Welcome to the 22nd WCP Congress Program Scheduling

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Mental Health Development in Bhutan – Challenges and Opportunities

Bhutan is known for its development philosophy of Gross National Happiness (GNH), conceived by the 4^th king of Bhutan His Majesty Jigme Singye Wangchuck in 1974, which prioritizes people-centered development over gross domestic product. Happiness, satisfaction, and contentment with life are the core principles of this philosophy.

The modern development in Bhutan began in 1960 with health, education, road, and agriculture as priority activities. In over six decades, Bhutan has achieved remarkable progress in all spheres of development, especially health. Today, Bhutanese enjoy a good quality of life and free health care services.

Bhutan launched its mental health (MH) program in 1997 with a handful of trained MH professionals with the policy to provide community-based MH services through a strategy of training Primary Health Care (PHC) workers on basic counseling and prescription of simple psychotropic medications. Today, the majority of PHC workers are trained and psychotropic medications are available in all PHCs and provided free to the people.

Major challenges are stigma related to MH, discouraging seeking treatment, and low competency in healthcare workers providing adequate treatment. The COVID-19 situation has caused major setbacks in service delivery and an increasing number of MH cases.

Under the direct patronage of the Queen of Bhutan, Her Majesty Jetsun Pema Wangchuck, the Royal Government of Bhutan has set up a national hub for mental health policy, planning, coordination, implementation, and research in 2021 to strengthen the mental health services in the country.

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Started in 1926 by Buddhist monks using traditional herbal medicine, mental health service in Mongolia has benefited from Western medicine introduced by the Soviets in the 1930s. After WWII, the first Mongolian physicians who graduated from the Mongolian National University contributed substantially to establishing modern psychiatry and nationwide mental health services. Although private hospitals and community-based services have recently diversified the mental health service in Mongolia, it is still mainly characterized by hospital-based care.

At present, Mongolia (population: 3.2 million) has 605 hospital beds (19/100,000; mean length of stay: 28.4 days), 118 psychiatrists (3.7/100,000), and 172 psychiatric nurses (5.4/100,000). As reported in the hospital-based national registry, the mean prevalence of mental disorders between 2014 and 2019 was 26,607±2,143 (837/100,000). According to the ICD-10, mental retardation (F7, 35%), substance use disorders (F1, 18%), organic mental disorders (F0, 17%), stress-related mental disorders (F4, 11%), and schizophrenia (F2, 10%) were the most common disorders in the national registry database. The mean suicide rate was 301±37 (9.5/100,000). In the corresponding period, the total percentage of those who had received any psychiatric treatment within 12 months was 1.4%. 17,704±1666 patients (557/100,000) received disability pensions (approximately $120/month). Health insurance covers all mental health services.

These achievements were supported by national policy and legal frameworks, including the mental health law and national program for mental health, which were recommended and supervised by WHO. Furthermore, this review will summarize the current challenges and future perspectives for modern mental health development in the country.