The number of people in Thailand suffering from mental problems rose from 1.3 million in 2015 to 2.3 million last year, while the number of suicides is also on the increase.
These alarming figures suggest the country’s mental health is a ticking time bomb that needs to be tackled urgently to avoid the disastrous effects of an explosion.
Wasted lives
One mother told Thai PBS World of her anguish as she watches her son’s life spiral out of control after he chose a path of drug abuse to deal with his mental issues.
“I noticed the change in his behavior, but could not afford treatment,” the mother said on condition of anonymity.
Her son, now 25, worked as a mechanic in auto garages before his mental health began to deteriorate.
“These days he just sits idle, staring into the distance all day,” she said. “I don’t have the money or the social status required to send him for drug rehabilitation.”
Limited access to care
Thailand has only 845 practicing psychiatrists – or about one for every 100,000 people. However, an estimated one in every 2,721 people require counseling.
Thailand’s ratio is tiny compared with that of Switzerland, which has 47.17 psychiatrists for every 100,000 people.
Their huge workload means that psychiatric therapists in Thailand’s state hospitals have little time to devote to each patient.
According to a report by Asst Prof Dr Thammanard Charernboon, each counseling session for a returning patient should last for at least 15 minutes, while a new patient should get at least half an hour.
“Based on this standard, psychiatrists should devote four hours to no more than 20 patients,” the report continued.
Presently, government psychiatrists serve between 30 and 50 patients every four hours or else waiting times would grow impossibly long.
How long can you wait?
Orn, 45, has been battling mental illnesses for more than 10 years now. She struggled hard to handle her job and colleagues, but gave up in the end because her mental troubles were getting out of hand.
“It took a long time for me and my family to accept the reality – that I’m mentally ill,” she said. “It’s difficult to face the music. We only began accepting this painful truth after my mental illness began adversely affecting people around me.”
She said her family contacted several state hospitals in the hope of scheduling an appointment with a psychiatrist, but were told they would have to wait for three to four months.
“My family knew that I could not wait any longer, so I was sent to a private hospital. The doctor’s fees and medicines were expensive, and I had no insurance. But there was no other choice if I was going to save my mental health,” she said.
Her first session lasted nearly an hour and after that she had to meet her psychiatrist every month. Each visit cost nearly 20,000 baht, with most of it spent on the medicines she was prescribed.
“They were expensive. But without the treatment, I would not have been able to live with others,” Orn said frankly.
She added that as soon as her condition improved, she stopped visiting the doctor to save money. She now relies on over-the-counter pills and is on a waiting list to meet a public health psychiatrist.
Mental Health Department wants psychiatric meds to be added to essential drug list
Training psychiatrists takes time
Mental Health Department spokesperson Dr Varoth Chotpitayasunondh said it takes a long time to produce a psychiatrist because training can only begin after students have graduated from medical school and spent three years as general practitioners.
General psychiatrists need to be trained for three years, while those who want to specialize in child and adolescent mental health need an extra year of training.
“Training is not free either. Aspirants must cover the cost themselves or get a scholarship,” Dr Varoth, who is also a psychiatrist, said.
He added that very few scholarships are available on this subject as relevant organizations only hand out financial support when they need to seek replacements.
“Production capacity is also limited because to produce a psychiatrist, we need to prepare three highly experienced lecturers specializing in the field,” he said. “As you know, we don’t have many psychiatrists in the country, let alone specialists.”
Clinical psychologists to the rescue?
Thailand can take comfort in the fact that clinical psychologists can do some of the work of psychiatrists, though they cannot prescribe medicines. However, these healthcare professionals are also few and far between.
“We are facing a shortage of clinical psychologists too,” Varoth said.
There is not a single psychologist at state hospitals in Trat, Phrae, Samut Songkhram, Sing Buri, Nong Bua Lamphu and Ang Thong, while Loei only has one psychologist for 52,717 patients.
The Mental Health Department and Thai Counseling Psychology Association are now working closely together to set standards so that counseling psychologists can help fill the gap.
However, this process is expected to take another four or five years because it involves many players and requires the formulation of solid regulations.
Northern crisis
Of all regions in Thailand, suicide appears to be most rife in the North. Mae Hong Son had the highest number of self-inflicted deaths for three of the five years between 2016 and 2020. Chiang Mai, Chiang Rai, Phrae, Tak, Nan and Lampang also recorded high numbers of suicides. All these provinces, except Tak, are in the North.
Figures in 2020 show that there were 17.44 suicides per every 100,000 people in Mae Hong Son, while the ratios in Tak and Chiang Mai were 15.46 and 14.61 respectively.
“We have noticed that more and more people are suffering from depression in Thailand,” Varoth said.
As of June this year, an estimated 1.35 million Thais were suffering from depression. Meanwhile the number of patients being treated for depression rose from 4,295 in 2013 to 259,467 in 2017.
“This increase can be put down to two factors – more stress and more awareness of mental-health issues,” Dr Varoth said.
By Thai PBS World
