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Mental disability is no stigma
Giuliana Galli Carminati
The mentally challenged are looked down upon in society and the mere discussion of the subject is a taboo in social circles. In the past, most families with such patients avoided discussing their problem but now more and more people are preferring to speak as they hope to get solutions somewhere. "We need to de-stigmatise mental illness," avers a leading Swiss psychiatrist.
Meet Giuliana Galli Carminati, head psychiatrist of the Units of the Psychiatry of Mental Development, University Hosptials, Geneva, who is dealing with mentally challenged adults who also have psychiatric problems.
She was on her first visit to the city recently to train teachers, therapists and supporting staff of Lebenshilfe, a special school for spastic children and adults.
Geneva, which has a population of 400,000 has an average of 800 persons, including children, who have the mental disability. The needs of the mentally challenged children and adults who do not have psychiatric problems are taken care by socio-educational institutions.
The population of mentally challenged who are over 18 years of age and suffer from psychiatric problems in Geneva district is around 300. The Units of Psychiatry take care of these patients. Hospital Units for 18 patients, a day hospital which receives about 35 patients a day, an ambulance and a mobile team complete the picture.
"We recommend hospitalisation only in severe cases, as we feel that the psychiatrist should avoid, or if not possible, shorten the duration of hospital stay of such patients, who can find comfort only with their family members, and alienation from them may cause behavioural problems," Dr. Carminati. "Our mobile team observes patients in their habitual environment and makes an assessment of their behaviour. It has been found that in a majority of the cases, counselling and reinforcement of mild intervention by the team is sufficient to solve the problem of aggressive behaviour."
Giant strides of development have been made in pharmacology for general psychiatry, but the same is not the case with psychiatric problems in mental retardation, she notes.
Referring to sexual problems in mentally challenged persons, she asserts that the need for their right to intimacy should be recognised. It is a normal phenomenon and a minimum of intimacy can solve the psychiatric problems to a great extent. There is every need to explain to the mentally challenged about the issue and adopt a step-by-step approach. Trying to conceal the problem or running away from it will make matters worse.
Quoting statistics, she says one per cent of the total population in the world are estimated to suffer from mental retardation. Fortunately, a vast majority of them can manage to live on their own and only 0.2 per cent need assistance.
Dr. Carminati expressed satisfaction at the methods adopted at Lebenshilfe in dealing with the mentally retarded. The teaching was fairly adapted to the different levels of development of different persons resulting in a perfect blend of group and individual care. She sees a lot of scope for collaboration and to share experiences and faculty between Lebenshilfe and the Units of Psychiatry.
"The mentally handicapped children who joined Lebenshilfe, when it was started 22 years ago, must be well into their 30s, 40s. The cases could be studied to evaluate behavioural problems in the mentally challenged," she says.
Patients of this type in India should be allowed to interact with the general population and vice versa. Sensitisation of the people was necessary as was being done in Geneva, where the general population who votes is very sensitive to the spastics. They compel the politicians to care for the welfare of the mentally handicapped. The parents of such patients have formed a very powerful association, which wields tremendous power over the functioning of the government. Such a system would help in alleviating the problems of the handicapped and their families in India also.
All said and done, the mentally challenged will be more independent and less of a burden on society, if they are given proper education and training, she adds.
B.MADHU GOPAL
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