The Bhutanese Leading the way.
The Chairperson of Social and Cultural Affairs Committee (SCAC), MP Lhaki Dolma presented a review report on mental health issues and suicide in Bhutan during the 28th session of the National Council. The SCAC committee proposed recommendations which will be finalized on 13th of December, 2021.
The committee recommended the Royal Government of Bhutan to continue to render steadfast support for the Royal Initiative in improving policies, allocating resources, strengthening inter-sectoral partnerships and conducting research and improving data collection to create a more robust and responsive system.
In the schools and education institutes too, the SCAC recommends prioritizing training of school counselors in various specialized fields, so that schools with bigger populations can have a minimum of 2 counselors (male/female) to attend to the wellbeing of their students.
The recommendation is to improve the counseling room facilities in schools across the country to create a more conducive environment to de-stigmatize and encourage open discussions about feelings and problems.
It asks to establish Help centers and publicize uniform helplines for people at both the Dzongkhag and national level, so persons suffering from any mental disorders or suicidal thoughts can avail immediate assistance.
Prioritize care for those who have attempted suicide, by ensuring they avail follow up counselling sessions for themselves and with their families. Explore the establishment of rehabilitation centers in the regions for substance and alcohol users to access treatment and counseling facilities
The SCAC chairperson stated as per the data collection and Analysis of Mental Disorders, from 2016 till October, 2021, 36,608 mental disorder cases were documented. There were 7 categories of mental disorder cases recorded and there was a surge of cases during the COVID 19 pandemic.
The cases of anxiety went up to 2,922 in 2021 from 2,141 in 2016; cases of depression increased to 1,644 in 2021 from 743 in 2016; cases of mental and behavioral disorders due to alcohol rose to 1,478 in 2021 from 1,024 in 2016; and cases of psychosis reached to 689 in 2021 from 318 in 2016. Cases of mental and behavior disorders due to multiple drugs and other psychoactive substance use, Dementia and other mental disorders also saw slight increase.
The mental disorder cases are most prevalent among people above the age of 15 years, which constitute about 92.30 percent of the total cases recorded. As per the annual health bulletins of ministry of health, the highest numbers recorded are within the age range of 15-49 years old followed by age range between 50-59 years, and 60 and above years.
The suicide cases have occurred across all 20 Dzongkhags during the past five years. The highest number was recorded in Samtse Dzongkhag (66 cases) followed by Thimphu Dzongkhag (57 cases), Chhukha Dzongkhag (39 cases), Sarpang (37 cases) and Paro Dzongkhag (36 cases). Gasa Dzongkhag had the least number with only 2 cases during the period.
People who committed suicide came from varied occupational backgrounds. Of the 553 cases, 43.20% were farmers and home-makers; 15.37% were students; and about 7.7% were unemployed. Another 7.59% of the total suicide cases were among employees of private sector.
Of the total suicide cases, 32.36% were from 10-24 years’ age group, 26.58% were from 43 and above age group, and 16.81% were from 25-30 age group.
While causes of suicide were not known for majority of the cases, significant numbers were due to anxiety or depression (14.74%), unhealthy family relationship (14.53%), and alcohol abuse (10.47%).
The National Statistical Bureau Statistical Yearbook of Bhutan 2021 reported that from 2016-2020, a total of 172 suicide attempt cases were documented, with the maximum number of attempted suicides in 2020 and 2017.
However, the Royal Bhutan Police and Ministry of Health and Dzongkhag officials said that many attempted cases of suicides are not reported due to the stigma and shame.
According to the Ministry of Health officials, the budget allocated for these two programmes has been between 2.5-3.5 million Ngultrum over the last five years. The WHO grants Nu. 1.5 million annually to the Suicide Prevention Programme.
According to the Bhutan Mental Health Strategy and Action Plan (2015-2023), mental health care in Bhutan follows the WHO recommended model of integrating services .Currently, general hospitals in Bhutan provide short term inpatient psychiatry, substance detox, outpatient psychiatry.
The JDWNRHs manages the maximum number of cases. It has a dedicated Out Patient Department (OPD) and ward with only one Psychiatrist, clinical counselors, Health Volunteers Overseas, and trained nurses in psychiatry.
Some District hospitals have clinical counselors and doctors trained on management of common mental illnesses. During the COVID 19 pandemic, there were a lot of toll-free numbers advertised to the general public to seek support during the lockdowns.
The National COVID-19 Mental Health and Psychosocial Response Team (NC19MHPRT) received between March and December 2020, some 1,153 telephonic calls from people seeking counseling services.
Out of that, 278 (24.11%) cases were on psychiatrist history and treatment, 80 (6.9%) on drugs and alcohol withdrawal problem, 16 (1.3%) on stigma related issues, 33 (2.8%) on violence, 32 (2.78%) on grief and loss, 28 (2.43%) on interpersonal conflict, and 18 (1.56%) on self-harm/suicide threats.
