“Let’s not stigmatise mental health"

“I am going to say what’s on my mind. I am going to share something that I rarely talk about.”

This was how the Minister for Foreign Affairs and Chair of the National commission for Women and Children, Dr Tandi Dorji launched the #OnMyMind campaign and the release of the State of the World’s Children Report, last week. The campaign and the Report focus on supporting interventions to promote good mental health.

“Long years of being away from home, the stress of medical studies and the long hours at night completely destroyed me,” the minister shared. “In a fraction of a second, I think it happened within an hour of that violent incident. After that I couldn’t stand. It was so bad that despite all efforts from my professors and doctors, they asked me to leave because I couldn’t continue. So, I returned to Bhutan.”

The minister recalled thinking about his ambition to be a doctor being over. “Because I couldn’t attend classes. I couldn’t be around people. I started fearing doing simple tasks like putting on the lights. Just the fact of putting on the lights would give me the fear of being electrocuted.  If I went to the toilet, I felt that I would slip, bang my head and die.  The thought of death, the fear of people looking at me like this…I would be thinking that they are scheming to kill me.”

He spent over three months at home. “I sought help. Very fortunately, my parents were very supportive. And lots of meditation, lots of religious activities, lots of medicines,” the minister recalled. “Somehow miraculously under the blessing of our Je Gayshay Gaydhen Rinchen (the former chief abbot), I became sufficiently alright to return to medical school and complete.”

Dr Tandi Dorji agrees that mental health issues are not talked about and even if they are, many do not understand.

“And in Bhutan we have had a long culture of accepting mild - moderate mental health. When we say mild-moderate, people with anxiety, people with fears, people were angry all the time. We tend to say that these are short tempered people. And then if you are little bit more serious, then we say, oh, he is mad, she is mad, without really knowing that all these can be managed and helped. I think that it is because of this attitude and stigma and discrimination in Bhutan that, for many years we were not able to provide the services that were much required by many, many people.”

Doctors, nurses, health workers, he said, generally did not choose to specialize in this field because of the stigma. “So, it has been only about two decades that mental health programs are funded. We have a mental health program in the Ministry of Health, however, I think this has been underfunded. There are less number of people and it is largely focused in Thimphu, the capital city. Once you go out, there are hardly any remnants of any mental health program and services. “

However, today, the minister said that there is research that inform societies of the main causes, about the preventions and even if people are affected, there is treatment available.

The minister citied a report that said that the number one cause of mental health issues in Bhutan, at least for those who are affected and those who came to seek care is marital problems. “But the difference between number one and number two is very small. Number two, and that for me is a very, very serious problem and big concern - is lack of care and support. And this follows divorces, moving away from a certain place, rural-urban migration, coming into new environments where you don't get the same kind of support,” he said.

“Many of our young people today live with caregivers rather than their parents. We've heard of abuses, of violence and most importantly I think lack of monitoring and care. Even today, in this day and age, many times I regret joining politics because I don't have the same time that I had with my children. I used to spend every day doing homework with my daughter but after I won the elections, it has not been possible at all. Nevertheless, I still make it a point every morning to drop my daughter to school.  So that at least during that 15, 20 minutes car ride, we can discuss few things.”

Not being able to care and monitor children, the minister cited, is one of the main concerns, one that the government and all other agencies must strive to ensure because the problems troubling the youth stem from many social factors.  

“Of course, in addition there is bullying in schools and violence and one of the recent reports, which really got me concerned and I am sure many of you also follow the news, is the impact that social media is having on our children,” the minister said.

He cited a report, which found that the amount of time Bhutanese spent online was above the global average. Bhutanese spend an average of 163 minutes every day online compared to the global average of 145 minutes. Paid employees spend 253 minutes, contract employees spend 224 minutes; unemployed youth spend 194 minutes and students are spending 201 minutes.

“So, if we are not able to monitor what is going on, and the government also has taken serious note of this, we have tried. Parents want PUBG to not be available, but it is impossible because we do not have resources not the technical capacity to stop these contents from coming to Bhutan. But these are serious things that we need to act on. What is most important as parents, as teachers and as caregivers is for all of us to recognize early signs and symptoms of mental health issue in children.”

As a Paediatrician, the minister said that he has tried in the past to educate parents, but it has not been without challenges.  Children may not speak up, but he called on parents and caregivers to observe subtle differences in their behaviour such as a changing eating pattern, exhibiting fear, withdrawal from going out with friends and the most dangerous - self-harm.

“In 2019, there were 4,200 mental health cases reported. In 2020, about 6,800 cases and these are just those who come to the hospital. Imagine those who are not coming to the hospital,” the minister shared. "And so, because of this concern, and very recently Her Majesty The Gyaltsuen also expressed very, very serious concern on mental health. The government with the Ministry of Health and Ministry of Education and the CSOs have been all commanded to work together to come up with a very comprehensive package on how to address mental health issues. It must be targeted. It must be implementable, and it must be nationwide, reaching every gewog.”

Given the complexity of the issue, the minister said that the mandate to address mental ill-health must not be left to only one agency. “If only one agency does it then it will never work and I think this is the message that Her Majesty The Gyaltsuen has commanded to the government - that we must get all on board and have a very good package that would truly target this unseen burden that we have had for so many years. And the State of the World’s Children Report actually ends with a very good commitment - we need to act, to commit and to communicate.”

“As leaders, as parents and as teachers, we will commit to addressing this issue and that we will form strong partnerships. The most important part is to converse, to start the conversation - let’s not stigmatise, not brush it under the carpet. I think it’s important that we start talking about it and we should start it right from the individuals - in our homes, ask our children, ask our partners, ask our parent - how they feel. Are they having any concerns? The last and the most important is to act. Act by minimizing the risk factors and maximizing the protective factors.

“Mental health issues - it has been too long hidden, and we have not been addressing and talking about it. So, let us start today and let us work together and let us make a brighter future for all the young people.”

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