Mental Health nursing in Sri Lanka

Shannon Flowers travelled to Sri Lanka for an elective placement to study mental health care in a developing nation.

As a student mental health nurse, I have always wanted to explore another healthcare setting and have been particularly interested in seeing how mental health is viewed in a developing country.

Shannon Flowers, far left, with colleagues in Sri Lanka

Earlier in the year I did just that, and took one of my hospital placements in Sri Lanka, with elective specialists Work the World.

When I first arrived at the hospital in Anuradhapura, one of the country’s ancient capitals, I was taken back by the size of the hospital and its many open areas. There was a lot about the hospital which surprised me, but it was functioning well, despite its clear lack of resources.

There were visitors and patients absolutely everywhere, in the waiting areas outside, walking around the grounds, and standing around the wards.

Everything is recorded on paper as there are no computers, and all patient notes are written in books, which the patients keep on their person and bring with them to whichever department they attend. The patients are also seen on a first come, first served basis.

Skill improvement

The consultant psychiatrist who supervised me took me under his wing. He explained patients’ cases to me, asked my opinion and got me to explain how I came to my conclusions, all in English. Working closely with him hugely improved my skills at assessment and record keeping.

I was also taken on prison visits, where we conducted mental state examinations, which are used in courts in relation to patients’ upcoming trials. It was apparent to me that prison wasn’t only used for rehabilitation for criminals in Sri Lanka: it was also used as a safe house for people who were mentally unstable.

One 87 year old man we assessed, had severe dementia; nothing he said seemed to make sense to us, and nothing we said made sense to him. It transpired that despite not having committed any crime, he had been arrested because he had been found wandering the streets, speaking incoherently. In Sri Lanka, sheltered housing for older people in unsusual, so there was no other option for the police other than to put him in prison.

In Sri Lanka, where the patient lives determines the medication they can have

Another man, 27, lost both his parents and brother in the space of a few months and sunk into a deep depression. A concerned neighbour reported him to the police, and soon after he found himself imprisoned rather than receiving psychological support, as he might in the UK.

I also saw women prisoners who reported domestic violence, financial and environmental stressors as the reason for the actions that landed them in prison.

Missing confidentiality

While being assessed, family members were allowed in to sit next to their relative, the consultant asked them questions to help find out more about the patient. I saw no evidence of any confidentiality in any part of the healthcare system; on the ward, in clinics and in the prisons, the consultant’s office door stays open and anyone can hear anyone else’s conversations.

I was surprised to see that treatment and medication were similar to what we offer back home, but in Sri Lanka, where the patient lives determines the medication they can have. If a patient needs medication that isn't available in their town, they have to travel to buy it. And if they can't afford to buy medicines, which was often the case, they have to go without, unless they travel to hospital.

As a result, we often saw late stage presentations of illnesses that could have been ameliorated with earlier intervention.

The elective placement helped me to realise how lucky we are to have the mental health services we have in the UK, but I was also able to see the positives in the Sri Lankan system.

Shannon Flowers is a mental health nursing student at Staffordshire University

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