story Y)
With a qualification in my pocket which gave me the right to diagnose mental illness, I wanted to diagnose her and of course was intent on helping her to change.
But this was all in the back of my mind, and did not trigger until I saw her near henveyru boalhadhandhu one fine day.
I now knew which ever mental illness she suffered from, there was no need to have any fear, people with mental illness were just very vulnerable people who needed our helping hands.
So I began to follow her around the boalhadhandhu and soon she realised this, and started calling me names and gesturing at me. But I walked behind her with a smile on my face, and she started to run. Well, I think that was one of the most hilarious moments of my life. My secretary who was watching this said afterwards,' that was just so funny’. Well, I ran behind her (and we both ran for some time ) until I finally caught up with her and said,
‘I just wish to talk to you, would it be possible for you to walk up with me to the place I work?’
She looked at me rather suspiciously and said;' are you not afraid of me?’.
Well, I replied, ‘not at all, and infact would like to be your friend’
Perhaps she has never been in a situation like this and did not know what to do, so just walked with me to my clinic.
When I entered, I offered her one of the big relaxing chairs to sit immediately she looked at me and said,
‘I cannot sit on a nice looking chair like that, if I did sit on it then noone else can sit on it, I have never sat on a nice chair like that’
I shook my head and said, ‘but that is where I think you should sit’
She sat down and began to feel the chair. I gave her time to enjoy this moment and once she settled down I began to communicate with her. I explained that I worked with the so called people with mental illness, and I would like to ask her a some questions.
I was shocked with her response. Her eyes immediately became filled with tears and asked me whether she could say a thing or two first. She told me that in her case being mad was a mechanism for survival. And then she told me tragic tales of her life, stories of limitless levels of abuse and explained to me that this behaviour of hers was based on a need for her to protect herself from further abuse, now she terrorise others before others could, and gradually all this has become a habit and this was her identity now and she no longer wished to come out of this state.
At that moment I realised that she did not suffer from any mental illness, she was one of the most intelligent and sane women I have ever met and there was nothing I could do to help her.
She smiled at me and said, she would leave now, but she was so happy that someone at least bothered to treat her like a human being and listened to her story. Perhaps she wanted me to tell the world about her life, she shook hands with me and said, she will never repeat this story, the real story to anyone. It was far too late for her to change now.
I watched her walk away. I had a heavy heart as I thought about the high prevalence rate of abuse of all forms in our society.
I felt very guilty, for having had a secure and protected life, felt guilty that I too had called her names, once upon a time and knew people will never know this side of her....and the sadest thing was there was absolutely nothing I could do to help her
(to continue..story Y)
Thursday 18 December 2008
There is music in the words,'...they are our own too!!'
I read a newspaper article in which the president has said some very forceful statements in reference to the current issues related to the release of prisoners on parole/family visits. The messages that I get from his words are that he considers that those in the prison and those released for family visits are 'our own people', and that he is determined to see them as rehabilitated and responsible individuals of the society, before the end of five years.
I think , this stand he has taken, so explicitly stated amidst criticism of the release of these prisoners from various authorities , reflects great courage and determination to see to the rehabilitation of these individuals. The task he has taken is very challenging, full of great obstacles and cannot be met with ease.
When we quote that more than 80% of our prison population are drug addicts, who probably are young male adults, we are talking about a huge group of people who are in need of treatment and rehabilitation and causing a huge burden on the country. While we must acknowledge that there is a lack of proper prison based rehabilitation , or community based rehabilitation in the country, and that our human resources to deal appropriately with this situation is grossly inadequate, can we afford to turn a blind eye and allow the prisons to bursts at its hem with people who have the chance of becoming better , who can with the support of appropriate resources, become good and great citizens of the country?
I think all Maldivians want to see this happen, but somewhere cannot really believe that these people can become better. And we are afraid that these people will cause more chaos in our lives and in our society once again.
To allow a paradigm shift in the minds of all of us, in relation to this is one of the greatest challenges ahead of us, this is about thinking out of the matrix, this is about bringing about a change in our belief system, this is about hope that those on whom we have given up hope, may still find light at the end of the tunnel. This is about seing beyond the labels stamped on their forehead..' addict...criminal...prisoner...bad person...threat....etc' and allowing them to feel ' they are our own' and giving them atleast this one last chance.
If my son (and they are all our sons...) was in the prison, at this moment I will thank god that he may get a second chance for a normal life and offer him all the support I can to make him a better person. And that will be the greatest contribution I, as an individual can make to participate in the process of change. Just imagine the magnitude of difference we can make, if we as a community unite and offer what ever support we can to make an impact on the lives of these people. At the moment , for many of us, it is perhaps difficult to even imagine this possibility.
However, it appears to me that we are in the midst of a sort of reconciliation process, we have never seen before in this country. This is something in which we can all play a positive role to make a difference.
I admit, this entire effort requires careful strategising , because this will not be a goal that will be easy to achieve but it is also ' not something impossible'. It is left for us to rise above the level of positive criticism we have indulged in so far and do something constructive by making the difficult and different decision, however challenging it may be.
I think , this stand he has taken, so explicitly stated amidst criticism of the release of these prisoners from various authorities , reflects great courage and determination to see to the rehabilitation of these individuals. The task he has taken is very challenging, full of great obstacles and cannot be met with ease.
When we quote that more than 80% of our prison population are drug addicts, who probably are young male adults, we are talking about a huge group of people who are in need of treatment and rehabilitation and causing a huge burden on the country. While we must acknowledge that there is a lack of proper prison based rehabilitation , or community based rehabilitation in the country, and that our human resources to deal appropriately with this situation is grossly inadequate, can we afford to turn a blind eye and allow the prisons to bursts at its hem with people who have the chance of becoming better , who can with the support of appropriate resources, become good and great citizens of the country?
I think all Maldivians want to see this happen, but somewhere cannot really believe that these people can become better. And we are afraid that these people will cause more chaos in our lives and in our society once again.
To allow a paradigm shift in the minds of all of us, in relation to this is one of the greatest challenges ahead of us, this is about thinking out of the matrix, this is about bringing about a change in our belief system, this is about hope that those on whom we have given up hope, may still find light at the end of the tunnel. This is about seing beyond the labels stamped on their forehead..' addict...criminal...prisoner...bad person...threat....etc' and allowing them to feel ' they are our own' and giving them atleast this one last chance.
If my son (and they are all our sons...) was in the prison, at this moment I will thank god that he may get a second chance for a normal life and offer him all the support I can to make him a better person. And that will be the greatest contribution I, as an individual can make to participate in the process of change. Just imagine the magnitude of difference we can make, if we as a community unite and offer what ever support we can to make an impact on the lives of these people. At the moment , for many of us, it is perhaps difficult to even imagine this possibility.
However, it appears to me that we are in the midst of a sort of reconciliation process, we have never seen before in this country. This is something in which we can all play a positive role to make a difference.
I admit, this entire effort requires careful strategising , because this will not be a goal that will be easy to achieve but it is also ' not something impossible'. It is left for us to rise above the level of positive criticism we have indulged in so far and do something constructive by making the difficult and different decision, however challenging it may be.
Wednesday 17 December 2008
Preventing substance abuse: A handbook for parents
I wrote this book in 2004, with the hope of publishing it to distribute it freely to anyone who may want it. However, I could not find anyone who would fund it at that time but fortunately, some of the chapters were edited and printed by Dharuma magazine between 2007-2008.
I am attaching those links with the hope that some one may wish to read this or find some useful information in here. Feel free to download and distribute to anyone whom you think may benefit.
Chapter1) http://www.dharuma.net/articles/jul2007naz1.pdf
Chapter 2) http://www.dharuma.net/articles/aug2007naz1.pdf
Chapter 3) http://www.dharuma.net/articles/sep2007naz1.pdf
Chapter 4) http://www.dharuma.net/articles/oct2007naz1.pdf
Chapter 5) http://www.dharuma.net/articles/nov2007naz1.pdf
Chapter 6) http://www.dharuma.net/articles/dec2007naz1.pdf
Chapter 7) http://www.dharuma.net/articles/jan2008naz1.pdf
Chapter 8) http://www.dharuma.net/articles/feb2008naz1.pdf
Chapter 9) http://www.dharuma.net/articles/mar2008naz1.pdf
Tuesday 16 December 2008
Post release management for offenders in Maldives : Challenges 2
Recent release of a number of prisoners for family visits has created some interesting headlines in the media and it has also brought to limelight some very covert loopholes that can play havoc to the post release management programme of offenders.
I will list some of the bits of news which I found rather fascinating.
1. News which stated that some families were requesting the police to take their family members back to the prison.
This bit of news shows that the families were perhaps in no way consulted or prepared under any programme to receive the prisoners and would rather have their family member in the prison than back in their homes. For me this is a very critical bit of information, which triggers an alarm in my mind. It informs that any post release management of offenders must make family preparation, building family support to accept the family member back into the family a priority and if this issue is not tackled properly the post release management programme can suffer in a similar way as did the community rehabilitation of drug addicts in the Maldives. We must make family counselling a priority and get a professional with training in family counselling to lead this programme. Family counselling or family therapy is one of the most challenging forms of psychological interventions and those who do so must be adequately educated in psychological theories and therapy with specialised focus on family counselling or in family therapy. If we do not have Maldivians with such training we must get expatriates and not hand over already dysfunctional and distressed families to amateurs.
2. News that a number of those who were released for family visits were already rearrested for re offending.
This is obviously interesting because their actions reveal that these people were not yet ready for parole at all. They have not gone through adequate or possibly any form of rehabilitation within the prison and were just not ready to join the community, just as yet. Therefore, I am sure the members of the parole board who understands all this would be screening these aspects in their interviews before parole is really granted and they are released to a post release management programme.
Just to decrease the number of prisoners in the prison we cannot shift people who have offended back to the community without preparing them to join the community, if they are they will definitely reoffend as has happened.
3. Demonstrating to the general public the degree of transparency that is possible in the current government and also the level of understanding, cooperation and communication between the parole board and the senior officials who were responsible for the release of these prisoners for the family visit.
I think it is a wonderful thing that the parole board chairman can go the media and say, they were not consulted prior to the release of these prisoners for family visits. It appears that the release of all these prisoners was more of an attempt by politicians to try and calm prison strikes. Another interesting bit of news is the police stating that they will not be held responsible if these people commit crime again.
It sure shows we are in a real democracy now, however, I think all this has only given an advantage to one group of individuals. The prisoners have understood these conflicts and I will not be surprised if they become the beneficiaries of this entire dispute. Now will they listen to the parole board if they say after the interviews that they do not qualify for parole and go back to prison? Or will they put up another strike? Hmmm
I will list some of the bits of news which I found rather fascinating.
1. News which stated that some families were requesting the police to take their family members back to the prison.
This bit of news shows that the families were perhaps in no way consulted or prepared under any programme to receive the prisoners and would rather have their family member in the prison than back in their homes. For me this is a very critical bit of information, which triggers an alarm in my mind. It informs that any post release management of offenders must make family preparation, building family support to accept the family member back into the family a priority and if this issue is not tackled properly the post release management programme can suffer in a similar way as did the community rehabilitation of drug addicts in the Maldives. We must make family counselling a priority and get a professional with training in family counselling to lead this programme. Family counselling or family therapy is one of the most challenging forms of psychological interventions and those who do so must be adequately educated in psychological theories and therapy with specialised focus on family counselling or in family therapy. If we do not have Maldivians with such training we must get expatriates and not hand over already dysfunctional and distressed families to amateurs.
2. News that a number of those who were released for family visits were already rearrested for re offending.
This is obviously interesting because their actions reveal that these people were not yet ready for parole at all. They have not gone through adequate or possibly any form of rehabilitation within the prison and were just not ready to join the community, just as yet. Therefore, I am sure the members of the parole board who understands all this would be screening these aspects in their interviews before parole is really granted and they are released to a post release management programme.
Just to decrease the number of prisoners in the prison we cannot shift people who have offended back to the community without preparing them to join the community, if they are they will definitely reoffend as has happened.
3. Demonstrating to the general public the degree of transparency that is possible in the current government and also the level of understanding, cooperation and communication between the parole board and the senior officials who were responsible for the release of these prisoners for the family visit.
I think it is a wonderful thing that the parole board chairman can go the media and say, they were not consulted prior to the release of these prisoners for family visits. It appears that the release of all these prisoners was more of an attempt by politicians to try and calm prison strikes. Another interesting bit of news is the police stating that they will not be held responsible if these people commit crime again.
It sure shows we are in a real democracy now, however, I think all this has only given an advantage to one group of individuals. The prisoners have understood these conflicts and I will not be surprised if they become the beneficiaries of this entire dispute. Now will they listen to the parole board if they say after the interviews that they do not qualify for parole and go back to prison? Or will they put up another strike? Hmmm
Monday 15 December 2008
I am not thrilled with the offer of 100 beds in India for drug rehabilitation of Maldivians
Yes. I don't feel thrilled at all. But instead a certain sense of loss and gloom is all I am feeling about this bit of news communicated by the state Minister.
Why?
I will just give a scenario to visualise .
100 Maldivians, in rehab centres in Mumbai, Bangalore, Trivandrum, Cochin, Madras...etc. In different parts of India, in rehabilitation centres along with Indians. Maldivian named X, Y, Z..... in these rehabs are getting exposed to the new drug subcultures, drug worlds of this country, through the friendships they will form in these rehabs...a whole new world of.....xxxxxxxxx ...will be exposed to our addicts, to import back to our country. Perhaps, their connection with the drug world, will find contacts in our country, to infilter...spread....this malice to NEW HEIGHTS...which we definitely did not reach in the past many years and we definitely don't wish to go to now!!!
I lived in India for 12 years, and I have a deep respect for this country as this is also the place where I acquired knowledge and experience. I have worked in the deaddiction centre of NIMHANS and have done voluntary work for years in rehabilitation centres across Bangalore and I am aware of the inside functioning of these places.
And based on all this , I strongly discourage sending 100 patients to rehab centres across India, but instead we must tap on their human resources, request India to make a 100 bed rehab centre in Maldives based on their successful treatment models and fund it in the same way the government of India funds its private rehabilitation centres.
If we do this, we have much to gain, in the long run we will have a new model of drug rehabilitation operating in the country to compete with the existing one, and we will have the benefit of having a facility that can offer treatment that is culturally sensitive and of long term benefit for the country. We must at this point also realise the multifaceted nature of drug rehabilitation itself, that it requires the involvement of family members, other supportive networks and also consider the duration of treatment each person will require..etc.
As a first step I recommend that we request India to send a mental health team with drug treatment expertise to develop a comprehensive prison based short term and long term rehabilitation model for incarcerated offenders and request them to send trained staff to staff feydhu finolhu rehab centre. The same way they managed IGMH...perhaps this is the moment to think out of the matrix and take a confident step which will benefit our country .
I think, we must not allow politicians or any one to that matter to take us from out of frying pan into a fire situation. We can do much better, and must not behave like monkeys rushing towards the peanuts that have been thrown at us, but instead request for something more concrete and beneficial for the country!!!
(To understand the Maldivian drug scenario read:http://www.mv.undp.org/Images/drug.pdf )
Why?
I will just give a scenario to visualise .
100 Maldivians, in rehab centres in Mumbai, Bangalore, Trivandrum, Cochin, Madras...etc. In different parts of India, in rehabilitation centres along with Indians. Maldivian named X, Y, Z..... in these rehabs are getting exposed to the new drug subcultures, drug worlds of this country, through the friendships they will form in these rehabs...a whole new world of.....xxxxxxxxx ...will be exposed to our addicts, to import back to our country. Perhaps, their connection with the drug world, will find contacts in our country, to infilter...spread....this malice to NEW HEIGHTS...which we definitely did not reach in the past many years and we definitely don't wish to go to now!!!
I lived in India for 12 years, and I have a deep respect for this country as this is also the place where I acquired knowledge and experience. I have worked in the deaddiction centre of NIMHANS and have done voluntary work for years in rehabilitation centres across Bangalore and I am aware of the inside functioning of these places.
And based on all this , I strongly discourage sending 100 patients to rehab centres across India, but instead we must tap on their human resources, request India to make a 100 bed rehab centre in Maldives based on their successful treatment models and fund it in the same way the government of India funds its private rehabilitation centres.
If we do this, we have much to gain, in the long run we will have a new model of drug rehabilitation operating in the country to compete with the existing one, and we will have the benefit of having a facility that can offer treatment that is culturally sensitive and of long term benefit for the country. We must at this point also realise the multifaceted nature of drug rehabilitation itself, that it requires the involvement of family members, other supportive networks and also consider the duration of treatment each person will require..etc.
As a first step I recommend that we request India to send a mental health team with drug treatment expertise to develop a comprehensive prison based short term and long term rehabilitation model for incarcerated offenders and request them to send trained staff to staff feydhu finolhu rehab centre. The same way they managed IGMH...perhaps this is the moment to think out of the matrix and take a confident step which will benefit our country .
I think, we must not allow politicians or any one to that matter to take us from out of frying pan into a fire situation. We can do much better, and must not behave like monkeys rushing towards the peanuts that have been thrown at us, but instead request for something more concrete and beneficial for the country!!!
(To understand the Maldivian drug scenario read:http://www.mv.undp.org/Images/drug.pdf )
Sunday 14 December 2008
The group of boys who broke the lock of my clinic door
I ran a small mental health clinic in a small corner of Male' between the period 2000-2005. One evening when I went to open the clinic I saw that the lock was smashed, but it was not completely broken. I looked around and saw about 11 boys standing a few metres from me and giggling at me.I smiled back at them .
It took me some time to get someone to come and replace the lock for me. The same thing happened the next day, and the next. On the fourth day , I was pretty sure about who was responsible for this so I went prepared. When I saw the lock, I just sat on the pavement, near the door and looked at the group of boys and smiled again. An hour passed, two hours passed, the boys meanwhile had stopped smiling and appeared anxious. I then walked up to them and said that I had a problem as someone was breaking my lock every day and the man who repairs it for me was not available and I had to see a really ill person within the next hour, I needed their help. As I spoke , all of them surrounded me eager to find out what I had to say. I asked them if anyone of them knew to break a lock , whether any one of them had the tools to break upon the lock so I could atleast open the door, I told them they were my last help. They looked at me as though I was crazy, but seing my helplessness one of the boys replied he knew how to break a lock but not to fix it. I said no problem , they can help me to break the lock. So they came with me upto the door and smashed the lock completely and well, I could open the door and enter. When I thanked them, none of them wanted to go away and instead were all standing near the door. So,I opened the door widely and told them to come inside and have a look at the place. These 13 to 15 year olds were surprised to see the big shelf of nearly a thousand books, my consultancy room full of toys, relaxing chair and other 'stupid things' inside.I took them around and told them what I did with them , what sort of work I did here , showed them what I had, the only valuable thing perhaps was the stetchoscope used by the psychiatrist who practiced in the same place.
I then told them that they were welcome to come inside if I was free. I also asked them what they did. They told me they were bad boys, they smoke and did other such bad things, they were suspended from school, they all had a wicked tale to tell, of how bad they were. I listened carefully and said, for me they were good boys because they helped me to get into my clinic. It was then that one of them said;' No one can ever touch your lock now, dont worry about that from now onwards'. And true to their word, nothing ever happened to the lock again, but something started to happen to that group. I realised that they looked forward to the times when I would be free and when I open the door. So I deliberately started to keep an hour aside to chat with them.
I will buy them coke, ask them to come inside and talk to me about themselves, about their dreams, about their future, about their parents hopes for them, about what they felt about the society at large, about crime in general, about the idea of using drugs, about being in jail, about having choices in life, about the freedoms we had to make these choices..about believing in self, in god...etc. They will sit and share with me...things probably they never thought anyone would ever ask....specially their dreams for themselves. I would ask them focussing on each person, what they were doing now to achieve their dreams and if they did not have any I will ask them to ask god to give them a dream that night which they could come back and share with me. Many times, they would say noone ever had any hopes for them, they were without a future, but I will ask the rest of the group to respond to that and fade out. Within days, all of them stopped smoking, and gradually one by one, took admission in private schools or started to talk to their parents about the possibilities of going back to school. Six months after...I never saw them in that corner. But....they will drop in to tell me....that they were doing something now to achieve their dreams. Today, I dont remember their names, but I do remember the faces and know....they are on their way to achieve those dreams..
BUT ...................as I look at the picture of the boy who is the suspected murderer of the last stab victim in Male', I wondered, if he was in that group....what would he have told me....what would have been his dream ??? Would he perhaps...have turned out differently? But unfortunately, I will never know...and now .it may be very late for him..
BUT..again..I will ask the reader to do a small task, take your eyes off the desktop and look out of your own windows and see those chaps who are loitering aimlessly?? Perhaps its not too late for them, perhaps it is you who will make the difference...to that person....perhaps?
It took me some time to get someone to come and replace the lock for me. The same thing happened the next day, and the next. On the fourth day , I was pretty sure about who was responsible for this so I went prepared. When I saw the lock, I just sat on the pavement, near the door and looked at the group of boys and smiled again. An hour passed, two hours passed, the boys meanwhile had stopped smiling and appeared anxious. I then walked up to them and said that I had a problem as someone was breaking my lock every day and the man who repairs it for me was not available and I had to see a really ill person within the next hour, I needed their help. As I spoke , all of them surrounded me eager to find out what I had to say. I asked them if anyone of them knew to break a lock , whether any one of them had the tools to break upon the lock so I could atleast open the door, I told them they were my last help. They looked at me as though I was crazy, but seing my helplessness one of the boys replied he knew how to break a lock but not to fix it. I said no problem , they can help me to break the lock. So they came with me upto the door and smashed the lock completely and well, I could open the door and enter. When I thanked them, none of them wanted to go away and instead were all standing near the door. So,I opened the door widely and told them to come inside and have a look at the place. These 13 to 15 year olds were surprised to see the big shelf of nearly a thousand books, my consultancy room full of toys, relaxing chair and other 'stupid things' inside.I took them around and told them what I did with them , what sort of work I did here , showed them what I had, the only valuable thing perhaps was the stetchoscope used by the psychiatrist who practiced in the same place.
I then told them that they were welcome to come inside if I was free. I also asked them what they did. They told me they were bad boys, they smoke and did other such bad things, they were suspended from school, they all had a wicked tale to tell, of how bad they were. I listened carefully and said, for me they were good boys because they helped me to get into my clinic. It was then that one of them said;' No one can ever touch your lock now, dont worry about that from now onwards'. And true to their word, nothing ever happened to the lock again, but something started to happen to that group. I realised that they looked forward to the times when I would be free and when I open the door. So I deliberately started to keep an hour aside to chat with them.
I will buy them coke, ask them to come inside and talk to me about themselves, about their dreams, about their future, about their parents hopes for them, about what they felt about the society at large, about crime in general, about the idea of using drugs, about being in jail, about having choices in life, about the freedoms we had to make these choices..about believing in self, in god...etc. They will sit and share with me...things probably they never thought anyone would ever ask....specially their dreams for themselves. I would ask them focussing on each person, what they were doing now to achieve their dreams and if they did not have any I will ask them to ask god to give them a dream that night which they could come back and share with me. Many times, they would say noone ever had any hopes for them, they were without a future, but I will ask the rest of the group to respond to that and fade out. Within days, all of them stopped smoking, and gradually one by one, took admission in private schools or started to talk to their parents about the possibilities of going back to school. Six months after...I never saw them in that corner. But....they will drop in to tell me....that they were doing something now to achieve their dreams. Today, I dont remember their names, but I do remember the faces and know....they are on their way to achieve those dreams..
BUT ...................as I look at the picture of the boy who is the suspected murderer of the last stab victim in Male', I wondered, if he was in that group....what would he have told me....what would have been his dream ??? Would he perhaps...have turned out differently? But unfortunately, I will never know...and now .it may be very late for him..
BUT..again..I will ask the reader to do a small task, take your eyes off the desktop and look out of your own windows and see those chaps who are loitering aimlessly?? Perhaps its not too late for them, perhaps it is you who will make the difference...to that person....perhaps?
Saturday 13 December 2008
Maldives: A country crying out for a mental health legislature, plan and program
Did you know the following facts about the Maldivian mental health scenario?
There is a dearth of epidemiological data on mental illness in the Maldives as the mental health system of the country has largely been neglected and the only internationally available literature is in the WHO-AIMS report on mental health system in the Maldives, (WHO-AIMS, 2006). According to this report in the year of data collection, 1275.73 users per 100,000 population was treated in the only available outpatient facility in the country and out of this sample, 40 % were diagnosed with neurotic illness, 17% with mood disorder, 2 % with personality disorder, 8% with schizophrenia, 8 % with substance abuse disorder, 25 % of the diagnoses was specified only as “others”. According to this report, the percentage of prisoners with psychosis is 2 % and ‘prison has at least one prisoner per month in treatment contact with a mental health professional’ (WHO-AIMS, 2006).
Have a look at the mental health resources of Maldives
Mental health policy -----------------No
Substance abuse policy--------------Yes
National mental health program------No
Mental health legislation-------------No
National mental health budget--------No
Disability benefits-------------------Yes
NGO involvement-------------------Yes
Beds (per 10,000)-------------------0
Beds in mental hospitals-------------0
Beds in general hospitals-------------0
Beds (Others)------------------------0
Psychiatrists (per 100,000)---------0.36
Neurosurgeons----------------------0.36
Psychiatric nurse---------------------0
Neurologists--------------------------0
Psychologists-------------------------1.2
Social workers-------------------------0
Source: WHO, Mental Health Atlas, 2005
Maldives is a country burdened with mental health problems but it is ill equipped to deal with the problems it has. Every day, there are news reports of problems which directly reflect the neglected status of mental health issues of our country . But few people , if at all even connect problems such as increasing incidence of substance abuse and violence, juvenile delinquency, learning disabilities subsequent school refusals, school truancy, anti-social behaviours etc as mental health problems that require specific types of early interventions along with other programs.
It is definitely time for us to proactively deal with the multitude of issues which our country is faced with, specially in the field of mental health which is little understood by the people of our country.
There is a dearth of epidemiological data on mental illness in the Maldives as the mental health system of the country has largely been neglected and the only internationally available literature is in the WHO-AIMS report on mental health system in the Maldives, (WHO-AIMS, 2006). According to this report in the year of data collection, 1275.73 users per 100,000 population was treated in the only available outpatient facility in the country and out of this sample, 40 % were diagnosed with neurotic illness, 17% with mood disorder, 2 % with personality disorder, 8% with schizophrenia, 8 % with substance abuse disorder, 25 % of the diagnoses was specified only as “others”. According to this report, the percentage of prisoners with psychosis is 2 % and ‘prison has at least one prisoner per month in treatment contact with a mental health professional’ (WHO-AIMS, 2006).
Have a look at the mental health resources of Maldives
Mental health policy -----------------No
Substance abuse policy--------------Yes
National mental health program------No
Mental health legislation-------------No
National mental health budget--------No
Disability benefits-------------------Yes
NGO involvement-------------------Yes
Beds (per 10,000)-------------------0
Beds in mental hospitals-------------0
Beds in general hospitals-------------0
Beds (Others)------------------------0
Psychiatrists (per 100,000)---------0.36
Neurosurgeons----------------------0.36
Psychiatric nurse---------------------0
Neurologists--------------------------0
Psychologists-------------------------1.2
Social workers-------------------------0
Source: WHO, Mental Health Atlas, 2005
Maldives is a country burdened with mental health problems but it is ill equipped to deal with the problems it has. Every day, there are news reports of problems which directly reflect the neglected status of mental health issues of our country . But few people , if at all even connect problems such as increasing incidence of substance abuse and violence, juvenile delinquency, learning disabilities subsequent school refusals, school truancy, anti-social behaviours etc as mental health problems that require specific types of early interventions along with other programs.
It is definitely time for us to proactively deal with the multitude of issues which our country is faced with, specially in the field of mental health which is little understood by the people of our country.
Friday 12 December 2008
Combating drug abuse in the Maldives;Challenges -1
During the last campaign, every candidate, made deep and high impact statements on how they would make a difference to our existing drug problem. I am sure, they all intend to do so and I sincerely wish them best of luck as this is a problem which effect the soul of our beloved nation, we all want solutions. Every citizen who love our country would wish to solve this problem and it is all in good faith and honest determination, that our leaders are trying to come up with different strategies to deal with this problem.
But for me, a person who had worked in this area in the Maldives for five years, who watched the programs very closely, the future appears to be full of challenges. Some times I feel , it is better for me to be silent and keep my thoughts to myself. Because what I say now, may create a retort among those who would not like me to spell things out like this. But some where, I feel an urge, a national responsibility to let the public know.Therefore, I plan to write a series of articles on this topic.
To deal with the drug situation in the country two programs are conducted simultaneously. One is the program on supply reduction and the other involves the demand reduction programs. I have often felt that our public confuses the roles and responsibilities involved in the two different programs.
So let me clarify the difference , demand reduction primarily involves the process related to drug rehabilitation and drug prevention or awareness programs , while those involved in arrests of drug addicts and seizures of drugs are involved in the supply reduction side.
If we are to see a change in our substance abuse scenario, both supply reduction and demand reduction programs have to be strengthened simultaneously. I can definitely make out that the supply reduction side seems to be very active as several arrests and seizure reports have been publicized recently. However, we do not get much information on whats really going on with the demand reduction programs.
I left NNCB in September 2005, and have had no contact with the organisation since then, therefore I am not able to comment on whats going on now.However, my hope is that many things would have changed for the better. I am sure, the counsellors would never give up the hope of fulfilling their duties to the best of their ability and will be putting in all they have. But, while I hope for this...some thing inside me is in conflict. As if I have to make a confession, that I seriously do not believe, things can improve..atleast not yet.
It is not due the conflicts in the management , or lack of will on the government to handle this situation that is creating the many challenges that our demand reduction programs are facing. But I seriously think our entire drug rehabilitation program need to be re evaluated. This was actually done by myself and an Indian Psychiatrist, Dr.Rastogi and was submitted as a report to the then commissioner of NNCB and as far as I was told a copy of this was presented to the presidents office, in 2004. What I remember from this report is, that the existing program was perceived as very weak indeed and clients had reported dissatisfaction with various aspects of the treatment that was provided at DRC at that time. Unfortunately, this report was never published , so the public has no access to its detailed content. Definitely, its a big loss as a lot of work was put into the collection of data and preparation of this report.
I think it will be a waste of resources to just begin rehabilitation efforts in different parts of the country, without objectively evaluating the existing program , preferably by an independent group of people who have expertise in evaluating such treatment models. But, due to the way the drug problem escalated in our country, with the prisons bursting with prisoners primarily with sentences related to substance abuse or related offenses, we are faced with an urgency to implement what ever we could so that these people could be sent for some form of treatment, so that families and general public will feel the government is serious about really doing something to tackle this issue.
My question is , is this the solution? I read that a number of prisoners will soon be shifted to feydhoo finolhu, and they will go under NNCB. What is the program that will be conducted here for them? Is this going to be of any use??? Once upon a time, I remember, a previous boss of mine telling me in a state of utter dilemma and confusion, " rayyitthun beynunvani mi meehuntha male' yn huskoh , rashe hadhaafa alhaalan...dhen emeehun feydhoo finolha alhaaleema aharun hadhaani vaki kihinei??' And when I spoke to some of those who were to go to these islands most of them showed eagerness and enthusiasm to help. But , many of them , who were young people, with minimum training did collapse under the weight of the type of problems they had to deal with. I really am proud of this bunch who said to me,' But we will go, we will do what ever we can, even if it is sometimes difficult for us to listen to them ....."
Do you understand what all this mean? Well....lets change strategy now , close your eyes and visualise this scenario.
Imagine this situation. We need, surgeons to do surgery and for different specialisations we have different types of surgeons. But , in this hospital, we have a number of patients presenting with similar problems , but perhaps the underlying problems are different and need to be handled differently..by different surgeons. But here there are only nurses, with some training, so they step in to do surgery, simply because they just cannot afford to wait and watch as patients were collapsing around them and they felt the need to do something. Fortunately, some patients recovered, and then the hospital management declared that from now onwards , in this hospital and all other hospitals belonging to them, surgery will henceforth be carried out by their own team of successful nurse surgeons . Ahem. Open your eyes now.
Lets return to the previous discussion...and keep this example in mind....while you read!!!
My question now is, does our country have appropriate and adequate human resources to deal with this situation?? If we don't then what should we do? Is shifting drug addicts from a confinement of a prison to another island....with some colours of counselling going to rehabilitate, individuals with Chronic substance abuse disorder, possibily with co-occuring mental health problems..past history of offending ...etc..?? In the long run is this going to help? OR is it time for us all to think out of the matrix??? (to be continued)
Follow the following link to read up the RSA of substance abuse in Maldives published in 2003;http://www.mv.undp.org/Images/drug.pdf
But for me, a person who had worked in this area in the Maldives for five years, who watched the programs very closely, the future appears to be full of challenges. Some times I feel , it is better for me to be silent and keep my thoughts to myself. Because what I say now, may create a retort among those who would not like me to spell things out like this. But some where, I feel an urge, a national responsibility to let the public know.Therefore, I plan to write a series of articles on this topic.
To deal with the drug situation in the country two programs are conducted simultaneously. One is the program on supply reduction and the other involves the demand reduction programs. I have often felt that our public confuses the roles and responsibilities involved in the two different programs.
So let me clarify the difference , demand reduction primarily involves the process related to drug rehabilitation and drug prevention or awareness programs , while those involved in arrests of drug addicts and seizures of drugs are involved in the supply reduction side.
If we are to see a change in our substance abuse scenario, both supply reduction and demand reduction programs have to be strengthened simultaneously. I can definitely make out that the supply reduction side seems to be very active as several arrests and seizure reports have been publicized recently. However, we do not get much information on whats really going on with the demand reduction programs.
I left NNCB in September 2005, and have had no contact with the organisation since then, therefore I am not able to comment on whats going on now.However, my hope is that many things would have changed for the better. I am sure, the counsellors would never give up the hope of fulfilling their duties to the best of their ability and will be putting in all they have. But, while I hope for this...some thing inside me is in conflict. As if I have to make a confession, that I seriously do not believe, things can improve..atleast not yet.
It is not due the conflicts in the management , or lack of will on the government to handle this situation that is creating the many challenges that our demand reduction programs are facing. But I seriously think our entire drug rehabilitation program need to be re evaluated. This was actually done by myself and an Indian Psychiatrist, Dr.Rastogi and was submitted as a report to the then commissioner of NNCB and as far as I was told a copy of this was presented to the presidents office, in 2004. What I remember from this report is, that the existing program was perceived as very weak indeed and clients had reported dissatisfaction with various aspects of the treatment that was provided at DRC at that time. Unfortunately, this report was never published , so the public has no access to its detailed content. Definitely, its a big loss as a lot of work was put into the collection of data and preparation of this report.
I think it will be a waste of resources to just begin rehabilitation efforts in different parts of the country, without objectively evaluating the existing program , preferably by an independent group of people who have expertise in evaluating such treatment models. But, due to the way the drug problem escalated in our country, with the prisons bursting with prisoners primarily with sentences related to substance abuse or related offenses, we are faced with an urgency to implement what ever we could so that these people could be sent for some form of treatment, so that families and general public will feel the government is serious about really doing something to tackle this issue.
My question is , is this the solution? I read that a number of prisoners will soon be shifted to feydhoo finolhu, and they will go under NNCB. What is the program that will be conducted here for them? Is this going to be of any use??? Once upon a time, I remember, a previous boss of mine telling me in a state of utter dilemma and confusion, " rayyitthun beynunvani mi meehuntha male' yn huskoh , rashe hadhaafa alhaalan...dhen emeehun feydhoo finolha alhaaleema aharun hadhaani vaki kihinei??' And when I spoke to some of those who were to go to these islands most of them showed eagerness and enthusiasm to help. But , many of them , who were young people, with minimum training did collapse under the weight of the type of problems they had to deal with. I really am proud of this bunch who said to me,' But we will go, we will do what ever we can, even if it is sometimes difficult for us to listen to them ....."
Do you understand what all this mean? Well....lets change strategy now , close your eyes and visualise this scenario.
Imagine this situation. We need, surgeons to do surgery and for different specialisations we have different types of surgeons. But , in this hospital, we have a number of patients presenting with similar problems , but perhaps the underlying problems are different and need to be handled differently..by different surgeons. But here there are only nurses, with some training, so they step in to do surgery, simply because they just cannot afford to wait and watch as patients were collapsing around them and they felt the need to do something. Fortunately, some patients recovered, and then the hospital management declared that from now onwards , in this hospital and all other hospitals belonging to them, surgery will henceforth be carried out by their own team of successful nurse surgeons . Ahem. Open your eyes now.
Lets return to the previous discussion...and keep this example in mind....while you read!!!
My question now is, does our country have appropriate and adequate human resources to deal with this situation?? If we don't then what should we do? Is shifting drug addicts from a confinement of a prison to another island....with some colours of counselling going to rehabilitate, individuals with Chronic substance abuse disorder, possibily with co-occuring mental health problems..past history of offending ...etc..?? In the long run is this going to help? OR is it time for us all to think out of the matrix??? (to be continued)
Follow the following link to read up the RSA of substance abuse in Maldives published in 2003;http://www.mv.undp.org/Images/drug.pdf
Wednesday 10 December 2008
Post release management for offenders in Maldives;Challenges 1
We must welcome the idea of releasing prisoners who have shown good behaviour in the prison and deserve to be brought back to the community on parole. However, as I slumber in athirimathi, some thoughts float through my mind and I thought of listing them down.
1. Why are we releasing these prisoners ? Is it because they are going on hunger strike and we are scared that things may get out of control? If yes, then, we are indeed reinforcing bad behaviour and they will soon learn that in order to gain something they must always create problems. But I am sure this is not the basis for granting parole to who ever is going to be released. I am going to base my faith on the intergrity of the members of the new Maldivian parole board. Still, I am stuck with this question ,why are we releasing them now?Is it because the jails are full and we cannot afford to feed all them or they are being an irritant to others by constantly fighting for their rights and discrediting the system governing them?Ahem!!! I am sure I that this is not the case. OK. then, I will assume that parole board will assess them carefully based on acceptabel criteria prior to releasing them into the Community.
2. Do we have a post release management program for offenders? I assume from what I have read in the newspapers that the parolees will be in touch with officers. What exactly is the meaning of this ? What would be the role and level of supervision that would be involved? It is important to have parole officers who will engage in intensive and client specific supervision, where in they monitor whether they are lapsing into past criminal behaviours, are they interacting with criminal groups and gangs? Visiting drug spots...ets, are the families giving cues and distress signals??? The parole officers must be oriented and trained enough to do these things and supervision has to be specific, it cannot be supervision if just somebody makes a visit and sign a book saying they are in touch.
3. Do we know the readiness level of the families to have them back? Maldives does not have aftercare homes or community residential facilities or the means to house those who are released on parole, so that means they go back home when they are granted parole. So it is very important that families agree to have them back and are willing to provide a supportive environment for them.If there are family issues that may worsen for the individual released on parole or family situtions which can deteriorate due the person rejoining the family, this will lead to larger issues. So, we have to have a system of care where support is provided for the families.
4. What are they coming back to? Prison history creates an immediate social disadvantage . Those on parole need to find gainful employment and in Maldives, I know how difficult it is to get employment even for those who are brought back from drug rahabilitation programs. So this is a critical situation...we cannot afford to have already fragmented individuals to loitre aimlessly on our streets day in and day out. They must find respectable means of survival. So what do we do? I have a fantasy. A large Dhoani, leaving at dawn for fishing, our youth, our blood line healing under the sun, as they relearn the ancient art of fishing... our ancestors passed on to us and in the process take our fishing industry towards a new era.......Ahem.,....!!!
5.Who is going to monitor them ? I am sure there are lots of NGO's in our society determined to take part in the process of changing the path of crime, violence and drugs some of our youth have resorted to. Government can and must involve the private sector and expand their role in the rehabilitation and aftercare process. It can however, play the central role of being the focal point to monitor whether those who are involved stick to atleast a minimum standard of care chalked out by the government.
1. Why are we releasing these prisoners ? Is it because they are going on hunger strike and we are scared that things may get out of control? If yes, then, we are indeed reinforcing bad behaviour and they will soon learn that in order to gain something they must always create problems. But I am sure this is not the basis for granting parole to who ever is going to be released. I am going to base my faith on the intergrity of the members of the new Maldivian parole board. Still, I am stuck with this question ,why are we releasing them now?Is it because the jails are full and we cannot afford to feed all them or they are being an irritant to others by constantly fighting for their rights and discrediting the system governing them?Ahem!!! I am sure I that this is not the case. OK. then, I will assume that parole board will assess them carefully based on acceptabel criteria prior to releasing them into the Community.
2. Do we have a post release management program for offenders? I assume from what I have read in the newspapers that the parolees will be in touch with officers. What exactly is the meaning of this ? What would be the role and level of supervision that would be involved? It is important to have parole officers who will engage in intensive and client specific supervision, where in they monitor whether they are lapsing into past criminal behaviours, are they interacting with criminal groups and gangs? Visiting drug spots...ets, are the families giving cues and distress signals??? The parole officers must be oriented and trained enough to do these things and supervision has to be specific, it cannot be supervision if just somebody makes a visit and sign a book saying they are in touch.
3. Do we know the readiness level of the families to have them back? Maldives does not have aftercare homes or community residential facilities or the means to house those who are released on parole, so that means they go back home when they are granted parole. So it is very important that families agree to have them back and are willing to provide a supportive environment for them.If there are family issues that may worsen for the individual released on parole or family situtions which can deteriorate due the person rejoining the family, this will lead to larger issues. So, we have to have a system of care where support is provided for the families.
4. What are they coming back to? Prison history creates an immediate social disadvantage . Those on parole need to find gainful employment and in Maldives, I know how difficult it is to get employment even for those who are brought back from drug rahabilitation programs. So this is a critical situation...we cannot afford to have already fragmented individuals to loitre aimlessly on our streets day in and day out. They must find respectable means of survival. So what do we do? I have a fantasy. A large Dhoani, leaving at dawn for fishing, our youth, our blood line healing under the sun, as they relearn the ancient art of fishing... our ancestors passed on to us and in the process take our fishing industry towards a new era.......Ahem.,....!!!
5.Who is going to monitor them ? I am sure there are lots of NGO's in our society determined to take part in the process of changing the path of crime, violence and drugs some of our youth have resorted to. Government can and must involve the private sector and expand their role in the rehabilitation and aftercare process. It can however, play the central role of being the focal point to monitor whether those who are involved stick to atleast a minimum standard of care chalked out by the government.
Gang violence in Maldives
Another death, another young man is buried and the search is on to nab the killer. So who feels safe in Male' now?
Me, because it has not happened to me or to any one in my family, yet and neither do I have any connections with gangs or druggies who are engaged in this sort of gang violence. So it has nothing to do with me and I am safe!
Have you ever thought like this and gone for a peaceful night of slumber?Well, you may be lucky today. I just wonder how soon violence caused by gangs and related to gang subculture is going to spill into all aspects of our daily living?
How many of us can recollect the early days when drug abuse was happening as a hidden phenomena with just occasional arrests ?Remember the time when many of us kept pointing our fingers at the other person and giving reasons about why there was an addict in that family and not in our own.But today, see our status, how many of us can truthfully say we do not have a victim of drug abuse among our family members now?
Now, ....the same story may repeat with gang violence. Today these news reports seem to shock or bewilder us but we seem to be reacting to these incidents in a sort of detached fashion. Perhaps for the time being we will just wait for the news that the police has nabbed killer, end of story!
Perhaps after a decade of gang violence and gang related violations of human rights....may be , just may be some of us would get onto a lorry and go shouting wake up....!!!!! Wake up and stop gang violence.But by then it may just be too late. Perhaps by then the roots of this would have infilterated the soil of our entire nation.
So if we want to shout 'WAKE UP' we must shout now, as what we are seing here is just the tip of the iceberg. The government and the people need to get ready to tackle this better than we did with the drug problem. Before this escalates and snowballs any further, we need to do research to identify whats really going on here, and hence develop a comprehensive public policy and plan which can be implemented. Unless we have a thorough understanding of whats really going on, we cannot deal with the situation in a proper way. We must not make adhoc attempts and assume gang violence has got under control. I seriously dont think we can afford to make blunders like bringing the gangs in front of the media and making them the future heroes and role models to our sons.
We, the Maldivians have to become proactive in dealing with issues which reflects the deteriorating social and mental health situation of our country.Lets all wake up...as we bury our last victim of gang violence. Lets think of his human rights....? Lets think why the police have to arrest an 18 year old for murder. It is time to tackle the neglected psycho-social problems of our society...and understand what has led these youths to organise themselves to terrorise our society and begin to change them.
(read on what other communities are doing to deal with gang violence, here is a link ; http://uk.news.yahoo.com/4/20081217/tuk-communities-urged-to-tackle-gangs-dba1618.html
Me, because it has not happened to me or to any one in my family, yet and neither do I have any connections with gangs or druggies who are engaged in this sort of gang violence. So it has nothing to do with me and I am safe!
Have you ever thought like this and gone for a peaceful night of slumber?Well, you may be lucky today. I just wonder how soon violence caused by gangs and related to gang subculture is going to spill into all aspects of our daily living?
How many of us can recollect the early days when drug abuse was happening as a hidden phenomena with just occasional arrests ?Remember the time when many of us kept pointing our fingers at the other person and giving reasons about why there was an addict in that family and not in our own.But today, see our status, how many of us can truthfully say we do not have a victim of drug abuse among our family members now?
Now, ....the same story may repeat with gang violence. Today these news reports seem to shock or bewilder us but we seem to be reacting to these incidents in a sort of detached fashion. Perhaps for the time being we will just wait for the news that the police has nabbed killer, end of story!
Perhaps after a decade of gang violence and gang related violations of human rights....may be , just may be some of us would get onto a lorry and go shouting wake up....!!!!! Wake up and stop gang violence.But by then it may just be too late. Perhaps by then the roots of this would have infilterated the soil of our entire nation.
So if we want to shout 'WAKE UP' we must shout now, as what we are seing here is just the tip of the iceberg. The government and the people need to get ready to tackle this better than we did with the drug problem. Before this escalates and snowballs any further, we need to do research to identify whats really going on here, and hence develop a comprehensive public policy and plan which can be implemented. Unless we have a thorough understanding of whats really going on, we cannot deal with the situation in a proper way. We must not make adhoc attempts and assume gang violence has got under control. I seriously dont think we can afford to make blunders like bringing the gangs in front of the media and making them the future heroes and role models to our sons.
We, the Maldivians have to become proactive in dealing with issues which reflects the deteriorating social and mental health situation of our country.Lets all wake up...as we bury our last victim of gang violence. Lets think of his human rights....? Lets think why the police have to arrest an 18 year old for murder. It is time to tackle the neglected psycho-social problems of our society...and understand what has led these youths to organise themselves to terrorise our society and begin to change them.
(read on what other communities are doing to deal with gang violence, here is a link ; http://uk.news.yahoo.com/4/20081217/tuk-communities-urged-to-tackle-gangs-dba1618.html
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