Bhutan ranked 54th in the world, in terms of deaths by suicides in 2018. Within the span of three years from (2018-2020), a total of 283 Bhutanese took their own lives, with 95 suicide cases recorded in 2020 alone.
The COVID-19 pandemic has further exacerbated the number of mental health issues and increased risk of suicides in the country. According to the leader of the National COVID-19 Mental Health and Psychosocial Response Team (NC19MHPRT), the cases could have been much higher during the pandemic, if not for the Druk Gyalpo’s Relief Kidu.
The Social and Cultural Affairs Committee of the National Council (NC) presented the Interim Report Review of Suicide and Mental Health Issues, where it was highlighted that the number of suicide cases recorded remained high from 2018 to 2020.
Samtse has the highest number of suicide cases consecutively for three years, at 39 cases, followed by Thimphu with 36 cases and Sarpang recorded 31 cases.
While attempted suicide may be undeclared, there is a very less chance for suicide cases to go unreported. Attempted suicides in Bhutan are better reported from schools with counselors in place as compared to those from the communities.
According to a Bhutan Global School Based-Student Health survey, 10 to 13 percent of students considered suicide. The youth continue to be vulnerable as social issues, like growing unemployment, schools closure, online schooling pressure, school drop outs, increased unwanted pregnancies, addiction and substance abuse issues during the COVID-19 pandemic have further contributed to the stress.
According to the Suicide Prevention Action Plan document (2015-2018) the key risk factors for suicide in Bhutan are due to mental problems (84%), stressful events (68%), addiction (59%) and domestic violence (46%).
In 2020, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) recorded 145 females and 97 males suffering from anxiety disorder; 30 females and 155 males with alcohol use disorder followed by depression cases with 67 females and 53 males. There were 76 cases of substance abuse.
In sharp contrast, the whole of 2018 only saw 164 females and 95 males with anxiety disorder, and 154 males and 22 females with alcohol use disorder.
1,578 calls has been received from April 2020 to March 2021, out of which 938 were related to mental disorders – anxiety, depression, alcohol and substance abuse, insomnia, trauma, interpersonal conflict, self-harm, domestic violence, grief and loss, stigma, mood disorder and psychosis. While most of the calls came from the general population, 791 calls were from the quarantine facilities and 328 from the isolation wards.
509 male and 472 female callers availed themselves of the mental health hotline service. In addition to the mental health hotlines, the team also received 1,040 queries/concerns through various social media forums, out of which 24 respondents revealed self-harm or suicidal intent and 489 respondents shared their substance abuse history, while the rest 77 revealed history of domestic violence and 13 disclosed psychiatric history.
The Social and Cultural Affairs Committee emphasized on the importance of reviewing the current programs and initiatives of the government to strengthen preventive and treatment programs. It was pointed out that there is insufficient support to mental health or suicide programs and recognition without a policy reference, at the moment.
The various action plans developed for prevention of suicide and addressing mental health issues are not binding, therefore, no one is held accountable.
The committee highlighted the challenges, that only 1 percent of the Ministry of Health’s (MoH) budget is allocated for mental health programs including suicide prevention annually. Over the last five years, the budget allocation has remained under Nu 3.5 million, despite the increasing number of patients seeking treatment for mental health disorders and high number of suicide cases reported.
Until an adequate number of psychiatrists are available, general duty medical officers and health assistants will continue to be trained in diagnosing and managing common mental disorders.
Limited rehabilitation centers and mental health literacy, stigma and discrimination are the other challenges.
According to the Penal Code of Bhutan (PCB), committing suicide is not illegal in Bhutan. However, complicity in suicide, if the defendant aids, abets, counsels or procures the suicide of another person is a misdemeanor offence. PCB also contains clauses to safeguard the interests of people with mental illness in the criminal justice system, including the provision of adequate treatment.
Meanwhile, the data maintained by the MoH from 2015 to 2019 show 7,500 cases of anxiety, followed by 5,748 mental disorders due to alcohol use, 3,377 depression, 1,634 psychosis and 1,342 mental disorders due to substance use. More than 8,800 cases of other mental disorders were documented during the same period.