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We as a society cannot run away from our problems. We must face them, and come to terms with the consequences of our past collective actions. For we have lived our lives and it is now time to reclaim our country regardless of race, creed, class, caste or political affiliation for the sake of our children and future generations.

Speech by Minister for Economic Reform, Science and Technology and Deputy Minister of Policy Development and Implementation Milinda Moragoda at the international conference on Mental Health and Psychiatry, 4 April, 2002.

Mr. Chairman, Ladies and Gentlemen, for the past twenty years, Sri Lanka has become a society riddled by increasing social disintegration, violence, war and hate. One could even venture to say that we are a society that has lost its soul. I was not surprised to read recently that a study had found one in five Sri Lankans to be suffering from some form of mental illness.

Our citizens have been subjected to trauma, pain, fear, and violence - in every corner of our island be it in the north, south, east or west, in every village and hamlet. Elections, considered to be a routine civic activity in msot countries, here is a period where violence and intimidation and even murder are commonplace. Where a simple activity such as the pasting of posters can result in violence and even killing.

The village as an ideal, is a fiction. With a large percentage of our women seeking employment in the Middle East, the conventional nuclear family is fast becoming the exception rather than the rule.

Families are torn apart, many fathers take to drink, or problems of incest or domestic violence occur, or young children are left to live with their grandparents, while the sudden prosperity from the monthly remittances sent by the wife is quickly frittered away while she labours aborad with the illusion that she will be improving the lives of her family, stomaching all the insults or abuse meted out by a cruel employer, only to return to find her husband no longer at home and her children maladjusted. Each family member suffering in their own separate worlds, suffering their own traumas, alienated, divided in their pain and experiences.

Not to mention the combat zone, where combatants and civilians alike live under difficult conditions in perpetual fear of attack or violence, many having witnessed brutal acts of violence, death and destruction. Recent studies indicate that we have over 600,000 land mines in the combat area and that between 10 and 20 mine causalities occur each month.

The high desertion rate of soldiers points to a potentially larger number of psychologically damaged individuals who now re-enter the non-war affected areas. Nor to mention those handicapped in the war, who have their personal war wounds as a constant reminder of their terrifying experience.

Even the privileged classes, here in Colombo are not left unscathed. Bombs in public places were something very commonplace in congested Colombo over these past several years, leading to further stresses that one experiences in the ever more crowded metropolis, where pollution, break down of infrastructure such as power, roads and services add to the further uncertainty of life here.

I often wonder what compels a young person, in the prime of life to take his life in such a brutal act as a suicide bombing and in this act create further death and destruction of innocent people. What could prompt such hate? Where have we gone wrong? And by the same token I am baffled how it is that the children of the privileged classes dance the night away in the night clubs until dawn in five star hotels while not even 200 kilometres away frightened barely trained young soldiers from less fortunate backgrounds face off another group of young combatants, pitched in battle against each other.

Yes, society has become further brutalized by the war. The types of crimes that have been occurring over the past few years have become even more ghastly. The dilapidated economy which is largely result of the high cost of war, leads to further despair, frustration and anger. Problems of alcoholism, drugs, prostitution and crime have increased due to this.

But have we become inured to this violence and social disintegration? Does the death of soldiers, the next suicide bomb, or crime not register? Do we forget as time goes on about this violence? Do we bury ourselves in escapism. Something has to give. As John Donne once remarked: "No man is an Island." All of these ills rebound on society in one form or other.

Fortunately, the ceasefire has given us a respite from some of the madness. Let us hope that we can find lasting peace to prevent further disintegration and re-establish normalcy in our little island.

Many of us would have experienced the loss of a loved one, the crying spells, the mood swings, sleep difficulties and troubling memories and dreams.

For persons who have been directly affected by violence, you can add further to the above litany: immense shock, depression, guilt, anger and very often a deep desire for revenge.

For those who have lost a child, parent or spouse in the distant war, some may never get over the shock of hearing that their loved one is not returning. These persons may live in a twilight world where reality is like a fog and nothing crystallises. For them each day is a trauma to be lived through, the old memories comeback and they re-live the last moments they had with the victim.

For those who have a loved one missing in the war, not knowing the truth is often more painful than for those who know that their loved ones are no more.

So there are many battles to be fought here. The mental traumas are not caused by one situation alone. There is the war naturally, but there is also a variety of social problems stemming from the lack of social cohesion, lack of economic opportunities, breakdown of the nuclear family, increased violence in society, entrenched class, caste, ethnic interests and political victimisation which often block merit - based upward mobility, social pressures and stresses of modern urban life.

Our economic situation has created many problems as well.

Take the extreme poverty experienced by too many of our rural population. No wonder that suicide amongst farmers is so high. For them the daily fight to feed their families can create unbearable pressures. Ask yourself, how can a father look on as his child dies of malnutrition? He blames himself, naturally, and he questions his own abilities as the head of the household.

Alcohol is an endemic problem in our society today. As is the use of drugs.

Many of our young people are without work. Often they turn to alcohol or drugs as a means of escaping reality if only for a few minutes. For them these few short moments of escape grow into a longer nightmare as they sink into brain damage, physical tremors, hallucinations or even death.

So all of these economic pressures can make life impossible for so many people. The woman working abroad, the father who feels inadequate and the children who suffer from poor health and lack of parental attention.

Sri Lanka's high literacy rate and social indicators, has created its own problem of impossibly high expectations and social pressures. On the one hand, this creates hopelessness and a feeling of a lack self worth which manifests itself in the abnormally high suicide rate among youth and on the other has sparked two successive youth insurrections in the South, the violent nature of which showed the deep resentment and hatred against the establishment.

It appears that Sri Lanka's political leadership and establishment have not delivered to the youth in the North or South of the island.

Everywhere you go in Sri Lanka you can see the problems that the war and an economy in collapse have caused. In the north and east it is mainly the war, loss of property and the inability to have a proper job. In the south it is the effect of young people going off to war, the state of the rural economy and the poor health of so many of our children.

I do not confess to be an expert on mental health. I know what I can see with my own two eyes. And I know that in Sri Lanka we have a huge problem.

Our Prime Minister, Ranil Wickremesinghe is working hard to turn things around. He understands the importance of solving the two key issues - the war and the economy. Neither can be turned around overnight. Nor will they be solved without some further pain.

If we can solve those issues, if we can turn our country around, then we can start to give our people fresh hope.

I believe we have three health challenges to face in the immediate future. The first is to improve the quality of our health service. If you live in Colombo and if you have the money then you can get good treatment. But for so many people the availability of a proper health service is limited.

If they are seen by a doctor many of those who are given prescriptions then find the drugs are too costly to purchase. That in itself leads to frustration and anger against a system that only appears to work for the powerful and the influential. This makes a mockery of the so-called free healthy system which we can ill afford.

Many of our health workers, especially the doctors and nurses work in intolerable conditions and with poor equipment. The joke is that you are more likely to catch a disease from going into hospital than by staying away.

But to improve our health service we shall need to look beyond the normal methods. Our central planning will need to be much better than in the past. We shall have to spend much more in building quality facilities in all parts of the country. And we shall have to recruit many more nurses and doctors than are currently available to us and to give better training to medical personnel.

But all of that involves money. The truth is that until we can turn our economy around we shall not be able to invest in our deteriorating health service or for that matter our education service or infrastructure.

This could be called the 'chicken and egg' syndrome. For the poor health of our people is inhibiting our economic growth. And without the economic growth we cannot afford to spend as much on health as we would like.

Our second problem is to tackle the distress and mental health problems caused by the war.

We are fortunate to have many aid agencies helping throughout the island. They are helping with the rehabilitation of our people. However, in the conflict areas, many people are still suffering from the trauma of being displaced and the shock of finding their homes destroyed when they return not to mention the trauma of those children who have been exposed to the horrors of war and conflict.

We shall need a very special sort of help from clinicians and psychiatrists who are used to dealing with post conflict mental health problems. We shall need to find a large amount of money just to see that part of the country return to normalcy and our people start to heal the mental as well as the physical wounds.

Nor should we forget the devastation suffered by the many poor families in the South and West who have lost loved ones in the war or who themselves may be veterans from the war.

They deserve the very best of treatment.

Our third problem is to heal the wounds caused by our fractured economy. Come with me to many poor areas in Colombo and you will see the devastating effects caused by lack of jobs, alcohol abuse, drugs and the inevitable crime that follows.

Whilst there are many NGOs helping us in these areas there is a gargantuan task to be done if we are not to lose a whole generation.

So far I have talked about the job we face in health generally and mental health more particularly. I was horrified to see the huge global burden of mental illness compared to other illnesses. A figure in excess of 12% or more than double that due to cancer or heart disease.

I accept that mental health is something that must be considered in the macroeconomic decision-making process. I also accept that we need to invest heavily in health. But we shall need to look critically at where our spending is being placed. Where our greatest needs are and how we can benefit our people the most with the limited funds available.

Equally we have to think about how we can create a partnership between Government and the people. For health is not just a matter for government.

It is a matter for all of us to see that we maintain ourselves as healthily as possible. I am reminded of a speech made by George Bush Senior, former President of the United States, in which he said (quote):

"I have spoken of a thousand points of light, of all the community organizations that are spread like stars throughout the Nation, doing good.

We will work hand in hand, encouraging, sometimes leading, sometimes being led, rewarding... I will go to the people and the programs that are the brighter points of light, and I will ask every member of my government to become involved."

Here in Sri Lanka we shall have to do the same. For those of you who are professionals in your fields we need your expertise like never before. We need you to show us the way to a healthier nation. We need you to help us mend the mental damages caused by 20 years of conflict and a declining economy.

We also need civic society to play its part. For friends and neighbours to play a selfless role in healing the wound of our society.

Mr. Chairman, this is an important conference, for our nation cannot sweep these problems under the carpet. We as a society cannot run away from our problems. We must face them, and come to terms with the consequences of our past collective actions. For we have lived our lives and it is now time to reclaim our country regardless of race, creed, class, caste or political affiliation for the sake of our children and future generations. We welcome you all here and we look forward to your deliberations being successful in finding solutions.

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