By Katalina Siasau

Stigma surrounding mental illness in Tonga is the main stumbling block in delivering and improving mental health services here, said Dr Mapa Puloka, who faces many negative or discriminatory attitudes towards mental illness in his work and workplace.

As the Psychiatric Specialist and Authorized Psychiatrist in-charge of the Psychiatric Unit of the Ministry of Health, at Vaiola Hospital in Nuku'alofa, Dr Puloka, in an interview with Matangi Tonga this month, talked about the difficulties of mental illness stigma and mental health misconceptions in Tonga.

World Mental Health Day is celebrated every year on 10 October and this year the theme set by the World Federation of Mental Health [2] was workplace mental health. The theme highlighted the importance of addressing mental health and wellbeing in the workplace, for the benefit of people, organisations, and communities. It also stressed the importance of coming together and talking about our mental health.

So what is stigma in mental illness? Stigma is having negative or discriminatory attitudes towards mental illness.

In Tonga, stigmatized behaviour towards mental illness includes ridicule (luma’i), mocking (fakakata’aki), and neglecting (hanga kehe mei ai.)

Dr. Puloka said that mental illness stigma is in fact a lot more common in Tonga, even though it is not acknowledged or often talked about.

He said that in his own workplace at Vaiola Hospital, psychiatric care is unattractive to doctors and nurses, because of the stigma surrounding mental illness.

Dr. Puloka has been leading the Ministry’s psychiatric care for over 30 years, and for 18 years was the sole doctor in the psychiatric care unit.

“The psychiatric field is not attractive to other medical doctors. Very few want to work in this ward.”

Dr. Puloka said doctors and nurses work with him only as interns and not permanently.

“I’m 66 years old, I'm supposed to be retired. The reason why I’m still working is because there is no one else!”

Education

Dr. Puloka said young Tongan doctors are being trained but he knew of only one who was currently overseas pursuing their Masters degree in mental health, to be completed in 2027.

“It is a challenge trying to make psychiatric care attractive to other doctors.”

He said psychiatric care is even stigmatized among doctors and nurses. “My name along with my ward is stigmatized. It is associated with the terms lunatic, idiotic, and madness.

“It tells us that this is a serious issue, that mental illness stigma is deep. It is not talked about.”

However, Dr. Puloka noted that the more he raises awareness, the more it becomes a paradox.

"I see it as a paradox. The more awareness people have of mental illness, the more stigma there is."

Dr. Puloka believes that it would help if other people in the community would help to raise public awareness on mental illness.

He hoped that having "normal people" promoting mental health would help lessen the stigma associated with the psychiatric ward.

Mental Health Care

Meanwhile, the Pasifika Medical Association (PMA) from New Zealand is conducting a Pacific-led project that aims to improve mental health and wellbeing in Tonga, by strengthening the capacity of health and community providers to provide mental health care.

Dr. Puloka said he is very supportive of this three-year program, as it would help lessen stigma.

The World Health Organization (WHO) defines mental health as a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

This week at the Commonwealth Heads of Government meeting in Apia, Samoa, leaders strengthened commitments to addressing mental health issues as well as non communicable diseases in its Commonwealth countries,