“We have reached a stage where we can’t afford to ignore mental health at all”

The health ministry has proposed Nu 60 million in capital outlay to strengthen mental health-related interventions in the country for the 12th Plan.

The intervention includes alcohol, treatment and management of mental illness, surveillance, survey, capacity development, and suicide prevention, among others.

During the ninth session of Bhutan dialogues at the UN House in Thimphu on July 12, on “Where is mental health in our development?” psychiatrist with the national referral hospital in Thimphu, Dr Chencho Dorji during his conversation with scholar Karma Phuntsho (PhD) pointed out limited resources as one of the challenges in addressing mental health issues in the country.

He said the country needs more treatment and rehabilitation centres and more programmes to teach people the better ways of living. “We need resources to implement laws. Law is not just to punish people but also to educate people on the positive things that we can do as a child or youth so that you are not into drugs.”

Dr Chencho Dorji said it is scary to see many young people getting arrested for abusing and illegal transaction of controlled substances in the country.

“We treat the abusers as patients. By making the trafficking laws restrictive and stringent, we are actually by default making many controlled substance addicts criminal,” he said.

He said people caught with controlled substances should not be set free but suggested that instead of locking them up, allowing them to pay fine and investing the money in treatment centres and strengthening mental health-related interventions.

“We need to shift from restrictive or stringent measures to more informative rehabilitative and positive ways of living things,” he said.

Dr Chencho Dorji observed that expressing emotion is a luxury at times and when it is expressed, people are not listening or unable to perceive the issue that they tend to do dramatic things to prove that something is wrong like attempting suicide.

“These are all cry for help. We have reached a stage where we can’t afford to ignore mental health at all. We all have to accept it as part of our life,” he said. “Psychological issues are coming up and now we have to find a way to express those emotions and deal with it.”

Education and parenting play a greater role in shaping and moulding children’s psychology skills, he added.

With the development of technologies, most parents and children tend to spend their time watching television or on their smartphones.

Spending quality time with your child is important, he said. Spending a couple of hours with children from their young age, talking to them about how their day was, what they did, who their friends are, what they would like to do and how they feel, is important.

Anxiety and depression are the most common mental health problems in the country today.

According to the national referral hospital’s latest annual report, the hospital saw 234 outpatient cases for anxiety in 2017, of which 151 are females. Of the 159 depression cases, about 103 are females.

About 595 mental health-related patients were admitted to the psychiatry ward in the same year.

Besides anxiety and depression, patients with psychosis, dementia, epilepsy, alcohol and drug problem, alcohol use disorder and somatoform can avail psychiatry services at the national referral hospital in Thimphu.

Bhutan saw a total of 4,292 cases related to mental and behavioural disorders last year, according to the annual health Bulletin 2018. The OPD (out-patient departments) cases from the national referral hospital is excluded here.

About 2,477 mental disorder cases were seen in the OPD of all hospitals excluding JDWNRH, and two military hospitals in Haa and Thimphu.

Meanwhile the hospitals across the country has admitted 1,440 patients with mental disorders in the same year. Two died of depression and other mental disorders.

Mental and behavioral disorders includes dementia; mental and behavioural disorders due to alcohol, multiple drug use and other psychoactive substances; psychosis, depression, anxiety and other mental disorders.

Dr Chencho Dorji said as the country develops and people’s lifestyle change, many move to towns and mental health is going to be challenged. “If we are not mindful and careful about our lifestyle now, our mental health will be jeopardised sooner or later.”

He said when it comes to treatment, consulting a psychiatrist is not the first choice.  Many patients and families have already consulted astrologers and conducted rituals before bringing the patient to the hospital.

“When they come to us, we know that they have done all these and they have come to us because they did not get much help or the other resorts are not effective,” he said.

Given the population’s limited understanding of mental issues and its management, he said, people expect to get well soon after taking medication. “Unfortunately, many mental issues are chronic when they are brought to the hospital so we have the challenge of having to break through that expectation of fast recovery and getting on with life,” he said.

The health staff must tell the patient and their attendants that they have to be patient and that medication takes time. “But results will show,” he said. “We have people expecting dramatic changes but it doesn’t happen that way and sometimes we lose patients in between.”

Dr Chencho Dorji said showing results is important to convince people that people do get treated and encourage other patients to avail treatment.

He also pointed out that cultural stigma associated with mental health is a barrier. “Mental health is a difficult subject for anyone to understand.”

Dechen Tshomo

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