Bhutan is dealing with increasing mental health disorders like depression and anxiety and disabling problems like schizophrenia, with recent research warning that some mental disorders are affecting even primary school children.

Globally, about one in eight persons live with a mental health disorder, according to the World Health Organisation, and studies link the global increase in depression to the use of social media, including gaming.  

As a small country which has identified well-being as a development goal, Bhutan is challenged to do more to alleviate the suffering that comes with mental health disorders. What are some of the mental health incidences Bhutan faces today? 

The spring 2023 edition of The Druk Journal highlights specific problems:

Trauma experienced in childhood result in disabilities later on in life, such as anxiety, and prolonged depression if help is not sought.

A Thimphu thromde study of the psycho-social well-being in 33 schools in the capital covering 24,036 students show a range of mental health disorders from depression, anxiety, panic attacks, social anxiety to Attention Deficit Hyperactivity Disorder (ADHD), Post-traumatic Stress Disorder (PTSD), Bi-polar Disorder and Obsessive Compulsive Disorder, Schizophrenia. 

Depression and anxiety was diagnosed in seven percent, or 936 respondents, in the study (youth from grades 5 to 12), and one percent, or 146 respondents, of younger students (grades 4 and below).

Triggers of mental health disorders such as bullying and abuse was reported in the form of verbal abuse ( 20% or 2,800 respondents), emotional abuse (11%; 1,493), physical abuse (9%; 1,302), cyberbullying (5%; 622) and sexual abuse (4%; 522). 

The Thrimthrom study indicates that one percent or 108 of the respondents (grades 4 and below) experienced bullying online especially when playing online games. And 17% had experienced physical bullying. 

The study found the presence of self-harm behaviour amongst 9 percent or 1,299 respondents (students grade 5 to 12).  While 8 percent or 1,114 students indicated that they had harboured self-harm thoughts, and 5 percent or 650 respondents had tried to hurt themselves.  

Our state of mind or mental health is connected with our relationships with others beginning from infancy. The important role of parenting in raising emotionally sound children needs added attention today. Educators point out that many who suffer from anxiety, depression, and self-harm thoughts are from dysfunctional families where parents fight, or neglect their children. 

There is concern that some young parents work abroad, leaving their children, even infants, in the care of grandparents. “This will have an impact on the child’s social emotional well-being. You can’t replace a parent,” says Karma Pokto, a senior teacher. 

Teachers acknowledge another common problem – alcohol addiction among youth and parents that lead to mental and behavioural disorders. 

Depression and anxiety are not stand-alone illnesses; the environment and conditioning of a child has a major role to play in triggering mental health disorders. The individual suffering is often responding to a larger challenging context – abuse, trauma, addiction etc. People’s reliance on schools, or the state health and security system to tackle these issues are inadequate if the root causes of some of these problems are to be addressed. 

Stigma and discrimination also makes it difficult for those suffering to seek help. College youth in a RUB study say that “mental health issues are often internalised as negative stereotypes and cause low self-esteem and shame”.

A systemic change is needed. Investments in healthy recreational facilities and in creating safe societal and public spaces need to be stepped up. Good parenting and child upbringing must be emphasised to groom a healthy generation. 

Educators elsewhere are piloting social emotional learning and integrating kindness curricula in schools. AI (artificial intelligence) today provides services for people seeking advice or someone to “talk to” when feeling lonely and anxious. 

The good news is that mental, social, emotional well-being is now recognised as a key factor in education that could reduce substance abuse and ailments affecting the performance of children and students. The Education Ministry has made mental well-being a key indicator of progress in its plans. 

“We’re looking at also engaging parents and community at large to be able to build our students’ resilience,” says Director Tashi Namgay of the Department of Education.

The Thimphu Thromde study recommends various interventions including enabling parents with skills and awareness to handle their own family situations and for school and parental collaborations.

The Royal University of Bhutan has set up nine ‘Well-being centres’ to provide counselling and other more healthy activities. CSOs like RENEW provide counselling and Lhomon Education continue to train teachers in meditation with some positive results. By investing a small amount in nourishing our minds every day, we could have a more flourishing community and society. 

The ministry has developed a local programme to train clinical counsellors, a much needed addition to the health care system. 

The Druk Journal discussed the issues at the Khesar Gyalpo University of Medical Sciences of Bhutan, KGUMBs (21st April) and the Samtse College of Education (24th April). Many suggestions were made including the following:

Encourage collaboration among children and youth agency services, including state service providers, civil society organisations, advocates and people with lived experience. 

The PEMA, which comprises a Secretariat and a Centre, is the overall planning and co-ordinating agency for mental health in Bhutan. It will guide clinical research, training and capacity building. By including recommendations made in the journal, PEMA can set standards for mental health care, prevention, and response. 

Social workers are needed in the process of recovery to work directly with clients seeking help and the community. Unlike counselling, social workers find resources needed to change the circumstances.

It’s time to recognise the underlying reasons for drug addiction rather than seeing it as a separate issue from mental health. There is need to focus on rehabilitation rather than penalising or criminalising people with addiction.

School counsellors need professional guidance and training to overcome lack of trust and confidentiality. There are concerns that students do not seek guidance and counselling from teacher counsellors who play the dual role of having to grade, discipline and counsel the students. 

Depression, dementia and other mental ailments affect the elderly. More facilities are required to cater to an aging population. 

Mental health and well-being is a significant and complex problem. Bhutan has been focusing on psychological first–aid, tending to the problems after they occur, but have not invested adequate resources and capacity into changing circumstances in the home, schools and communities. There is need for a concrete plan to make mental health a part of the strategy of cultivating well-being in Bhutan. 

Mental health disorders are treatable and preventable. 

Contributed by

Siok Sian Pek-Dorji