Mental Health System Development in Sri Lanka

Abstract

Sri Lanka has been a model country for many decades in terms of quality of population health outcomes in a low- or middle-income country, with relatively small but smart investment in population health. It has, however, experienced 30 years of civil conflict, ending in a brutal civil war in 2009. The island's coastal regions were devastated, with massive loss of life and population displacement, by the Indian Ocean tsunami in 2004. The conflict and the tsunami brought to the fore the importance of renewed attention to the mental health of the Sri Lanka population, particularly among the most affected communities. While indigenous conceptions of mental health and illness, and strong Ayurvedic and other traditional forms of health practice, continue to be important across the Sri Lankan population, Western forms of psychiatry and systems of care have become dominant over a long period, particularly during the British colonial era. Human resources and physical infrastructure for mental health treatment and care have been very limited. Although general hospital, inpatient psychiatric units in several parts of the country were established much earlier in Sri Lanka than in many other countries, until recent times three national psychiatric institutions, all near Colombo, were the main locus of care and the main resource for psychiatric treatment. Conditions in these institutions were very poor. The impact of the tsunami, and the influx of aid and technical expertise, created an opportunity for major reform of the mental health system, with an orientation to community-based treatment and care, major improvements in Angoda Psychiatric Hospital, and establishment of small inpatient units in most district general hospitals across the country. Major innovations in dealing with the shortage of mental health human resources have been a particular feature of the mental health system development in Sri Lanka in the past decade. A focus on suicide prevention has yielded very positive results. These and other aspects of the process of reform of the Sri Lankan mental health system have generated international interest. This chapter provides a brief account of a very effective process of mental health system reform in a middle-income country. (PsycINFO Database Record (c) 2017 APA, all rights reserved)