The mentally ill in South Sudan have extra burdens. The country has been at war for almost 45 of the last 60 years. Last week, I wrote about traumatic stress manifested in the entire country including its leaders. This week, I traveled with the local police, who are getting the mentally ill on the street some real help.
Back in 1975, I worked at South Shore Mental Health Center in Quincy, Massachusetts. At that time, the first initiative for de-institutionalization was taking place because of the Community Mental Health Centers Act passed in 1963. In 1975, the case of Gallup v. Alden established that a patient had a right to be treated in the least restrictive environment. The case caused a mandate to empty the state psychiatric hospitals in Massachusetts.
State hospital patients were discharged, and they were being treated in the community, but there was little incentive for them to return for medication. However, the patients liked to eat sweets, and South Shore Mental Health Center understood this – as did then-mental health area director Harry Shulman. A Wednesday night clinic was initiated where patients came to South Shore Mental Health Center for "Prolixin and doughnuts." Because of the doughnuts and other food that was offered, patients were motivated to get injections of the long-acting anti-psychotic medication.
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I have since moved from the mental health field to journalism. As a journalist, I first visited South Sudan in 2008. I have been coming back ever since. I came to South Sudan in February with Cholene Espinoza, M.D., and we have been working with the Ministry of Health and Atong Ayuel, M.D. (There are only two psychiatrists in South Sudan – a country of almost 11 million people.) Dr. Atong was in great distress about the number of psychiatric patients roaming the streets without food, clothes or medication. I told her about the 1975 South Shore Mental Health Center's initiative, "Prolixin and doughnuts," and she loved the idea.
Dr. Atong went directly to Minister of Health Dr. Riek Gai, who immediately signed on. He has launched a true community health initiative with the local police and community-trained health workers to bring the patients to the Juba Teaching Hospital. Dr. Atong does the yeoman's work. Not only is food and medication provided for those who are picked up from the street, but she decided to give them haircuts and clothing as well. With the assistance of the local police, the patients, motivated by the food, came to the hospital. The local police even assisted with clothing and haircuts.
Today, at the opening of the program for street patients, Dr. Reik Gai said, "We are brought here not by politics, but humanity brought us together. The problem of mental health has increased by the marginalization of our people." (South Sudan has endured two wars with what is now Sudan and one civil conflict resulting in the deaths of about 4.5 million people.) "South Sudan is the only country where naked people roam the streets. This new program has the political support of the president and the cabinet. To give a human being their dignity is our first priority. It could have been you or me affected by this disease. We must do something to restore the dignity of these people."
The Minister also complimented GEMS Development Foundation (GoatsfortheOldGoat.com) and the cooperation of the police force for handling the patients in the most humane manner, as well as the minister of the interior for working with the Health Ministry to establish this program.
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On the first full day of the program, there were 10 patients. One patient felt his father's ex-wife had bewitched him. His behavior became strange, and his brother's wife threw him out of the house. (He had been living with his brother.) Another woman had been wandering for years in Juba. Asked if she had family, she said, "The government has family, I don't." Patients who became aggressive had family members who no longer could care for them, and they took to the streets. Another group of 125 patients cannot be controlled in the open psychiatric unit of the hospital and are cared for in the Juba central prison, even though they have committed no crime. Anti-psychotic drugs have been hard to come by; however, one non-government organization, the International Disability and Development Consortium, based in Italy, has been supplying psychiatric drugs. It is the only "go-to" organization for these drugs.
The South Sudan health minister has supported this, but it exists because of the leadership of one person, then a mental health area director, and now South Shore Mental Health Executive Director Harry Shulman, who provided financial support 40 years ago. Now the small, regional program of South Shore Mental Health has stretched across the globe to the world's newest country – South Sudan. It shows how a small idea can have big impact even 40 years later.
Media wishing to interview Ellen Ratner, please contact [email protected].