MENTAL health must be at the centre of addiction care, a psychiatrist told participants at the Fiji Medical Association (FMA) mini conference.
Acting Medical Superintendent at St Giles Hospital, Dr Sheetal Singh, has urged health workers to stop treating drug use as a purely criminal issue.
Instead, she suggested it be recognised as a public health and mental health problem that demanded early screening, empathy, and community-based intervention.
Addressing the conference, she opened by thanking colleagues and mentors .
“You are doing an amazing job,” Singh said before turning to the central message of her talk: mental health cannot be separated from addiction, chronic disease, or general medical care.
She said too many patients are being judged rather than helped, especially those struggling with methamphetamine, cannabis, and other substances.
“Most of the system in our country is criminalising it or institutionalising it,” Singh said, arguing that this approach fails to address the deeper causes of substance use.
In her view, drug use often emerges from trauma, bullying, family stress, academic disappointment, depression, or anxiety.
“There is always mental health affected,” she said, stressing that prevention must begin long before addiction becomes severe.
Singh also drew a direct link between mental health and chronic illness, warning that patients with diabetes, hypertension, and other non-communicable diseases are less likely to follow treatment plans if they are emotionally unwell.
“If the mental health of a person is not in the right state, they will not be able to adhere to the plans that you are giving them,” she said.
She added that stress, fear, and untreated depression could worsen physical illness and drive long-term complications.
Her message was especially strong on early detection. She warned that minor symptoms were often missed until they develop into serious psychiatric or medical crises.
“If you’re not able to pick it up, if you’re not able to address it, then it will lead to a major diagnosis in the future,” she said.
Singh described alarming examples of what clinicians are already seeing: schizophrenia, methamphetamine-induced psychosis, tuberculosis, HIV, and other complex conditions that are difficult to manage in resource-limited settings.
Rather than waiting for specialist facilities, she said frontline providers should build rehabilitation into ordinary clinical practice.
“We do not need to wait for the government to build the building for the rehabilitation centre,” she said.
What matters, she explained, is not a physical structure alone, but an approach rooted in compassion, listening, and respect.
She called for a shift away from judgment and toward harm reduction. “The goal is not immediate abstinence, it’s movement towards the change,” she said.
Singh urged clinicians to ask simple, non-threatening questions about sleep, stress, weight loss, and substance use, and to use brief screening tools such as PHQ-9, AUDIT, and DAST-10 to identify problems earlier.
She emphasised the importance of family support, counselling services, and motivational interviewing.
“Mental health is not an optional extra in medicine; it is central to addiction care, prevention, and recovery. We need to include mental health now.”
