Depression in Maldives: Part Two

Aaiz Ahmed Rasheed, a trained and experienced Maldivian psychologist was interviewed for this article in order to get the clearest picture of depression in Maldives, with a focus on Male’ and touching on the Maldives as a whole.

While touching on awareness, understanding mental health and laymen’s understanding, Aaiz stated that people have gotten too friendly with categorical diagnosis and not really trying to understand what’s happening. He stated that this is not just a layman problem or just a professional problem. It is imperative that things such as this is not treated with textbook understandings as this is a very deep and complex topic.

What needs to be understood is what is making someone mentally well or mentally ill. WHO’s definition of mental health focuses more on a system that makes someone mentally well or ill. The less mentally well off someone is, illness tends to creep in.

While tackling the symptoms would be a go-to, it is better to understand what is missing from their system that would otherwise make them well, such as recreation, family, friends, loved ones, the aforementioned material safety, etc. This subsequently leads to a diagnosis.

What needs to be prioritized is the person first. To understand what makes them tick and fill in the missing blanks. Therapy with a psychologist is the first step that needs to be taken from a professional vein, followed by any medication if needed.

Aaiz stated that psychiatry is one of the ways treatment is conducted for mental illness or mental health issues in general. Medication tends to work faster as a targeted approach. However, it can create dependency. It tackles more surface level issues, without really touching on the root causes. While medication is good, it should not be a first resort, if the person can go about their daily lives without issue.

Aaiz said that therapy ideally looks at the person themselves on an individualistic level. Learn about them, their lives as a whole such as how they were like as children, their school life, relationships, medical history, their relationship with their family, the kind of trauma they have, etc. Afterwards come the symptoms and then the process of putting everything together.

This is an investigative process, with questioning, testing, etc. This leads to diagnosis, what kind of path to take to tackle the issues, reduce symptoms, whether they need medication while all of this is going on, etc. A very holistic understanding of a person is needed.

Aaiz went on to emphasize that quality care is extremely important over speed. Mental health camps are conducted in islands, where expedited consultations are held in order to accommodate as many people as possible. Sometimes even interns do the consultations. A large amount of diagnoses are given to patients, along with obscure treatment plans without maintenance and no way for reviews to take place.

This only creates more problems when the path that should be taken is quality care that takes time to look at the individuals as a whole.

Aaiz stated that when looking at treatment, there are faster forms of treatment, one such being Cognitive Behavioral Therapy (CBT).

Aaiz explained that CBT is a scientific form of therapy with well researched and well known advantages. However, oftentimes this ends up being a brief form of treatment that is over utilized in Maldives with a high turnover rate due to its success within four to eight sessions.

However, Aaiz went on to say that it is known that there is a much higher percentage of relapse in brief therapy compared to the slower forms of treatment due to certain issues which are not addressed.

Longer treatment orientations can last one to two or three years but it tackles all the deeper issues, lowering chances of relapse. However, this leads to the issue of longer wait lists, which leads to fewer people getting treatment overall. Therefore, whichever orientation your therapist follows, it is important to not just address symptoms, but the deep roots of issues as well., stated Aaiz.

Psychologists take around one hour sessions, with best practice stating that they should not take on more than five patients a day. But due to a lack of psychologists in Maldives, a lot of them tend to take on 6 to 8 patients daily. This capacity issue comes from a major increase in demand, along with an insufficient number of psychologists, which Aaiz says that it is not on the professionals, but rather the system itself.

More psychologists are needed to address this but the way it is being addressed now is with rapid treatment protocols which doesn’t get to the depth of the problems.

While training psychologists in Maldives, Aaiz said that trainees need more practical experience and training in order to truly understand how therapy works. Internships and placements are key, but with this being quite unavailable in Maldives, this can create more issues down the road as greenhorn psychologists need to rely on hands-on experience from patients. Confidentiality is also quite a big factor in Maldives, as patients are not really open to a trainee being privy to private details about their lives while being treated by their therapist.

A lack of capacity for clinics sees issues in training and in serving patients. Clinics in Maldives tend to only have two to four rooms. If one therapy session runs for one hour in four rooms each, this will see around 24 patients within six hours. That is one working day, and most clinics tend to run into the night, which can stretch the patient number to 48. However, when running the clinic for two sessions, this will increase costs in order to run at full capacity.

When this is the case, Aaiz said that it is quite a challenge to train psychologists as well, which reduces the quality of psychologists overall with less training being available along with the already few number of psychologists.

Aaiz went on to say that the exorbitant prices in attaining treatment is due to the private sector not being as well off money-wise. Most private clinics are homegrown businesses renting out apartments in order to run their business. Covering overhead costs along with paying salaries can take a heavy toll, which explains the exorbitant treatment prices. This also leads to less patients coming in to seek their services. When there are fewer patients, clinics are forced to increase prices to cover overhead costs. Clinics have opened and shut down due to this as well.

Aaiz said that despite these financial barriers, he is glad to see that people prioritize their mental health and continue to seek help.

Aaiz said that the most important thing people can do in this day and age is to increase awareness as much as possible. Fact check what you are reading and build your own coping strategies as much as possible and find reflective spaces.

Journaling, grounding oneself, mindfulness, etc are surface level coping strategies that need to be experimented with. It can be quite trial and error but each individual is different. Find things that work for you and this will help one feel more grounded, and while this is not a 100 percent fix, it will help quite a bit, stated Aaiz.

Another thing Aaiz said one can make use of is social support. A big part of why therapy works is, is a person willing to sit with you for an hour and truly listen and try to understand you? This itself can make a lot of difference. When you have issues you know that won’t change or are difficult to overcome, it is important you surround yourself with healthy individuals. Seeking and forming healthy support structures are very important.

Aaiz said that one needs to find proper resources that are available from private clinics. Some clinics have a resource where trained staff can hold chat sessions to those in mental distress. Find and tap into support spheres such as this, says Aaiz. The Therapy Center offers such a service.

He went on to say that, when speaking on pain and pleasure, if you are experiencing too much pain, find things that give you pleasure and make you feel better. This can range from swimming, dancing, singing, music, gaming, taking a walk, whatever works for you. Do the things that make you feel happy within healthy limits.

He ended by saying that good information and proper awareness needs to be prioritized as overdiagnosis and self-diagnosis can also be an issue. While social media may show tips and tricks, it is always better to dive more into proper psychology podcasts, fact check against available data, read up papers and topics from valued resources, etc. Do not look at diagnostic criteria but look at actual accounts, at people who have the actual mental health problems.