Feature: Mental health issues still stigmatized in Bhutan but slow progress being made

On the busy streets of Bhutan's capital Thimphu city, a tall, slender, good-looking and well-dressed man in his late 20s can is seen walking around on a regular basis, yet he is laughed at and mocked by those he talks to.

Sonam, a pseudonym, is a young school dropout who is fighting with mental illness. He was born to a well-off family and wasn't left on the streets, but isn't receiving treatment for his illness either.

Three hours away from Thimphu, in a small village in the Haa district, 59-year-old Pempa, who graduated from university in the late 1980s and used to work for the government, now spends his days roaming the village.

Everyday he walks for miles and returns home towards the evening, where his family would keep food for him, but not to sit down to eat with him.

He has no friends and can't talk to anyone, as people fear being close to him. He eats alone, stays alone and talks to the sky. He has been declared mentally ill since he was in early 30s, and forcefully removed from his government job.

Unlike Pempa, his neighbor Phojo has been staying indoors for more than 40 years. Often she peeps through the window and sings at villagers passing by her house, but she doesn't get to step outside.

At home she is loved and cared for by her three sons, but they don't let her go outside, fearing she might be harmful to others.

People are scared to talk to her or visit her house, if she is alone.

This is the harsh reality of life for those suffering from mental illness in the small Himalayan country, often referred to as the last Shangri-La. The country, with a population of 700,000 people, has only a handful of psychiatrists and no specialist hospitals to treat those suffering from mental illness.

The psychiatrist said although mentally ill patients are not discriminated against, there is a stigma attached to mental illness, thus preventing people from seeking early medical help. The tiny country has thousands of mentally ill patients who, for this reason, have never visited a hospital, doctors said.

The psychiatrist with the JDWNRH hospital in Thimphu said most people come for consultations and diagnosis as a last resort, or when they are refereed by other physicians.

In other circumstances Bhutanese people sometimes try to get help from traditional healers, including Shamans, or spiritual healers before opting to visit a regular hospital, even for other illnesses. Such a culture contributes to the fact that people seeking help for mental issues, often do so later rather than sooner.

Doctor Nirola said that the majority of people suffering from schizophrenia in the country have never been treated properly. They were either left to be on their own or restrained and incarcerated if they were violent. This accounts for why some people suffering from schizophrenia can be seen roaming the streets, the doctor explained.

Modern health care in Bhutan only began in the early 1960s, prior to that religious rites and traditional systems of medicine were the main forms of treatment, as per official health reports. Although the primary health care system has become exemplary in the South East Asia region and applauded by the World Health Organization, a dedicated mental health care program was only launched from 1996.

Even today, mental health care services are provided by general hospitals, and there are officially only three practicing psychiatrists including one volunteer. The total number of patients treated so far is over 6,000, spanning anxiety disorders and depression, these being the most common disorders.

Following a three-year action plan in Bhutan to prevent suicide, implemented in July 2015, it was found that mental health issues, including depression, can greatly increase the risk of suicide.

Hence, a mental health curriculum has been included in the pre-service training of the health workforce at the Royal Institute of Health Sciences, and the National Mental Health Program in the country.

The curriculum states that the mental health services available in the country are still limited and rudimentary, with limited trained mental health professionals. There are no clinical psychologists or social workers in the mental health care cadre in the whole of the country, it adds.

A thesis by medical student Rinchen Palzang proffered that organizing mental health services for this predominantly scattered population with diverse cultural practices is indeed a daunting task.

Low financial resources, scarcity of mental health personnel, lack of comprehensive mental health policy, presence of conflicting healing systems, and, the stigma of seeking help for the mentally ill further compounded this complex issue, he found.

The government spends 10 percent of the country's GDP to provide free health service, however, of that only about 1 percent is allocated for mental health care.

Doctors here have said that mental illness is an emerging issue in the country and also a contributing factor for the increasing cases of suicide. It require immense awareness to help prevent mentally ill patients from being stigmatized by society, and also to urge families about the necessity to consult psychiatrists at the early stage.

But while progress in this area may be slow, things are improving commensurate with the country's modernization, but the pace of progress is being hampered by a lack clinical psychiatrists and nurses trained to provide appropriate care to those in need.

Palzang further said the allocation of adequate funds is necessary to provide the best standard of care to people with mental illness.

He suggested that policy makers need to take into consideration the costbenefit analysis of treating people with mental illness and accordingly allocate sufficient funds for mental healthcare in order to make healthcare services viable and sustainable in the country. Enditem