by Dr Nwe Thein, Consultant Old Age Psychiatrist, South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Founder/Trustee, Mind to Mind Myanmar (UK charity registration number 1165005)
When I was a medical student in the mid-1990s in Myanmar, depression was merely a topic studied for the exams. Patients with depression were not so visible in the institution where we went for the placement in psychiatry. Students were more fascinated by the strange psychotic symptoms in schizophrenia than the sad and gloomy symptoms of depression.
In any case, psychiatry was not a subject that attracted serious attention from the medical students or doctors and specialists. The undergraduate medical curriculum paid very little attention to the mental health aspect of a person’s health. Mental health services also suffered a similar lack of interest from the policy makers.
According to the WHO AIMS report in 2006, only 0.3% of the total health budget was invested in mental health.
Recent figures from the charity mental health clinics that are funded by our charity showed depression as one of the top morbidities among clinic attendees. It is nowhere near being representative of the whole population in the country, but it has certainly highlighted that depression is a common mental health problem in Myanmar like
anywhere else in the world.
In Myanmar, depression is not much known or accepted as an illness. People tend to take it as a predictable part of life and try to get over it by getting on with their routines. Those with mild symptoms recover while those with more severe symptoms worsen over time. By the time they are brought to the hospital, sometimes in restraints, by their families, patients are very ill and lacking an insight into their illness and its associated risks. Specialist mental hospitals in Myanmar, until recently, could offer only unmodified ECT. Understandably, patients and clinicians dreaded this option, although it could be the only life-saving treatment of severe depression.
There is also a belief that the religion (Buddhism) protects people in Myanmar from depression. It is true for mild symptoms related to stress; people take refuge in the religious faith, practise mindfulness and insight meditation, or perform the rituals which are in fact more traditional and cultural than religious. However, not everyone in Myanmar is Buddhist or particularly religious. More crucially, people who suffer moderate to severe depression need specialist medical attention and treatment.
In recent years, the suicide rate in Myanmar has gone up a few positions in the list of 25 top causes for YLL (years of life lost) quantifying the premature mortality. According to the WHO report (2012), Myanmar’s suicide mortality rate was 12.4 per 100,000 population, higher than the global average of 11.4. With the known link between suicide and depression, this places emphasis on the need to diagnose and treat depression early and properly.
There is hope and optimism. In a country where social cohesion is still strong, Myanmar may not require all the formalities of the Western way of managing depression, but rather a pragmatic combination of strands drawn from the evidence-based Western model and the inexpensive psychosocial approach based in its social structure, community spirit and existing helpful practices. In order to achieve creative and innovative ways of managing depression, people need to talk more and talk openly about depression first.