6 June 2024

According to the World Health Organization (WHO)’s estimate, one in eight of us is currently struggling with mental health problems. But in Thailand, only a fraction of these sufferers receive the help they need.

“Only a few million Thais have ever been treated for their mental health issues,” Mental Health Department spokesman Dr. Varoth Chotpitayasunondh revealed recently.

While some people decline to seek help because they think they can handle their conditions alone, others are too worried about the possible stigma and negative reaction from their family and society if they get psychiatric help.

“On top of that, some are not able to get help because they can’t access the services,” Varoth said.

Too few experts

The WHO’s Mental Health Atlas 2020 reveals that Thailand has just 1.28 psychiatrists per 100,000 people – over 10 times lower than the global average of 13 per 100,000. The average in high-income (OECD) nations is over 15.

Thailand’s shortage of psychiatrists has become a serious issue partly because the number of people seeking their services has almost doubled in the past 10 years.

“As more celebrities talk about their mental health conditions, public understanding of mental health is growing. As stigmatization eases, more people are coming forward,” Varoth said. “People now understand that they need to take care of both their emotional and their physical health”.

According to the Public Health Ministry, the number of Thais receiving psychiatric treatment rose from over 1.3 million in 2015 to 2.4 million in 2022.

Yet if the WHO estimate is accurate, around 8.75 million people in Thailand’s population of about 67 million are struggling with mental health issues such as anxiety disorders and depression.

Mid-life crises

Fifty-one-year-old Aj (not his real name) recently discovered that he was suffering from depression that had affected him to the point that he could not sleep and had to leave his job in late 2021.

“I was unable to function the way I used to at work. The fun of working was gone,” Aj told Thai PBS World.

After years of working for big companies, Aj had come to think that stress was merely part of the corporate world and had long relied on alcohol to get him to sleep at night. That tactic worked to a degree, but Aj knew full well that he had not slept deeply for years.

Married with children, Aj tried to bear his condition and struggle on alone. Stress, anxiety and insomnia, he thought to himself, were something he should be able to handle.

Ahead of the COVID-19 pandemic, Aj decided to switch to a new job that meant traveling farther from his home to a new office. But the move eventually only exacerbated his fatigue and boredom. He got respite during COVID lockdowns, when his company allowed staff to work from home. But when the pandemic eased, he was called back to the office. The call to return to work proved to be the last straw.

“I handed in my resignation,” he said.

His bad mood continued, though, even after he switched to freelance work. But the realization that he was suffering from a mental disorder only came when he swore at his kids in an emotional outburst.  “That’s when I decided to consult a doctor,” he said.

Taking advantage of the universal healthcare scheme, he visited a doctor at a small clinic near his home. The doctor referred him to a psychiatrist at a hospital.

Last November, he met with a medical specialist, who promptly diagnosed him with depression, prescribed medicines, and advised meditation therapy.  “I now meditate every morning before sending my kids to school,” Aj said, “My sleep quality is not yet good. But I feel better”.

Calls for better medicine

A group of depression sufferers and their allies recently submitted a petition to Public Health Minister Dr Cholnan Srikaew calling on the government to add four more antipsychotics and antidepressants to the national drug list so that people struggling with mental illness could receive them for free.

The four medicines are olanzapine, aripiprazole, venlafaxine, and methylphenidate.

“The Mental Health Department, Royal College of Psychiatrists of Thailand, and Psychiatric Association of Thailand consider these medicines superior to those that are currently on the national drug list,” said Thitinob Komalnimi, a member of the group that drafted the petition.

Cholnan responded by saying the government would try to ensure that necessary medicines are included on the drug list.

However, Dr Pongkasem Khaimook, director-general of the Mental Health Department, insists that the medications currently available to Universal Health Care patients are good enough, citing results over the past two decades.

“It’s just that some people may find different medicines at private hospitals,” he said.

Meager budget for mental-health care

Move Forward Party MP Sirilapas Kongtrakarn, who has made no secret of her battles with depression, complains that the government budget for mental-health care is too little to ensure an effective service.

“The Mental Health Department requested 4.3 billion baht for fiscal year 2024 but was given just 2.99 billion baht. This accounts for just 1.8% of the Public Health Ministry’s total budget,” she said.

She also pointed out that the government tends to focus on mental disorders of drug addicts rather than those affecting the general population, a far larger group.

Meanwhile, budget constraints meant the 1323 Mental Health Hotline could only handle around 100,000 calls a year. This year, the budget has been increased to 26 million baht, thanks in part to a 5-million-baht grant from the National Health Security Office (NHSO). The hotline should now be able to handle up to 520,000 calls a year.

The hotline’s staff are often flooded with callers desperate for help with their stress, anxiety, depression and even suicidal thoughts.

One university student reported that after her call was put on hold for more than half an hour, she went ahead with her plan to commit suicide. Fortunately, her family rushed her to hospital in time.

Prevention better than cure

Phongkasem said he wanted more funds to be spent on promoting good mental health to prevent people from succumbing to mental disorders in the first place. “Families, communities and schools can serve as ‘vaccines’ against mental problems,” he said. Some educational institutions and companies in Thailand already provide services and support to help their members stay emotionally and mentally fit.

By Thai PBS World’s General Desk