Mental Health in Myanmar

We typically categorise health into two areas, physical and mental. Physical health relates to the fitness and condition of our bodies while mental health refers to our emotional, psychological, and social well-being.


Mental health affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.


Read the article below about mental health in Myanmar and decide if the following statements agree with the views of the writer in the article below. Write

  • YES, if the statement agrees with the views of the writer

  • NO, if the statement disagrees with the views of the writer

  • NOT GIVEN, if it is impossible to tell whether the writer agrees or disagrees with the statement

  1. Mental health problems in Myanmar have been made worse by violence associated with the military coup.

  2. Research has revealed that stigma in Myanmar has a significant impact on mental health.

  3. Stigma about mental health in Myanmar is partly caused by outdated legislation.

  4. Funding of mental health in Myanmar needs to be more than 2% of total health care expenditures.

  5. The healthcare system in Myanmar will probably be negatively affected by the Civil Disobedience Movement (CDM) and military rule.

  6. Medical professionals should stop their strike as they are causing major disruption to the public healthcare system in Myanmar.

  7. Mental health campaigns will need to be critical of the military government.

  8. Mental health professionals, such as Aung Min Thein believe counseling needs to focus on the behaviour and actions of the military.

 

Before the coup, mental health was a neglected issue in Myanmar. Myanmar is an unstable country, both in terms of political and economic factors. Decades of protracted conflict combined, more recently with the economic impact of COVID-19, which according to a study in October 2020, saw the proportion of the population living in poverty rising from 16% to 63% over the past 8 months, have created increased instability.

Moreover, since the February 2021 coup, violent crackdowns have already had, and will continue to have, a significant impact on citizens’ mental wellbeing. Senior UN officials warn that ‘Myanmar is spiraling into becoming something like a failed state’ with ‘potentially massive humanitarian ramifications’.


As Myanmar continues to exhibit more characteristics of a failed state, there will be serious ramifications for its population’s mental wellbeing. These ramifications can be seen in other conflict afflicted countries. According to a global WHO synthesis of 129 studies done in numerous conflict-affected contexts, ‘one in five people in conflict-affected populations have mental health conditions’. Conditions identified among these populations include depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia. The report concludes that, ‘given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden.’


A 2019 HelpAge International study found that ‘there is, [effectively], no mental health policy in Myanmar; staff are not adequately trained and there is little infrastructure to facilitate these services, particularly in rural areas’. The study also pointed out that stigma and cultural understandings are also key issues: ‘while there is no data in Myanmar on how stigma impacts mental health, studies from other, similar countries suggest it has serious consequences.’


Legislation and funding

Myanmar’s mental health legislation is legislated by The Lunacy Act, dating from 1912. Violate this law and you’ll face a fine of 50 Indian rupees – a currency that has been obsolete since 1952. That Myanmar’s current mental health law focuses on criminalising ‘lunatics’ who pose a danger to society goes a long way to explain the stigma that mental health currently has in the country. The Lunacy Act was also used in India, yet was replaced there in 1987 and then again in 2017 by the Mental Healthcare Act, which explicitly stated the need to implement ‘programmes to reduce stigma associated with mental illness’. In Myanmar, a new bill has ‘been discussed by relevant ministries and agencies since 2013 but has not reached parliament,’ according to the Myanmar Times.


Myanmar’s mental health landscape is also shaped by its Mental Health Policy, which is part of its National Health Policy. Last revised in 2006, the National Health Policy sees 0.3% of total health care expenditures spent on mental health, versus a global median of 2%. Up until 2012, Myanmar had one of the lowest rates of healthcare spending in the world. While spending since then has risen significantly, Myanmar’s national healthcare expenditure as a percentage of GDP is the lowest in the ASEAN region, and outside of Africa, remains one of the lowest in the world. Furthermore, one has to keep in mind how badly funded and managed healthcare was in Myanmar for so many years. According to DFID: ‘even with the increase, a much larger injection of funds is necessary to reverse decades of neglect and mismanagement.’


How the ongoing Civil Disobedience Movement (CDM) and the junta’s approach to healthcare governance will affect the healthcare system is yet to be seen, though the impact of these shocks is unlikely to be positive. Military rule in the past has coincided with chronic government underspending on healthcare, and their recent behaviour against any health workers who are deemed to be threatening the stability of the government does not bode well. As of early May, at least 97 healthcare workers have been arrested and 10 killed since the coup, while arrest warrants have been issued for 400 health workers participating in CDM. Thousands continue to strike, bringing the country’s public health system – which accounts for 80% of the hospitals and clinics in the country – to its knees. Striking doctors have set up their own clandestine clinics, yet these are overloaded and face the risk of arrest if discovered.


‘The public health system is near collapse,’ Dr Mitchell Sangma, of Medicins San Frontiers told the BBC. “It’s a grim situation”. Those who cannot afford private care, simply are going without any healthcare. Though no research is currently available, given how limited the public provision of mental health support is at the best of times, now, when even life-saving care is unavailable, it must be close to non-existent.


(Mis)understandings of mental health

Public understandings of mental health are also an issue of concern. A student who graduated with a BA in Psychology from East Yangon University a few years ago noted that her course was extremely unpopular: of approximately 4,000 students who graduated from the university in her year, she had only three other course mates. It was the least popular course in her year. Furthermore, the reaction from friends, extended family members and even fellow students when she told them what she studied revealed that people’s understanding of psychology is often confused and that they tend to associate psychology with extreme mental illness.


Promising signs

There are, however, more promising signs, most notably in the private sector provision of mental health. Aung Min Thein, the founder of Counselling Corner, a private mental health CSO based in Yangon, explained how they address the problems facing the provision of mental health services in Myanmar.


According to him, ‘we have found that Myanmar people are not very familiar with counselling and generally don’t want to burden the system. This is the result of two main factors, the lack of information and stigma that mental health currently has in the country, and arr nar dal – the feeling of not wanting to impose oneself. It is therefore vital that we take a pro-active approach to mental health provision – while passive techniques have an important role to play, real results require real and meaningful interaction between the target groups and mental healthcare professionals. We have found that interactive workshops offer the best environment for therapy as they encourage people to talk freely in small groups about themselves – often realising that they share the same emotions, feelings and experiences.’


Mental health in the wake of the coup

Looking forward, addressing these financial, legislative, structural, and cultural changes will take time, particularly given the current political situation. The junta government has made it clear that it will not accept any criticism of its rule, which causes a problem for any mental health campaign. While mental health was certainly an issue in Myanmar before, it is an issue that has been exacerbated by the military coup and the subsequent, and ongoing, destruction that has followed. Even for those who have not directly experienced extreme traumatic experiences (like being imprisoned, physically attacked etc.), anyone with a Facebook account will have been exposed to content that poses severe mental health risks. Stresses related to the severe economic implications of the coup, such as mass unemployment and financial insecurity, may also act as triggers on top of the previous existing challenges caused by Covid-19, past traumas, or even the normal difficulties in a person’s life.


The coup puts mental health at an impasse: many of the mental health issues people will be experiencing will be caused directly by the coup, yet any treatment likely cannot explore these issues or place any blame, lest they run the risk of censorship – or worse. However, as Aung Min Thein tells me, the importance of therapy is not about placing the blame on somebody or something, rather about working on one’s own issues. His approach is to focus on the feelings of the individuals rather than the stimuli that caused them. This strategy does not legitimise the coup, but rather a recognition that the resilience people require to resist the regime depends on their mental wellbeing.


While the situation seems bleak, the first step at least is clear: we need to deal with the stigma associated with mental health in Myanmar, and to help people realise that asking for mental health support is both completely normal and healthy. Only then can mental health issues in Myanmar be truly addressed.


Full article at https://teacircleoxford.com/2021/06/28/mental-health-in-myanmar-challenges-pre-and-post-coup/


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