The government's main hospital, IGMH, has around 700 people on the waiting list to see a psychiatrist. At Hulhumale' Hospital, the number is more than 350. There are six psychiatrists working at the two major government hospitals in the Male' City region. Even after accounting for private hospitals and clinics, the total does not exceed 15. Psychiatrists and psychologists are equally under-represented. Nonetheless, current data indicates that the nation's mental health patient population is continuously growing. Numerous individuals who remain untreated and are waiting indefinitely for their treatment are tied to the shackles of depression and anxiety.

Mental Health is defined by the World Health Organization (WHO) as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", hence mental health is a very crucial part of healthy living.

The exact picture of mental illness in the Maldives is not current as the last national level study on mental health was conducted in 2003. The study, which was conducted across the country by the Ministry of Health, was carried out among people concerned with mental health and neurological disorders. The findings of this study showed that 29.1% of the population were experiencing some form of mental illness. Of these, 22.4% had neurotic disorders. Only 1% had psychotic disorders, and 6.1% had epilepsy. The study found that 5% of the respondents had depression and anxiety. Only 4% of patients had somatic symptoms.

What is Depression and Anxiety?

Depression is a mental health disorder characterized by feelings of low mood, hopelessness, lack of interest, vegetative symptoms like sleep disturbance, change in appetite and energy levels and cognitive symptoms like memory and concentration difficulties, which affect a person's life and causes a variety of psychological and physical problems. Depression, if left untreated, can lead to severe consequences.

Anxiety is a state where one feels nervous, anxious and on the edge, will have difficulty controlling the worries, difficulty relaxing, can become easily annoyed and irritable. Anxiety can present with physical symptoms like palpitations and muscle tension. There are five related but distinct anxiety disorders, which are panic disorder, agoraphobia, specific phobia, social anxiety disorder and generalised anxiety disorders.

The state of mental illness in the country from the eyes of a Psychiatrist

According to Dr. Shajee Puthiya Purayil, Consultant Psychiatrist at Tree Top Hospital in Hulhumale', the number of people suffering from depressive and anxiety disorders in the country is on the rise. He reports that panic disorder is the most common anxiety disorder for which patients seek treatment in his practice.

Panic disorder involves sudden, intense episodes of fear called panic attacks. Symptoms include rapid heart rate, sweating, shaking, shortness of breath, chest pain, dizziness, and a feeling of losing control. These attacks can occur unexpectedly and lead to ongoing fear of future episodes or avoidance of potential triggers.

According to Dr Shajee, panic disorder is common with many patients residing in the atolls and that by the time they come for treatment, the condition has become rather bad.

"What I noticed was that there are a lot of cases of childhood sexual abuse (CSA) in Maldives. I have come across many cases of CSA who present with various symptoms of Post-Traumatic Stress Disorder (PTSD). They describe how childhood sexual assault has changed their lives. This, too, is a major cause of many anxiety disorders," Dr Shajee explained.

A 2006 study of women's mental health and life experiences found that one in three women aged 15 to 49 years experienced physical violence or sexual violence. The study also found that people who experienced such behaviours were more likely to experience psychological problems than other women.

Anxiety stemming from starry-eyed relationships and corporate environment

Dr. Shajee believes that anxiety disorders are particularly prevalent among the nation's youth and that having one makes it challenging to lead a normal life.

"A lot of things lead to anxiety disorders. One of the most prevalent reasons that one come across are relationship issues. This can also be the case with the use of different types of substances [e.g. cigarettes, drugs, alcohol]. We are also facing this kind of problem due to bullying in the work environment. Apart from this, there are other factors that can lead to various anxiety disorders," Dr. Shajee stated.

Why are number of men seeking Psychiatric treatment so less?

Even though depression and anxiety are more prevalent in women, men are also susceptible to these illnesses. Dr Shajee states that even if men suffer from mental illnesses, they do not seek help fearing social stigma. Seeking help is viewed as a weakness in some communities leading men to be hesitant about seeking psychiatric help. Difficulty expressing emotions, men may struggle to verbalise their feelings or share them with others, coupled with the ingrained belief that they should “man up” and deal with it themselves. They often do not talk about it leading to risk of being unrecognised and untreated.

Hesitancy to seek treatment despite mental illness

The societal stigma around mental illness is a major deterrent for patients to seek treatment. While the number of patients residing in Atolls are higher, the number of patients seeking treatment are far less, especially in island with smaller populations. They tend to seek traditional healers and are much more hesitant in seeking treatment.

"Stigma is really a big factor here. Many patients are concerned about confidentiality and ask if the information they are divulging will go into the hospital records. That's because they're really scared about it, and it takes time and energy to make them understand that the information will be confidential," Dr Shajee explained.

Many people still do not accept the concept of mental illnesses. Most people assume that someone is lazy or without motivation, if they notice a change in the behaviour of the person or find that they are not able to perform to their fullest capacity. That is not how it is, similar to physical illnesses, mental illnesses too can be disabling and needs to be diagnosed and treated.

Another barrier to seeking treatment for mental illness is the paucity of psychiatrists and psychologists and patients being on a long, endless wait list. Since seeking treatment from the private sector is expensive, many are still waiting for it from the public sector. However, every second counts when it comes to mental health, which often requires early treatment.

Maldives needs more solutions to combat mental illness!

Three groups of medications that are commonly used for psychiatric disorders. They are antidepressants, antipsychotics and mood stabilizers. We do not have access to all the antipsychotics and antidepressants, which is a concern.

The most common neurodevelopmental disorder that occurs in childhood is Attention-Deficit/Hyperactivity Disorder (ADHD). It affects a child's ability to focus, stay still, and control impulsive behaviour, which can affect their performance at school, relationships, and daily functioning. Borderline Personality Disorder (BPD) is a personality disorder, which is chronic and requires multimodal. However, treatment essentially remains partial because Dialectal Behavioural therapy (DBT), which has the best evidence for BPD is not widely available in Maldives.

"The first line treatment for ADHD is stimulants. But there are no stimulant based medications in the country which prevents patients with this condition from getting the best available treatment for the condition and we have to rely on only using non-stimulant medicines," Dr Shajee revealed.

Shortage of psychiatrists and psychologists for the country's requirement is a concern shared by Dr Shajee who also currently treats 10-15 patients every day.

"If my information is correct, there may be four psychiatrists at IGMH and two at Hulhumale' Hospital. There are private clinics, which offer treatment for mental health issues. However, it is not enough for a population of half a million. In addition, trained psychologists are also scarce and mental health nurses are unavailable in the country,” Dr Shajee added.

In order to reduce mental illnesses in the country, the government and public need to present a united front. The government has established a Mental Health Hotline (1677) as an aid to mental health professionals, which provide round-the-clock service and provides psychological support to all age groups.

While there are about half a million people in the Maldives, the number of people suffering from mental illness is alarming. According to Dr Shajee, educating children about mental illness during their school years through awareness workshops is the first step in reducing stigma and encouraging them to get mental health care. Workplace awareness initiatives can also aid in educating, lowering stigma, and encouraging people to seek assistance early for mental health concerns.