If we look to 2030, the World Health Organisation (WHO) forecasts that depression will be the single largest contributor to the burden of disease worldwide. However, in most of Asia, the concept of mental health has long had to suffer from stigmatisation and a pronounced lack of attention, professional care, and resources. While things are moving in the right direction, much still needs to be done.
In Laos for example, mental health issues are often believed to be caused by the possession of evil spirits. At the end of 2013, only two psychiatrists served a country of six million people, and there is still no mental health legislation to speak of (The Huffington Post, 2013). With inadequate access to treatment, mentally ill people face discrimination in all aspects of their lives, including exclusion from the labour market, and even social exclusion within their own families and communities.
Cambodia’s distressing history, with decades of unrest and the consequences of the tyrannical Khmer Rouge regime which saw up to two million die from 1975-1979, has meant it is very susceptible to the effects of PTSD. This trauma continues to reverberate through subsequent generations, and also afflicts many other countries throughout the region that have suffered years of war and civil unrest, including Afghanistan, Nepal and Sri Lanka.
In Vietnam, the reported percentage of the population estimated to have mental disorders is 15-20 percent, but psychiatrists working on the ground say the figure is much higher. Despite knowing that their children are mentally ill, many families refuse to seek help for fear of social discrimination. They fear that their children will not be able to get married or find a job. When someone suffers a chronic mental disorder, the effects are usually not confined to just them. Their families are often also subject to stress, worries and depression, not to mention the financial burden associated with paying for medical and other related expenses.
In South Asia, those who suffer from mental illness suffer from discrimination, and often, violence. There is a severe lack of policy programs and limited budgets, and where mental health services are available, they tend to be focused within urban outlets and based in hospitals. This leaves a large majority of the rural-based population unavailable to benefit from such services.
In China, attitudes to mental health are moulded by Confucian ideology. With Confucian thought emphasising personal duties and social goals as opposed to individual rights, failing to fulfill one’s duties to family and society can lead to common symptoms of psychological distress. Statistics released by China’s National Center for Mental Health showed that as of 2009, 100 million Chinese suffered from mental health problems.
The portrayal of mentally ill people in Chinese media tends to be negative, even if they do not overtly discriminate. They tend to be portrayed as victims or perpetrators of crime, and face avoidance, indifference or ridicule in portrayals of society.
A lack of professional psychiatrists exacerbates the problem in China. Worldwide, there are four psychiatrists and thirteen nurses for every 100,000 people; in China however, that ratio drops to just 1.5 psychiatrists and 2.2 nurses per 100,000 (The Atlantic, 2013).
According to the Ministry of Health in Indonesia, some 19 million Indonesians have a form of mental health disorder. Many uneducated people living in rural areas believe that mental illnesses are a result of being the victim of a curse or black magic. Thousands continue to be chained or shackled because of mental illness. A big problem is that trained psychiatrists often lose out to witch doctors and spiritual patients when it comes to treating mental health patients.
According to Dr Asmarahadi, one of 14 psychiatrists at the government-run Suharto Heerdjan Hospital, changing this stigma is critical to effectively addressing the problem. “We need to get the message out to people that mentally ill patients can be treated with medication, and can live normal lives. People think that with medication they will turn into shells of themselves, and not be able to have sexual relations with their partners. That’s not true.” (BBC, 2013).
Every person with mental health issues has their own unique story. Each country has their own unique challenges when it comes to what they need to do to effectively address mental health issues. But there are common links between different parts Asia from which lessons can be learnt, and undoubtedly countries can share resources and best practices with each other.
If you think you may be experiencing depression, anxiety, or another mental health problem, please contact ANU Counselling on 6125 2442, Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636.