Where can you find help?

Sri Lanka has both governmental and non-governmental services available for people with mental health/psycho-social problems and sometimes it might seem difficult to access these services.

The list below is not conclusive but I have attempted to list out some services that you might find helpful. It is okay, to seek help when you need it.


 Adult and Child Mental Health

1. National Institute of Mental Health, Angoda, Sri Lanka.
    +94 112 578 234

2. Lady Ridgeway Hospital
   Dr Danister De Silva Mawatha, Colombo 00800, Sri Lanka

+94 11 2 693711

3. National Hospital, Sri Lanka ( Ward 59)
    0112691111 ext. 2279

4. Colombo South Teaching Hospital ( Kalubowila)
    + 94 11 276 3261.


Counselling Services

1. Alokaya Counselling Centre ( FPA)
    +94 2 584 157 ext. 233

2.  Damrivi Foundation ( Counselling with a Buddhist foundation)
     0117272555 

3. Women in Need
    Crisis Line: 0114718585

Befriending Services

1.Sri Lanka Sumithrayo ( Face to face,telephone,e-mail)
http://www.sumithrayo.org/
60B Horton Place, Col.07
0112692909/0112696666

2.CCC Line-1333 ( Telephone only)


Child Protection 

1. National Child Protection Authority
    Helpline: 1929

2. Escape 
    0114954111/ 0117398100

3. Emerge Lanka Foundation
    0112 512 872/ 0112512 729

Lesbian, Gay,Bisexual, Transgender, Inter-sex and Questioning

1. Equal Ground
    5679766/ 2806184

MAYA'S STORY- CHILD SEXUAL ABUSE- A SURVIVOR'S TALE

What you need to know before seeing a therapist

The decision to see a therapist is not an easy one to make and there can be some back and forth which is a struggle for some. There is also stigma and sometimes shame associated with being a service user that can cause more difficulties in getting the help we need.Sri Lanka is still in it's infancy when it comes to Psychology and Psychotherapy so there maybe questions and concerns that you, the people, might have.

This is an attempt to answer some of those questions so that the entire process of going for therapy might be made easier for you.

1. We go for therapy due to different reasons. We may have a crisis that we need help with or a lingering problem that needs to be solved, or sometimes parents, teachers, and elders may force us to see a therapist. This is difficult for some of us and might cause some confusion and doubt. We might not be ready, or not willing to start therapy and that is okay. There is no need to rush unless we are in dire circumstances or if there is a potential risk of harming ourselves or someone else.

2. It is important to have an initial conversation with the person who might be your potential therapist either over the phone or in person. This conversation would help you know more about the background and qualifications of the person so that you feel more confident. The advantage of such a conversation is also that both the therapist and you would be able to ascertain whether you are suitable for each other. You have the opportunity here to clear any doubts or concerns you might have.

3. Therapy is a transparent process and so is the fee charged by the therapist or the service for the provision of services. Ask your therapist details about charges for both assessments and psychotherapy,

4. The first time you meet your therapist would involve an assessment and history taking, where the therapist would ask you questions about different aspects of your life. You will also be asked about signs and symptoms that you experience and difficulties that you face in your life. This might be overwhelming for some of us, to open up, to share certain things we have never shared with anyone else. However therapy is a safe space, where you have the opportunity to be yourself and also to share your vulnerability with someone who is accepting and non-judgemental.

5. Your therapist will also discuss issues concerning boundaries and confidentiality with you. Ask questions, and clarify any issues that might crop up.

6. There maybe instances where your therapist might seek information from a family member/s and this would be done with your consent. You can also invite family members to join you in session and this decision can be made collaboratively with your therapist.

7. You might find your therapist jotting down notes while in session and this would most often be done with your consent and you will be able to read those notes as well. You can request for notes at any time and you can share those notes with family members etc if you wish to. It is the responsibility of the therapist to make sure that records are kept safe and confidential and they will not be divulged to anyone without your informed consent. However there are limits to confidentiality and this would be discussed with you in the first session.

8. Standardized assessments might sometimes be conducted to get a baseline score or to measure progress so that you know that your therapeutic goals are being met. These assessments include comprehensive reports that your therapist will share with you. You can ask him/her for a copy.

9. A session would usually last up to fifty minutes or one hour but this is flexible and you can discuss this with your therapist.

10. It is okay to cry in session, because it is your session. and you can be your authentic self. You will not be criticized or judged. You are safe in therapy and your therapist will hold space for you.

11. There will come a time where therapy has to end, and endings are often difficult, no matter whether it is a therapeutic relationship or otherwise. Your therapist will work with you towards this and you will most likely have booster sessions after a certain period of time so that you can follow up on any issues that may come up.

12.Finally, you have the responsibility as a client to inform your therapist of any difficulty keeping to appointments,  and also to engage in any homework given in session. You are an active catalyst of change and in order to achieve your therapeutic goals, there needs to be commitment and mutual respect in the therapeutic relationship.



Disclaimer: I've written this post both from the perspective of a practitioner and a client, because as a student of Psychology, I've been in therapy too.

Self Harm in Young People

What is Self Harm?

Self harm is a way of coping for young people especially when there is a need to express difficult emotions. These emotions might not be easily expressed in other contexts. Physical pain sometimes is easier to deal with than emotional pain because it is almost visible and tangible. However it is important to understand that this only gives someone temporary relief and does not include dealing with underlying emotions and issues that an young person might be facing in his/her life. Some people engage in self harm for short bursts of time, whereas for some it is a long term, chronic problem, almost a ritual.

Why Do Young People Harm Themselves?

The reasons are varied and there is no one accurate answer to this question. 

­

It temporarily relieves pressure and pain.

It helps one feel something other than feel completely numb, to feel alive.

It externalizes emotional pain, so you feel pain outside rather than inside.

It could be self soothing behaviour for someone who has depleted resources within and without.

It could be a form of self nurturing, especially when tending to wounds for someone who was not shown love and care.

Self harm could be a way of asking for help indirectly.

Let's play True and False!

 Here are some common myths about self harm that have been challenged with facts.

1. Young people who self harm are attention seeking.

False- They are trying to cope with the painful feelings/pressures they experience.

2. Young people who self harm use it as a way of releasing tension and feelings.

True – It is sometimes said that physical pain releases some of the emotional pressure.

3. It is easy to stop harming yourself.

False- You find young people harming themselves because that might be the only way left for them to cope. The underlying feelings are the main issue to be focussed on.

4. Young people who self harm are usually feeling suicidal.

Mostly False- Self harm is not always an attempt at ending one's life. It is more a way to cope with extreme stress and emotional pain. However there is always a risk of those self harming attempting to end their lives at some stage.

Factors that Influence Self Harm in Young People

Young people in Sri Lanka have numerous challenges related to growing up, academics, parental pressure,mental health problems etc. Different people deal with these pressures in different ways, some adaptive and some maladaptive. Each young person copes in a different manner when compared to peers in the same age group and it is important to take heredity and the environment into account as well. The life context of the adolescent or the child would also play a role in influencing coping ability and coping skills. Parenting also plays an important role here, in order for the person to learn adaptive coping strategies.

Other influencing factors might include...

·       Relationship problems

·       Poor body image

·       Bullying

·       Exam stress

·       Failiure

·       Loneliness

·       Not having someone to talk to

·       Guilt

·       Rejection

·       Trauma/Abuse ( sexual/physical/emotional)

·       Substance misuse ( Alcohol/Drugs)

·       Low self esteem

·       High impulsivity

·       Lack of problem solving skills

·       Teenage pregnancies

·       Bereavement

How do Young People Self Harm?

·       Cutting

·       Biting self

·       Burning,scalding,branding

·       Hair pulling

·       Head banging ( against a wall)

·       Picking at one's own skin

·       Breaking bones intentionally

·       Reckless driving/sports

·       Unsafe sex/promiscuity

·       Drug/Alcohol abuse

Note: This list is not conclusive

What are the Warning Signs?

·       Withdrawal from activities the person once enjoyed

·       Spending increased amounts of time alone

·       Prolonged time spent in the bathroom/bedroom

·       Sharp objects like scissors,knives,razors dissappearing from their usual locations.

·       Unexplained cuts,bruises,scars,burns.

·       Wearing long sleeved t-shirts/shirts at inappropriate times

·       Blood stains on clothing,bedding and towels

·       Frequent accidents

·       Unexplained smell of Dettol/Savlon/Surgical spirits

·       Frequent mood fluctuations

·       Changes in eating and sleeping patterns

·       Irritability

·       Low self esteem

·       Feeling worthless

·       Previous attempts

Self harm might not be identifiable at first, because it is often subtle and the young person might not want anyone to find out. This is where open communication between children and parents, an open,safe environment and a listening ear becomes extremely important. The adolescent might self harm because of the lack of safety and trust in his/her relationships,familial and otherwise. Cutting might be the only anchor they can find. Everyone deserves feelings of safety and this should be emphasized on in parenting.

There is no one social strata, ethnicity,religion, caste or creed when it comes to self injury. It is not only the unfortunate adolescent or child in a rural village that would self harm, but it happens right under our noses even in Colombo 7. It is easy to live in a cocoon of comfort,luxury and illusional safety, and think that this sort of thing will not happen to my son or daughther. However it does come as a rude shock for some parents, when they finally open their eyes to notice that cut on their son's forearm. Distraught, angry, ashamed, confused, guilty are some of the feelings a parent might encounter at that moment, but this could be minimized or avoided. It is preventable. Love, respect and affection is all what you need sometimes, coupled with non-judgemental compassion, and not so much a psychiatrist or anti-depressants.

What do I do if my Son/Daughter Self Harms?

Try not to panic. I know it is easier said than done, but stay calm and ensure the child's safety.

There might be injuries that require immediate medical care. You know what to do, call 1990 and ask for an ambulance.

Now, just listen. There is no need to judge, criticize or blame yourself or the child. Just be open and available. The young person needs compassion, love and kindness. This is sometimes powerful, way more than what a doctor or a therapist can offer.

Ask about thoughts/plans of ending his/her life. Ask directly, don't beat around the bush.

Allow the young person to be in control. Listen to his/her views, and keep him or her informed of every step that you take.

Consult your son or daughter on how they would like to be supported. Are there any immediate concerns? Threats to their safety? Anyone else they'd like to talk to? Anything they need?. Ask them, and ask with respect.

If you and your child arrive at a place where a collaborative decision has been made to seek help, then visit a psychologist or a trained counsellor.

“ Hope is the thing with feathers that perches on the soul-and sings the tunes without the words-and never stops at all”- Emily Dickinson

Child Sexual Abuse- Prevention and Intervention

" An old, fat grandpa fondling his grand-daughter inappropriately",

" The school van driver having time alone with a young girl in his van"

" The ayah at school, making stealthy trips to the wash-room with an unsuspecting child"

" The tuition master, going astray from his tuition"

These are tit bits of what I have seen in the media amidst countless other stories of incest, rape, sexual abuse/assault carried out on young children by adults in different parts of the world. Ideally, the westerners with low moral values, would indulge in this, or so we conveniently think, but the real picture is something that we sometimes deliberately choose to brush aside, because its unpleasant,shameful, disgraceful, stigmatizing, or we merely worry about what our neighbours will say.

Rings a bell?

Ding Ding! It happens in Sri Lanka too. 

Child Sexual Abuse is the interaction between a child and an adult ( or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer. It is a reality that is omnipresent in today's context, and there is an overdose of it in the media, bang in front of our eyes, but sometimes avoidance takes over, and that is what helps maintain this ugly phenomena, amongst other things. This article focusses on certain aspects that requires our attention in order to prevent child sexual abuse and also to intervene in the event that it does occur. It can happen to anyone's child.

First things first!

1. Child Sexual Abuse is wrong! No matter who does it.
2. The domination of the child is key here.
3. The child is not to be blamed.
4. The child does not understand the meaning/signs of sexual abuse.
5. It can happen anywhere, to anyone.

Forms of Child Sexual Abuse

1. Touching a child's genitals or making a child touch someone else's genitals.
2. Playing sexual games with the child  " i.e. "pants down" games.
3. Putting any object/body part into the vagina,mouth,anus of the child.
4. Exposing one's genitals to the child.
5. Exposure to pornography.
6. Sexual acts with animals in front of children.
7. Photographing a child displaying sexual behaviour.
8. Coercing a child into prostitution.
9. Abusing another person in front of the child.

Who Abuses Children?

It is often someone close to the child that he/she trusts, and the offender may groom people around the child to establish trust. You as a parent,caregiver, teacher or just as a responsible citizen need to watch out for these behaviours and take appropriate action.

Grooming Behaviours

1. Offering to baby sit or taking the child on overnight outings alone.
2. Actively excluding a child from other adults and children.
3. Insisting on physical affection like kissing,petting and hugging.
4. Being overly interested in the sexual development of the child.
5. Increasingly spending time alone with the child.
6. Taking unnecessary pictures of the child.
7. Exposing one's genitals to the child.

Signs of Child Sexual Abuse

1. Sexualized behaviour that would be inappropriate for the child's age.
2. Exhibiting behavioural problems and you might also notice withdrawal, depression and over compliance to instructions.
3. Avoidance of certain people and places.
4. Imitating sexual sounds.
5. Mutism.
6. Repeating certain phrases i.e " Get Under" " Don't Tell" " Suck This".
7. Self injury ( cutting, banging head against the wall etc)
8. Unexplained gifts from 'new' friends.
9. Anxiety
10. Nightmares.
11. Bite marks, wounds, bleeding around the genitals, difficulty sitting or excreting, urinary problems, would also be possible indicators of sexual abuse.

What You Can Do

1. Believe your child when he/she reports something.
2. Have clear guidelines at home and also for when your child is outside.
3. Model privacy and appropriate behaviour at home ( Knock before you enter your child's room).
4. Bedrooms and bathrooms- Sexual abuse could occur here, so ensure privacy and also be alert.
5. No secrets.
6. Provide basic sex education.
7. Teach your child about good/bad touch.
8. Help your child be independent.
9. Teach your child to respect his/her body.
10. Trust your instincts.

It is essential that you report any suspicions of abuse taking place to relevant authorities and in the event that abuse has taken place, a medical examination is of utmost importance. Do not wash your child or change his/her clothes before the medical examination is carried out. 

Where Can You Get Help?

  Police: 119/118

 National Child Protection Authority: 1929 ( Helpline)

 ESCAPE: 0114954111

Sleep Hygiene- Daily Practices to Enhance Quality of Sleep

Sleep hygiene is nothing but an umbrella term for good sleep habits which helps maintain a healthy sleep cycle and also contributes to well-being. There are different practices that people adapt when it comes to sleep and these vary culturally and it is also important to note that sleep has different meanings for different people. The intention of writing this blog is to create awareness about how sleep hygiene is important especially when dealing with Psychological illness.

Why is quality sleep important?

Sleep is essential to rejuvenate our minds and bodies after a hard day, and it also helps regenerate cells that are damaged and basically replenishes the entire system with all that it has lost during the day. Sound sleep also prepares your brain for the next day, and promotes growth and learning. Our hormones are also sufficiently balanced during sleep, which helps maintain homoeostasis in the body. You might have noticed, feeling fresh and alive the next morning if you have had a good night's sleep. This is because sleep has a positive effect on our immune system as well, and helps fight diseases and other harmful agents in our bodies.

It is common to hear an old grandma saying ' Puthe, panadol peththak beela, nidaaganna, ethakota oyage una bahi'. This highlights the importance of sufficient rest and sleep in all aspects of our lives. However there are also situations in which we find it difficult to sleep, or experience insomnia. This could be due to illnesses like depression and anxiety, heightened stress levels, pain, etc and this tends to affect our overall functioning.

What does inadequate sleep do to us?

 Dizziness, lethargy, loss of balance, increased appetite, are some of the phenomena we experience when we do not get adequate rest. I believe most of us would have experienced this at some stage, especially when completing dissertations or assignments, or meeting deadlines. Lack of sleep could also cause accidents and pose risks to our safety. Our reaction time decreases and this could make us prone to serious accidents, especially while driving.

Let's crack some myths about sleep and insomnia

1. A drink will help you sleep

Alcohol might help you sleep when you find it most difficult to fall asleep, but as it begins to travel through your body, it might make you feel restless at a later stage and even cause you to wake up earlier than you intended to.

2. Insomnia is only due to psychological reasons

   Insomnia can be caused to due to poor sleep hygiene, pain, drug side effects etc.

3. Exercise helps you sleep

   Exercise does induce a great feeling of well-being in us which will help us experience better sleep, but, exercise just before the time we hit the sack can cause our bodies to be stimulated, overtly alert and could increase body temperature which will make it difficult to achieve good sleep. Avoid exercise close to the time you plan on sleeping.

4. Watching TV or staring at the computer will help me sleep.

  Wrong! This will only stimulate you further and reduce brain melatonin levels which will make it difficult to fall asleep. Shut down your computer and TV when you are ready to sleep, and as an alternative put on some relaxing music.


Sleep hygiene tips for better ZZZZzzzzzzz....

1. Get Regular: Discipline yourself to go to bed and wake up at a certain time everyday and this regular rhythm will help you get adequate rest.

2. Say No to Caffeine and Nicotine: It might be beneficial to avoid consuming caffeine based products and nicotine based products as you are approaching bed time as these act as stimulants and will prevent you getting a good night's sleep.

3. Associate your Bed only with Sex and Sleep: Avoid using your computer, having meals, etc on your bed as this will only add more clutter to your 'peace' time. Therefore your body will learn the connection between your bed and sleep.

4. Get Out of Bed and Try Again: If you have not been able to sleep for 20 minutes or so, get out of bed, sit quietly on a couch/chair and do something boring like counting back from 100, or reading the phone book, and try again when you feel sleepy.

5. A Comfy Room is Ideal: Make sure your room is quiet and comfortable,especially where temperature is concerned. The room should be dark, and noise free.

6. Use a Sleep Diary: To note down your sleeping habits, patterns so you have facts rather than assumptions. This will help you make necessary changes.

7: Eat Healthy: Heavy meals before bedtime will make it difficult to fall asleep, and unbalanced meals will also do the same. So, you know what to do!

8. Take a Shower/ Bath- A hot water bath before bedtime will help you sleep.

It is also important to consult your doctor and get medical advice if you have chronic sleeping difficulties, and do remember to go easy on yourself:)

How Important is it to Listen?- TED Talks on the Value of Listening

Watch!