‘Living Hell Girl’ – Doctor responds

I wish to draw your attention to the above article published in The Sunday Leader of March 29, 2009 and present my perspective on it as a psychiatrist.

In order to prevent any misleading information about me and National Institute of Mental Health, where I serve as a consultant and the director, it is my utmost duty to inform the public about certain aspects of the story titled “Ashanthi – Living Hell.”

I strongly believe that I have a right to reply as my name has been cited in the article penned by an anonymous writer. However, I will not go into the details about the said case as legal proceedings are on-going and I have an ethical duty to protect the patient’s confidentiality.

However, I strongly object and deny the erroneous and malicious allegations levelled against me and the institution I serve, in the said article.

Rigorous training

I have been working as a consultant psychiatrist for over 14 years at this institute. I have been certified as a specialist in the field of psychiatry by the Post Graduate Institute of Medicine, University of Colombo after five years of rigorous local and foreign training and passing the relevant examinations. I also engage in activities of continuous professional development. I also wish to state that I am the president of the Sri Lanka College of Psychiatrists, which is the highest professional body with regards to the specialty of psychiatry.

I am also a member of the Board of Study in Psychiatry for over eight years. I have been the director of the National Institute of Mental Health, Angoda for over seven years and have made many changes to improve the quality of services provided by the institute to patients and their families.

As a result I have managed to change the institute from a custodial hospital where patients did not have much rights or dignity, to a more humane, rights based acute care hospital. As a result of this achievement, the National Institute of Mental Health was selected as one of the top five hospitals in the Health Excellence Awards 2008. I was also selected as the second best director in a tertiary care hospital in the country in 2008.

Dedicated service

In the year 2008, the Rotary Club of Colombo - Mid City, gratefully recognised my dedicated services rendered to Sri Lankan society. My service to mentally ill patients in this institute was recognised by the World Health Organisation in Sri Lanka, as well as the World Health Organisation Headquarters in Geneva.

The said patient was brought to me by her parents and her husband on the instructions of her counselor from Women-In-Need. This fact has  been deliberately ignored by the writer. Even the counselor has rightly been able to identify the possibility of mental illness in this particular patient at the time she was presented to the counselor.

Having seen this patient in a private hospital I had instructed the patient and the family that she required further investigations and observations before arriving at a diagnosis. For this purpose the patient was admitted to Asiri Central Hospital with her consent.

However, later she refused any treatment and behaved in such a manner that it was not possible to manage her in a private hospital. Hence, on January 30 she was admitted to the National Institute of Mental Health as an involuntary patient.

Clinical examination of the patient indicated that she was suffering from mental illness.

Difficult to diagnose

As this patient’s case was somewhat difficult to diagnose, a second opinion from an independent psychiatrist without mentioning the clinical details or the circumstances that led to her admission to the institute was sought. The independent psychiatrist’s opinion was also that this patient was suffering from a mental illness of that nature which needs admission and treatment.

I would like to highlight the fact that this decision to obtain a second opinion was initiated even before various organisations and rights groups came into the scene. This fact too has been ignored. After obtaining a second opinion I initiated the treatment and continued the investigations including CT scan of the brain and electroencephalographic studies to exclude any organic brain pathology. However, the patient is of the view that she was not having an illness, a trait commonly seen in patients with mental illness. 

As a result, the patient was making various requests such as to be seen by a human rights lawyer and various visitors. It was decided that this kind of requests, mobile phones and visitors would hamper and prolong her recovery from the illness she was suffering from, and her visitors were restricted as commonly seen in the case of those with other medical disorders.

Access to a lawyer

She was granted access to a lawyer from a human rights institution. As a specialist in this field it is my duty to take an independent, non judgmental view on diagnosis of mentally ill patients brought to my attention and treat them appropriately. This is a fulfillment of my obligation that comes under the protection of patients with mental illness and improvements of care adopted by the United Nations.

However, if one realises that there is danger to a patient as a result of not being able to understand an illness, by the family or others, a psychiatrist has an obligation to look after the patient’s right for treatment. If I do not treat this type of patients, the damage caused to the patients themselves and their families would be devastating.

There are always people who are interested in exploiting the mentally ill. This could be unintentional as they may not be aware whether the particular person is mentally ill or not.

On the other hand there can be predators out there plying on more vulnerable individuals.   At the same time early treatment will give better results and minimise disability.

An equal chance

It would have been better — as we often  see and read in other news media — if inquiries had been made of the medical aspects of a presentation of a patient, and an equal chance had been given to the medical practitioner and the specialist to express their specialised views as well.

I too respect dignity, equity, fairness and justice as any other person in this country, particularly which your paper is apparently fighting for.

As my concluding remark, I would like to mention that my experience of 20 years serving in Sri Lanka is that, when there is a difficult patient, a difficult diagnostic issue or a difficult patient management issue, the media tends to sensationalise rather than investigate every aspect of the story.

This has resulted in damage to my reputation as a psychiatrist which I have managed to build up over the years by hard work and dedication in treating the most underprivileged members of Sri Lankan society. Please be kind enough to give the same publicity to my letter as you have given to the article titled ‘Ashanthi – Living Hell.’

Dr. Jayan Mendis

Consultant Psychiatrist

Director,

National Institute of Mental Health 

Angoda, Sri Lanka