Failure to detect mental illness driving drug abuse, says psychiatrist

Fiji’s escalating drug crisis is being driven not only by the widespread availability of substances but also by failures in frontline healthcare to detect and manage underlying mental health conditions early.

Speaking at the Fiji Medical Association West Conference at the Novotel Nadi last Saturday, psychiatrist Dr Sheetal Singh said substance abuse and mental illness were increasingly intertwined, yet routinely missed in clinical practice.

Dr Singh said methamphetamine, cannabis, alcohol and ketamine were readily available in communities, but many patients passed through health facilities without proper screening due to stigma, denial and time constraints.

“Most patients are in denial, and as doctors we are not prioritising mental health and drug‑use behaviour,” Dr Singh said.

Dr Singh said clinicians often overlooked clear physical signs of substance use, including poor dental hygiene and dry mucosa, because structured screening was not consistently applied in outpatient care.

She said the problem was compounded by a culture of judgement and time pressure in clinics, particularly in private practice settings where consultation time was seen as a financial trade‑off.

“Some practitioners fear losing clients if they ask about drugs. When we start interviewing about substance use, people often do not come for the next clinical follow‑up.

“We need to be more empathetic and not judgemental. Listening is more powerful than lecturing,” she said.

Dr Singh called for routine screening using validated tools such as the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST) and Patient Health Questionnaire (PHQ‑9), likening them to routine vital‑sign checks.

“The goal is not instant quitting. The goal is movement towards change.

“You need to express concerns and relate substance use to the current health issue. You can say this presentation may be linked to drug use.

“People may not be interested in general drug talks, but when it is related to their current condition, they are more likely to engage and consider reducing or stopping use,” she said.

Dr Singh warned that untreated anxiety, depression and insomnia were major drivers of self‑medication, particularly among young people and working‑age adults, leading to escalating dependence on substances.

She also highlighted a case involving a 12‑year‑old patient with HIV and methamphetamine dependence, describing it as evidence of severe early vulnerability and system failure.

“These children are victims. Every client could be a user. You are not there to judge; you are there to identify and refer,” she said.

Dr Singh said patients should be categorised into at‑risk groups, current users without complications, and those already experiencing severe outcomes, stressing that early intervention was critical to preventing long‑term strain on the health system.

“If we don’t treat vulnerable populations now, in 10 years the complications will overwhelm us,” she said.

She also urged stronger integration between health services and community‑based rehabilitation programmes, including faith‑based initiatives, to address gaps in government capacity.

“Fiji’s drug crisis will continue to escalate unless mental health is identified earlier, screened consistently, and treated as a core part of primary healthcare,” Dr Singh said.