Issue link: https://maltatoday.uberflip.com/i/952911
maltatoday SUNDAY 11 MARCH 2018 Interview 14 By Raphael Vassallo Mental health has been in the news a lot recently. Government has just announced a major revamp of Mount Carmel Hospital; controversy erupted over a Carnival joke at the expense of the mentally impaired; and just this week, it was revealed that a man lost his job after going public about a specific condition (bipolar disorder, in that case). At the same time, there are statistics indicating that the proportion of people who suffer from such issues may be much higher than we think. How do you account for this apparent spike in concern? Are we discovering a reality that always existed? Or is it a case that – with today's stressful pace of life – more people are actually suffering from mental issues than before? DANIELA CALLEJA: It is a bit of both, really. There is more aware- ness today, so people tend to rec- ognise symptoms more. They also seek help more than they used to. Whereas before, it was something people used to hide... today, people are hiding it less. There is also the factor of stressful lifestyles: there are statistics showing that one in four persons suffer from depres- sion, for instance. Depression is expected to be the highest disease of burden, globally, in a few years' time. So it is a bit of both. But we're seeing it more now, also because... this is a strong feeling I have: Malta is ready, but now Malta needs to learn... Ready for what, specifically? DC: Ready to reduce the stigma, ready to understand... ready to see that you can seek help, and that you can lead a good quality life, at the end of the day. Because there are people who suffer in silence. If it's one in four of us, there must be many people suffering in silence out there. With the calls we're get- ting now, we can feel the pain of these people... The fact that you're getting those calls means that people are now willing to seek help for such problems. It wasn't the case in the past. Do people still consider 'mental health' issues as being somehow 'different' from other medical conditions? DC: When we teach mental health first aid, we use this analogy: if you start getting symptoms of diabe- tes, for example...how long would it take you to go to a GP? In most cases, the answer would be 'within a week', at most. If you start getting symptoms of depression or anxiety, however, and you don't recognise them... it might take much longer. Some people might take even up to 10 years to seek help for these con- ditions... That reminds me of a famous quote, to the effect that: 'if you're in the lowest part of a valley, you can't see what's beyond the hills'. Isn't it also a case that people suffering from a condition like depression are not in a position to realise they have a problem, because the problem itself distorts their perspective? DC: I'd say it's more a case that... let me give a simpler exam- ple. If I wake up in the morning, and I'm coughing and sneezing... I have a touch of fever, feeling nau- seous, etc... I would have already diagnosed myself with the flu. Right? Because they're common symptoms that people know about. If I wake up in the morning, and feel sad for no particular reason... my heart is racing all the time... I don't feel like eating, I can't sleep... and it's been happening, day in day out, for two weeks... If I don't know that those are symptoms of depression, I'm going to think a million and one other things. So, to go back to your quote: sometimes, you won't even know you're in the valley. You're blindfolded... But under those circumstances, nobody can be expected to seek help. If someone doesn't know he has a condition, because the condition itself impairs the ability to realise you have a problem... [DC] But it's not the condition that does that. It's society. It's not the condition that stops you from seeing, that gives you a lack of in- sight; it's the fact that we are not educated enough to recognise it. My son, who is 10 years old, knows enough to recognise symptoms of the flu. He knows what the flu is. If, in future, he gets thoughts of suicide... I want him to know what that is, too. I want him to recog- nise that it is a condition he can do something about. That he can go to a doctor for it. That is where we are at right now: we need to learn how to recognise the symptoms... to say, 'it could be this', and to seek help. Coming back to the stigma: in years gone by, there may have been a perception – not entirely unjustified, given that psychiatry is a relatively young science – that... if something goes wrong with your body, maybe the doctor can fix it. But if something goes wrong with your head... that's it. There is nothing that medical science can really do. Does that perception still exist? DC: I always find this very para- doxical, because I always say that your head is still part of your body. It's part of the physical 'you'. If your kidney can get sick, your brain can get sick. And in both cases, there are conditions that can be cured, others that may be chronic... but you can still live with them... True, but the stigma still exists. There have been cases (one this week) where people reportedly lost their job – and probably many more where people would not have been employed at all – on the basis of real or perceived mental conditions. This raises the question of how symptoms of mental illness are viewed by oth- ers: employers, for instance... DC: When people think of men- tal illness, the first thing they go to is... aggression. OK, so someone has a mental health issue... there- fore, that person is aggressive. It was a question we were asked about the case you mentioned ear- lier: we were approached by people who said they might be interested in offering that person a job: but... 'would he be violent?' Because in the past – and up to a point, also today – the media tended to por- tray people with mental health problems as aggressive. The reality, however, is that people with mental health problems are most often the victims of violence. There are am- ple statistics to confirm this. They are the vulnerable ones... [STEPHANIA DIMECH SANT]: And the law-courts don't help very much, either. Very often you hear about cases involving violence, where the alleged perpetrator would be sent to Mt Carmel Hospi- tal. And that is what the media pick up: so the courts and the media sustain this perception that people with mental health problems are violent... or that people who com- mit violent acts might have a men- tal health problem... Another message sent out by that sort of verdict is that the only 'solution' in such cases is to simply lock up people with mental health problems... SDS: It was the same with dis- ability until not too long ago. With disability, we have moved forward in leaps and bounds, thanks to the efforts of Agenzija Appogg, for ex- ample, and government, and KP- MD. They worked very hard, and got us to the place where we are to- day. With mental illness, however, we're still a little behind... With the disability stigma, there was also the archaic view of a 'physical impairment' as some kind of 'punishment' for the sins of the past. With mental health, there is the added perception of a condition that might 'run in the family'. People may be afraid to seek help, also because the stigma may also affect the people around them. Do you encounter these kind of concerns? DC: Yes. I've known cases where families were worried that, if their loved one speaks out, the entire family would be stigmatised. Some- times we get people who call us, telling us that family member has this or that problem... 'but don't tell him we called. I don't want him to notice that I'm noticing.' So even between family members, there is a barrier. One of the issues we encounter is precisely this: people might call us seeking help for a fam- ily member, but unless the person concerned accepts to be helped, we cannot do anything. Unless we're at the stage where they're a danger to themselves or others, and then you have to involuntarily give help. Which is the very last thing we, or anyone who works in mental health services, would want to do. There are cases where it has to be done, obviously. But it's still imposing treatment on someone who doesn't want it. And we don't have to reach that stage. If people didn't have to fight against social stigma to get help, they wouldn't reach a stage where they're so unwell they have to be treated involuntarily. Peo- ple would consent much earlier. Without the social stigma, there wouldn't be such a price to pay... Earlier we alluded to the case of a man who was fired because he publicly revealed that he suffered from bipolar disorder. That is another 'price to be paid'. Is it something that happens a lot, and in what way does the Richmond Foundation assist in such cases? My son, who is 10 years old, knows enough to recognise symptoms of the flu. He knows what the flu is. If, in future, he gets thoughts of suicide... I want him to know what that is, too. I want him to recognise that it is a condition he can do something about. That he can go to a doctor for it If people didn't have to fight against social stigma to get help, they wouldn't reach a stage where they're so unwell they have to be treated involuntarily. People would consent much earlier. Without the social stigma, there wouldn't be such a price to pay SYMPTOMS STIGMA The silent stigma