Relative to its economic indicators, Sri Lanka has a high health status. The life expectancy in the year 2001 was 70.7 years for males and 75.4 years for females. Maternal and infant mortality rates have shown a downward trend over the past half century and now are around 2.3 per 10 000 live births and 16 per 1000 live births, respectively. These trends are mainly due to the high literacy rate and comparatively large investments made in health and social welfare.

The situation regarding mental healthcare services is very different. As in many developing countries, negative attitudes to mental illness, social stigma and a lack of appreciation of the suffering and disability caused by mental illness have resulted in low priority being given to mental healthcare services in Sri Lanka. This situation is, however, beginning to change.

Overview

Major psychiatric illnesses form the bulk of the clinical load of psychiatrists in Sri Lanka. The suicide rate, though declining, is still higher than global average rates (De Silva & Jayasinghe, 2003), and alcohol-related problems are rising (World Health Organization, 1999). Drug misuse, which appears to be less of a problem than alcohol misuse, is mainly confined to heroin and cannabis (Ratnayake & Senanayake, 2002).

Long-term mental illness has a considerable social, economic and health burden (De Mel, 2001). The fast-growing elderly population, which will amount to 21% of the overall population by 2020, is likely to pose enormous mental health problems. Thirty years of civil disturbances coupled with ethnic violence have resulted not only in trauma but also a range of other problems, including loss of life, refugees, displacement, the disruption of the physical and social infrastructure as well as the poor economic performance of the entire country. The inevitable mental and psychosocial distress associated with the above problems, especially in the north and the east, compounds the existing mental health burden.

In the absence of a formal referral system, patients have the liberty to consult any mental health professional – or any other type of healer – in any part of the country. In view of the concentration of services in urban areas and also because of the perception that services in urban areas are of better quality, many patients gravitate towards these centres.