Ninety.
Every 90 hours, Bhutan is at risk of losing another life to suicide. From an average of six cases a month between 2009-20131, the average number of suicide cases has risen to eight a month – two every week, from 2018-2020.2 Suicide is now among the top six leading causes of death in Bhutan.3
Suicide and mental health are issues in every society. So, Bhutan is no exception. At any stage of our lives, any one of us may find ourselves at different points on the mental health continuum – from experiencing positive mental well-being, with the ability to cope well with both good days and the bad, to encountering periods of serious distress to suffering long-term and disabling conditions.
The COVID-19 pandemic has, however, raised the visibility and relevance of mental health, flagging the need to strengthen personal resilience and psychosocial support in new and important ways. It has highlighted that mental health problems can affect anyone, creating a much-needed window for dialogue, action, and investment. It has opened an avenue to address the many difficult and sensitive questions and unite as a society to tackle the root causes that inhibit good mental health.
The momentum that had begun towards breaking the silence has received the leadership of Her Majesty The Gyaltsuen with mental health becoming a national priority. The review reports and the series of consultations by the National Council’s Social and Cultural Affairs Committee are commendable steps to support Her Majesty’s initiative in promoting mental well-being. The discourse, while complementing the existing efforts and action plans by the Ministry of Health4, must lead to increased investment – additional financing, more human resources, adequate facilities, new capacities, and enhanced coordination. The reported numbers demand concerted urgent action.
From more than 4,200 cases related to mental and behavioral disorders in 2017, the number has risen to 6,858 cases in 2020.5 Depression incidence (per 10,000 population) is up from 6.0 (2017) to 10.4 (2019).6 Between December 2020 and February 2021, the Ministry of Education recorded 671 clients seeking counselling, of which 88 per cent were children and youth between 9-24 years.7 The highest number of calls seeking counselling were from 15-year olds. Despite the increase in the number of cases, over the last five years, the annual budget allocation to mental health programmes including suicide prevention has remained under Nu 3.5 million a year, which amounts to one per cent of the Ministry of Health’s budget.8
Promoting mental health and well-being and addressing mental ill-health require a whole-of-government, a whole-of-society and a whole-of-lifecycle approach. It requires us to focus on the primacy of parenting, the importance of educational settings, the criticality of primary health and community-based interventions, tackling poverty, responding to humanitarian crises, and building resilience. These approaches must be collective in terms of communication, commitment and action. They must be substantial and sustained.
Tapping on the momentum that has begun, one of the immediate actions Bhutan could consider in addressing mental health issues is to bring all concerned stakeholders together for an action-oriented dialogue – vital actions needed in the short-term, medium-term and longer time horizons. Such a national forum, which the UN agencies remain committed to support, could provide a platform to enhance coordination among and commitment from all sectors and actors involved in providing services for children, adolescents and adults to promote mental health and wellbeing. It would be an opportunity to identify areas of action, advocacy and commitment.
It is an opportunity to look into investing much, much more in mental health. Recent estimates found $340 billion is the global annual cost to societies of mental health conditions and suicide among children and young people.9
We would like to recommend the following to help respond to the growing issue of mental illness:
Ensuring access to comprehensive, integrated and responsive mental health and suicide prevention is essential to prevent, detect and effectively treat persons with mental disorders and psychosocial disabilities.10
Conduct an investment case to lay out what the country is losing in economic terms from mental ill-health and suicide versus what investments are needed to take comprehensive, sustainable action to promote mental health, well-being and resilience, and provide early detection and remedial interventions. An investment case would help policy makers arrive at informed decisions when allocating funds for both mental health promotion and responses to mental ill-health.
Promote parenting skills and knowledge to improve children’s and young people’s mental well-being and resilience, and to recognize early signs, speak up, and seek support services. Parents and caregivers also need support to engage with their children from an early age onwards to foster their social, emotional, physical, and cognitive development.
Reduce stigma and create more inclusive environments. Enhance mental health literacy programmes, put in place strategies to reduce stigma and to build environments where children, young people and adults can openly talk about their mental wellbeing and challenges.
Increase the availability of accessible and acceptable mental health services including for vulnerable groups. People living with disabilities and their families, minority groups, including ethnic groups, LGBTQIA+, people living with HIV, and survivors of abuse and exploitation, all require dedicated attention and specific programmes to ensure services meet their needs.
Strengthen youth, village health workers’ and community leaders’ mental health capacity-building initiatives. Young people in Bhutan have started sharing their concerns about mental health and well-being. Continued support is needed to provide them with the means for active and meaningful engagement. Village health workers, religious and community leaders can be key influencers in promoting mental health.
Ensure that schools are safe and inclusive. Invest in school-based mental health promotion, empowering schools to provide regular mental health and psychosocial well-being training for teachers, children, adolescents, and families. Interventions should target the whole school, creating a positive environment, a sense of connection and belonging, and actively involve students, teachers, and families. Schools must strengthen policies/strategies to address bullying and harassment.
Strengthen strategies to prevent substance abuse and suicide. Self-harm is one of the leading causes of death among adolescents. Enhance systems to identify high-risk groups. Schools and community groups are crucial partners in this process, helping to identify children and youth at higher risk and providing support.
Tackle the impact of poverty and unemployment. Poverty and mental health are intimately linked, with many risk factors for mental ill-health heavily associated with unemployment or underemployment, as well as lack of opportunities to be meaningfully engaged in the society. Social protection schemes and employment initiatives can significantly improve mental well-being in children, adolescents, and adults. Engaging, particularly out of job youth, in meaningful activities is important until they seek or find employment opportunities.
End gender-based violence (GBV). Violence against children and women, in the home, both physical and emotional, has severe negative impacts on children’s, adolescents’ and women’s mental health. Nationwide preventive interventions are needed to break the inter-generational transmission of violence, including GBV.
We remain committed to support the Royal Government of Bhutan in its efforts to ensure the mental health and well-being of people in the country.
UNDP, UNFPA, UNICEF, UNODC, WHO
1. Kuenzang Lhaden. Suicide trends in Bhutan from 2009 to 2013. Journal of Bhutan Studies. 2014;30.
2. 2021 Review report on Suicide and Mental Health Issues in Bhutan.
3. Damber Kumar Nirola. SUICIDE: “Every 40 seconds, someone loses their life to suicide.” Editorial, Bhutan Health Journal. 2019, 5:2.
4. Royal Government of Bhutan 2018, Suicide Prevention in Bhutan – A five-year Action plan (2018-2023)
5. Annual Health Bulletin-2017.pdf (moh.gov.bt) and 2020 communicated by Department of Public Health, Ministry of Health.
6. Microsoft Word – Bulletin_2020_Final (1)19-5-2020 (moh.gov.bt)
7. CECD, MoE, Sherig Counselling Services
8. 2021 Review report on Suicide and Mental Health Issues in Bhutan.
9. UNICEF 2021, State of the World’s Children
10. WHO 2013, Mental Health Action Plan 2013-2030?