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Practising psychiatry in Sri Lanka: challenges and opportunities

Published online by Cambridge University Press:  08 February 2023

David Skuse Open the ORCID record for David Skuse [Opens in a new window]
David Skuse*
Affiliation:
Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK. Email d.skuse@ucl.ac.uk
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Abstract

This month's issue of BJPsych International focuses on psychiatry in Sri Lanka, with articles on suggested improvements in education and training, the country's outdated legislation regarding involuntary psychiatric treatment, and the misuse of prescription medications.

Keywords

Sri Lankaeducation and trainingprescription drug misusemental health legislationinvoluntary psychiatric treatment
Type
Editorial
Information
BJPsych International , Volume 20 , Issue 1 , February 2023 , pp. 1
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
Copyright © Royal College Psychiatrists, 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

Our theme this month concerns the practice of psychiatry in Sri Lanka, with three related articles by Hapangama and colleagues. The first of these concerns the training of medical students and postgraduate education in psychiatry.Reference Hapangama, Kuruppuarachchi and Hanwella1 Throughout the world, as medicine advances, one might expect the attitude of medical students to have evolved towards greater interest in and empathy for mental illness, among their peers and patients. Recent research (e.g. Wang et al, 2016;Reference Wang, Ko, Chen, Yang, Lin and Cheng2 Pascucci et al, 2017Reference Pascucci, Ventriglio, Stella, Di Sabatino, La Montagna and Nicastro3) suggests that negative attitudes persist. In Sri Lanka, the place of psychiatry in the medical school curriculum is not prominent, and the authors propose introducing a postgraduate internship in psychiatry as an option during foundation year training. It would be interesting to see how enthusiastically this option is selected.

A second article considers the need for an updated version of Sri Lanka's mental health legislation concerning the management of involuntary patients.Reference Hapangama, Mendis and Kuruppuarachchi4 Some elements of the existing law date back to the days of British governance in the 19th century, and reform has been pending for decades. It is concerning to learn that current official guidance mandates involuntary treatment in just one hospital, which is located in Colombo, so patients may be held ‘on remand’ for weeks in other parts of the country before their transfer can be arranged.

Finally, the authors draw our attention to the problem of drug misuse in Sri Lanka, with a focus on the ready availability of prescription drugs that are effectively unregulated.Reference Hapangama and Kuruppuarachchi5 As we know from the epidemic of misuse of drugs such as OxyContin in the USA and Europe, even if there are controls on who has a license to prescribe, these can easily be undermined. The concerns expressed here about the ready availability of mind-altering legal medications are not confined to Sri Lanka.Reference Morley, Ferris, Winstock and Lynskey6

Declaration of interest

D.S. is Editor of BJPsych International.

References

Hapangama, A, Kuruppuarachchi, K, Hanwella, R. Achievements and challenges in psychiatric education and training in Sri Lanka. BJPsych Int 2023; this issue.CrossRefGoogle ScholarPubMed
Wang, PW, Ko, CH, Chen, CS, Yang, YHC, Lin, HC, Cheng, CC, et al. Changes of explicit and implicit stigma in medical students during psychiatric clerkship. Acad Psychiatry 2016; 40: 224–8.CrossRefGoogle ScholarPubMed
Pascucci, M, Ventriglio, A, Stella, E, Di Sabatino, D, La Montagna, M, Nicastro, R, et al. Empathy and attitudes towards mental illness among Italian medical students. Int J Cult Ment Health 2017; 10: 174–84.CrossRefGoogle Scholar
Hapangama, A, Mendis, J, Kuruppuarachchi, K. Why are we still living in the past? Sri Lanka needs urgent and timely reforms of its archaic mental health laws. BJPsych Int 2023; this issue.10.1192/bji.2022.26CrossRefGoogle ScholarPubMed
Hapangama, A, Kuruppuarachchi, K. Sri Lanka's response to prescribed drug misuse: is it enough? BJPsych Int 2023; this issue.CrossRefGoogle Scholar
Morley, KI, Ferris, JA, Winstock, AR, Lynskey, MT. Polysubstance use and misuse or abuse of prescription opioid analgesics: a multi-level analysis of international data. Pain 2017; 158: 1138–44.CrossRefGoogle ScholarPubMed
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