Bhutan’s suffers from a major deficiency when to comes to mental health care with an acute shortage of specialised professionals and facilities, according to the health system review report.
The country has only four psychiatrists, no specialised child and adolescent psychiatrists and no psychiatric hospitals or beds.
The need for psychiatrist and other professionals and expansion of necessary psychiatry services are seen critical in the Regional Referral Hospitals and bigger district hospitals in a country, according to the report.
As of now the psychiatric care at the secondary and primary health care levels is dependent on general doctors and primary health care workers the report states. Due to such challenges the patients requiring long-term care and treatment are not admitted for the required duration burdening families with the patients.
“This is problematic especially with psychotic patients, and puts great stress on the family,” states the review report. “Additionally, patients with mental health do not seek treatment due to the stigma attached to the disease.”
Currently the department of psychiatry in Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) has three psychiatrists with 18 beds, eight for psychiatry and 10 for detoxification in a ward staffed by nurses with no specialized mental health training. “The two regional referral hospitals also have psychiatry departments, but they do not have any psychiatrists and so are not able to provide specialized psychiatric care,” mentions the report.
The maximum mental health conditions treated at JDWNRH are anxiety depression, psychosis and drug and alcohol dependent issues where the treatment is also extended to patients with epilepsy. Further, suicide has also been identified as a public health problem with about seven suicides every month.
The health ministry is planning to provide postgraduate residency programme at Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) and JDWNRH in psychiatry to ease the shortage of psychiatrists in future.
Since alcohol and substance dependence and alcoholic liver diseases account for a very high number of inpatient admissions with highest number of mortality rate, the mental health programme has also planned for establishment of detoxification centre at Gidakom. “Without a dedicated detoxification centre the rate of relapse is very high as the current 10 beds in JDWNRH are inadequate for number of patients,” the report states.
The mental health programme has appointed nurses as mental health focal persons in each district hospital who are trained in basic mental counseling and conduct mental health awareness programme. In addition, all new doctors are provided basic identification and treatment of mental illness.
To reduce the burden on families especially those caring for psychotic patients, the ministry also found the need to institute long-term care and specialized psychiatry in a health system.
Currently Bhutan has no laws and regulations governing mental health care.