The Bhutanese Leading the way.
Bhutan has launched its first comprehensive National Mental Health Strategy 1.0, signaling an urgent national commitment to combat the rising burden of mental health conditions. As per the strategy, recent data underscores this urgency with anxiety and depression disorders constituted approximately 55 percent of the total reported mental health related conditions in the country in 2023 (Annual Health Bulletin 2024).
Specifically, health services reported 3,762 cases of anxiety disorders and 2,687 cases of depression. The proliferation of these difficulties across all age groups, compounded by global shifts and rapid societal transitions, risks “irreparable consequences” if left unaddressed, necessitating this robust strategic overhaul.
The creation of this strategy is rooted in the visionary aspiration of Her Majesty The Gyaltsuen Jetsun Pema Wangchuck, who instituted The PEMA Secretariat three years ago with a mandate to safeguard the mental health and wellbeing of the Bhutanese people.
The ultimate goal of the strategy is to establish a society that promotes mental health and builds a responsive, resilient, and integrated care system, embracing a life-course approach. The core mission is to ensure people-centric mental health services are within the reach of every citizen, thereby “leaving no one to suffer in silence”.
This national direction places mental health at the center of the country’s development, aligning with the Healthy Drukyul Program under the 13th Five-Year Plan, which prioritizes “Holistic and Compassionate Mental Health Care”.
The strategy also explicitly targets the existing suicide rate of approximately 12 per 100,000 population, committing to reducing this by the end of the implementation period.
Acknowledging that mental health exists on a continuum ranging from optimal well-being to severe disorders, The PEMA Secretariat developed this comprehensive National Intervention Framework based on four distinct pillars.
The first pillar focuses on prevention and engagement programs, adopting an upstream approach to promote mental health and mitigate risk factors.
The second pillar addresses response services, ensuring timely and quality interventions for acute mental health challenges.
The third pillar, treatment and rehabilitation services, focuses on delivering quality, accessible, and community-based mental health care.
Finally, the fourth pillar, reintegration and aftercare programs, facilitates empowerment and productivity for recovery and community re-entry.
The overall implementation of the strategy is guided by core principles, including a life course approach (spanning all stages of life), a multisectoral approach, and the overarching commitment to universal health coverage, ensuring access to essential services “irrespective of age, gender, ability, socioeconomic status, race, ethnicity, or sexual orientation”.
Furthermore, Bhutan recently ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), cementing the commitment to ensure mental health services are tailored for individuals with psychosocial disabilities.
The strategy outlines four key strategic objectives, starting with strategic objective 1 as leadership and governance, where The PEMA Board will serve as the highest national-level decision-making body, providing guidance and support for implementation. This governance structure aims to formalize national and dzongkhag-level coordination mechanisms, embed mental health into national five-year plans, and align mental health policies and legislations with international human rights instruments.
Strategic objective 2 as promotion, prevention, and response focuses on strengthening universal mental health interventions by building individual resilience through a life-course approach. This includes crucial actions such as integrating perinatal mental health screening, and management into routine maternal and child healthcare services, and embedding evidence-based social and emotional skills programs across educational institutions.
Regarding acute challenges, the plan mandates developing guidelines and Standard Operating Procedures (SOPs) for postvention services, designed to provide immediate and coordinated support to individuals bereaved by suicide. Additionally, national media engagement guidelines for responsible reporting on suicide and mental health conditions will be reviewed and implemented through sensitization and capacity building of media firms.
Under strategic objective 3, it will focus on treatment, rehabilitation, and reintegration, a major policy shift is the decentralization of specialized services. Currently, specialized mental health services are primarily provided only in the capital through the Department of Psychiatry, JDWNRH.
The strategy mandates scaling up specialized access to regional service centers and integrating basic mental health care into primary health facilities nationwide. The goal is significant to increase the number of mental health professionals recruited in general hospitals from a baseline of 26 to over 70 by 2030.
Other service enhancements include initiating teleconsultation services to increase access to specialized care, and scaling up day care services in hospitals and institutions, aiming for 20 hospitals to have these services by 2027, up from the baseline of five. By 2030, the strategy aims for over 80 percent of dzongkhags to have trained health workers in primary health centers (PHCs) on community-based mental health care.
Finally, strategic objective 4 focuses on establishing robust information systems and research initiatives to ensure evidence-based decision-making. Key actions include developing an integrated and centralized mental health information system, establishing a functional suicide registry and postvention information system, and the commitment to producing an annual mental health report.
The effectiveness of the entire strategy will be rigorously monitored using annual performance assessments tracking input, process, and output indicators.
The long-term success will be measured against outcome and impact indicators after five years, with major targets including reducing the treatment gap for common mental health conditions from over 70 percent to less than 40 percent and increasing the mental health professionals to population ratio from approximately 20:100,000 to 40:100,000.
