Despite the growing concern and advocacy about mental health globally, it is still left to debate how much tangible corresponding action has been taken to achieve this.
Indeed, the promotion of mental health is a collective effort that requires the understanding and involvement of all individuals, families, communities, and healthcare providers, among other stakeholders.
Mental health has for so long been significantly less considered globally, but more severely in developing countries. Thus, translates to how deep-rooted it is in us, and so is the time and effort needed to overcome this.
I was recently awakened to this reality by my brief personal experience. I recently moved to a new environment, a different time zone, and with all the associated new duties. As a result, I was unable to have a moment of good sleep for a number of days—a frustrating moment that frightened me to the point that I felt I was ‘losing my mind’. It was evident to me that I felt sick and lifeless, yet thinking of seeking medical help was not in any of my forethought options.
Luckily, this was temporary but the experience left me thinking of those that live all their life having to be strong with undoubtedly more concerning underlying mental health issues. If I had a small cut wound on my leg, I would have gone to the hospital immediately, but the truth is, the cut wound is definitely not in any way comparable to this in terms of the debilitation caused. It is just that sadly to admit so, in our culture and subconsciousness; the cut wound is a more acceptable and ‘normal’ condition!
I found myself pondering whether we, as medical practitioners, are doing enough towards improving the current state of mental health. It is indeed easier for medical practitioners to advocate and sensitise the public on seeking mental health consultations than it is to actually pay attention to the same subject when we meet patients daily in our practice.
I can not recall all the patients that have told me that they were not able to sleep well or concentrate on their work, among other complaints, but I, unfortunately, focused more on treating the ‘seemingly interesting’ surgical conditions of my specialisation.
Maybe the surgical condition was not the actual burden for the patient to come for a consultation, but rather a chance for them to seek medical consultation with a considerably more physical disease without feeling judged—or it could have been the only visible reason they could present to their spouses, or employers to easily leave their homes or workplaces to the hospital.
As a plastic surgeon (and almost certainly with other medical specialties), most of the emphasis during our training and careers has been on treating the physical conditions that patients present. From the time the patient is walking into my consultation room, I am observing and already looking out for any physical disabilities that I can surgically correct. Of course, we also have to appreciate the fact that we always have limited time per patient given the long queues and, hence, eliciting probable non-obvious mental health concerns might not be easily achieved. But how about those seemingly ‘lighter’ complaints that patients tell us during these visits and we ignore? Some patients are actually not comfortable opening up and might even mention such towards the end of the visit or even on their way out of the room.
These symptoms might include complaints such as sad moods, loss of sleep, loss of interest in activities, lack of concentration at work, withdrawal from friends and family, excessive fears or worries, alcohol and drug abuse, hostility and anger issues, hallucinations, loss of interest in life or even thoughts of suicide, among others.
It, therefore, is very important, and our responsibility as clinicians, that we do our best to explore the mental health state of our patients, and never take lightly any complaints or signs that might point to a more serious mental health condition. That could be the closest chance that the patient had to meet with a clinician that would help them to live a normal life, or even prevent a dreadful event from an untreated mental health condition.
It is also very important for patients to understand that a referral to a mental health expert for further evaluation and help is not shameful, but rather one’s benefit and should not be misinterpreted as offensive.
Dr Ian Shyaka is a plastic surgeon at Rwanda Military Hospital & Fellow of Reconstructive Microsurgery at Chang Gung Memorial Hospital (Taiwan)