Mental health is a public health concern for Bhutan. Since the eighth Plan, a policy was framed to develop community mental health services and make it a component of primary health care services.
The policy was to build human resource, involve families, create advocacy, and improve monitoring and financing for mental heath. Going by recent reports on mental illness, this policy appears to have remained on paper.
The country has only four psychiatrists, three at the national referral hospital and one at the army hospital. We have no accurate national record on people living with mental disorders and only a percent of the health budget is allocated to mental health programme. Desperate for help and given the limited capacity of community health workers, almost all families of mental illness patients reported consulting traditional healers.
As a country that prioritises the well-being of its people and claims its development to be inclusive, we have failed to meet the needs of the mentally ill. Most remain confined in their homes, in remote parts of the country, without medication and care, invisible and forgotten.
The plight of mental health patients in Tsirang is disturbing. A whole neighbourhood in Darchharang village is home to mentally ill persons, given up by health workers and tolerated by helpless family members. With a strong belief in superstitions and spiritualism, it is not uncommon for family members to believe that an individual’s health condition is a consequence of evil forces or karma. Such beliefs can be persuasive and even propagated in the absence of healthcare professionals to advise and provide treatment.
Similar situations could exist in other parts of the country. According to a NSB report, 6,297 people who suffered some kind of mental disorders visited the OPD, JDWNRH between 2000 and 2014. That is about 450 cases a year, or one everyday. Young people between 10-24 years constituted 33 percent of these cases and reports how a growing incidence of substance abuse induced disorders.
These numbers alone are enough to indicate the need to strengthen mental health care services in the country. The need for a mental health act has been made but it appears that this need is driven more by the need to show than uphold human rights. To ask for an Act to act while sitting on a policy is weak planning.
Instead, attention must be given to enhance monitoring services and ensure regular follow up on cases in each community. While our tendency to see mental illness in spiritual terms creates challenges in providing modern psychiatric services, efforts to infuse traditional medicine with modern must be made for people to seek treatment. The health ministry must take the lead and bring on board other agencies from the central to the grassroots level. It must engage civil society organisations and family members in advocacy programmes. People must know that there is help.
But with no specific mention of mental health care in annual performance agreements or the 12th Plan, our planners and policy makers may have yet again forgotten those living with mental illness. This indicates the priorities of a society. It tells those living with mental disorders that basic health services for them are a privilege, not a right.