April 8, 2017
… as Bhutan observes World Health Day
The increasing number of people suffering from depression in the country is a concern, health minister Tandin Wangchuk said during an event to observe World Health Day at the Yangchenphug Higher Secondary School in Thimphu, yesterday.
“This is evident from the increasing trend in persons availing health services for mental disorders that include depression,” Lyonpo said.
The highest number of depression cases is in the age group of 15 to 49 years in the country. The average death due to suicide stands at around seven per month, which comes to 84 suicide cases in 2016 alone.
Lyonpo said that depression affects people of all ages, from all walks of life, in all countries. But, it is preventable and curable.
There is nothing to be ashamed of being depressed, Lyonpo added. “Just like any other diseases, it is important for a person suffering from depression to get treated.”
Lyonpo urged people who feel sad and lose interest in activities that they normally enjoy and are not able to carry out daily activities, to talk to their friends, teachers or parents or anyone they are comfortable to talk to.
People can also seek help from health workers in Basic Health Units and hospitals or call the Health Help Centre toll free number 112.
Psychiatrist with the national referral hospital in Thimphu, Dr Chencho Dorji, said that the theme this year, ‘Depression: let’s talk,’ is pertinent and timely from the mental health perspective.
He said that depression causes a lot of suffering for the individual and family. It can impair functioning, compromise quality of life and even take life. “It is an important public health problem, one of the leading causes of disease burden and suicide in the world.”
He pointed out that depression had remained a silent and little known subject in our society for so long but not anymore.
“We can no longer ignore or avoid this deadly disease,” he said. “So let’s start talking and discussing how best we can address this growing menace in our society.”
Just as depression can be prevented and treated, so is suicide, he added. “If we can take proper care of people with depression, a lot of suicides can be prevented. Suicide does not happen just by chance.”
He said that a suicidal person would have spent a lot of time agonizing about his fate. Just by talking or encouraging the person to speak about his problems can relieve a lot of their burden.
“We need to encourage depressed people to come out of their dark shadows and talk. Only then, we can provide them the necessary help they need,” he said.
He said that the current situation of depression in Bhutan is alarming for a variety of reasons.
One reason could be a huge gap in the number of people living with depression and those receiving treatment in the country.
According to WHO estimates, Bhutan should have about 20,000 people living with depression in the past year while only about 1,000 people sought treatment in hospitals. Which means only 5 percent of the people suffering from depression received treatment.
“This big gap may also be contributing to the high suicide rate in the country,” he said.
Dr Chencho Dorji said that depression is a difficult disease to be identified and diagnosed, as there is no specific test or equipment to diagnose the depression. Diagnosis is mainly through clinical interview and examination.
“Most of our health workers are not skilled or have adequate experience in diagnosing and managing depression cases,” he said.
Strong social stigma and discrimination of people with metal disorders including depressing could be another reason.
He said that not only there is shame in seeking treatment due to lack of awareness among our population, there are strong superstitions surrounding the causes of mental disorders that prevents depression patients from seeking treatment.
The causes of depression are usually multiple or multi-factorial including psychosocial stressors like ill health, difficult relationships, financial burden and poverty. Individual factors like traumatic experiences, poor coping skills, unemployment, drugs and alcohol abuse or lack of social support could also cause depression, he added.
“In some cases, the cause of depression is not clearly known or understood. Even a bout of viral infection or taking certain medications can trigger a depressive episode,” he said.
Mild forms of depression can be cured with psychotherapy and supportive treatment. Moderate depression responds better to a combination of anti-depressant medication and psychotherapy while, severely depressed patients need admission to hospital for intensive treatment with medications, psychotherapy and electro-convulsive therapy.
Dr Chencho Dorji said that mental disorders management does not necessarily require sophisticated technology or expensive medication. “A well trained health worker can manage depression in a peripheral hospital if supplied with appropriate medication and support.”
There are only two types of anti-depressant medications available in the country today. “Certainly, there is need for both increasing the variety as well as reach of these essential medications.”
He said that if Bhutan is to move forward as a GNH aspiring country and reduce its burden of depression and suicide, a lot needs to be done to further reduce the treatment gap.
“Both accesses to treatment and quality of services need improvement, along with increasing the demand for services through creating awareness on depression and other mental illnesses,” he added.
He said that the health ministry’s information communication bureau and mass media can play a vital role in educating the general public on depression.
In order to reduce the treatment gap, mental health should be made a priority national agenda in the 12th plan, he added. “The National Mental Health Programme needs to be strengthened in terms of both human resources and funding in order to improve the mental health of our people.”
During the event, the health minister also awarded a prize to a student of Rinchen HSS for winning the best artwork in category B of the regional poster competition “MindArt’ for youth organised by the WHO Regional Office for South-East Asia in two categories.
As part of the event, a report on assessment on health sector response to gender based violence in different levels of health facilities in Bhutan was also launched.
The students of YHSS performed skits related to depression.
Dechen Tshomo