The PEMA to push mental health as Bhutan’s forefront agenda Suicide cases on the rise

Yeshey Lhadon

“Suicide is on the rise, depression and anxiety is on the rise. It’s timely that we really need to
consolidate all our effort into one,” said the Chairperson of The PEMA, Health minister, Lyonpo
Dasho Dechen Wangmo during the mental health sensitization program.

Tshering Tshencho Zam from the Pema Secretariat stated that starting from 2019 when the Covid-19
pandemic found its way into Bhutan, the mental health issues have almost doubled in a year and in
2020-2021.

Globally every 40 seconds, one life is lost to suicide. In Bhutan, going through the data from past five
years on average, seven or eight  people lose life to suicide in a month. As shown in the data, The
Pema noticed an increasing trend for all mental health related issues and especially for anxiety and
depression. Bhutan also has the burden of alcohol liver disease which is still at the top spot as the
cause of death.

“And the mental well being of the Bhutanese population became a huge concern for everyone
including their Majesties,” said Tshering Tshencho Zam. Thus, a mental health board was formed on
 October 23, composed of six members with the health minister as the chairperson after receiving an
audience from Her Majesty the Gyaltsuen.

Kezang Dukpa from the Pema Secretariat said that instituting responsible reporting frameworks for
suicide incidences is necessary.”People are less aware as they inform the public through media. They
don’t realize that suicide is psychologically contagious,” he said.

The Pema Secretariat stated that the media plays a strong role in preventing suicide by reporting it
in the right manner.
He said, “A wrong message can actually lead to clustering of suicides like that happened in some
other countries. When we are less aware, the dynamics of social cognition, we then go about
reporting such incidents in a way it was reported. “

The PEMA encourages the principals in schools not to sensationalize, glamorize or glorify suicide
incidences.
“At times, when suicide incidences are reported in a glamorized way, people with similar stories are
waiting in the other part of the world. And when they see that a person like their story has died by
suicide, they begin to  and somebody who is popular or famous , if they compete suicide, then they
start to identify,” said Kezang Dukpa.

“Reporting and informing people on suicide incidences can have spiral consequences,” he added.
According to Kezang Dukpa, the highest risk factors are  found in people with suicidal idea or having
history of previous attempt. “If anybody had previous attempt , that’s the biggest risk factor for
further suicidal cases,” he said.

The Pema Center Secretariat will maintain registry who have
attempted suicide and  follow up services to stay connected with the people who need support.
Kezang also mentioned that if suicide happens in same house, people tend to focus on the incident
and forget about the family, and those who are left behind.

He said, “They are the ones primarily exposed  and undergoing the similar issues that the deceased
had been experiencing. At the same time, they are also traumatized seeing such incidents. They
need the maximum support.”  Kezang said that the secretariat will assist the families and identify the pattern of issues in the families which might have led to the suicide.

During the lockdown, Pema Center Secretariat has few numbers published on their websites for
people to seek help. The Center supported 1048 people during the lockdown. Thus, response
services, social media surveillance, plays in saving lives.

“There were incidents where through the help lines could  save lives, as extreme as people who
were about to jump in the river,” said Kezang Dukpa.
The Pema Center Secretariat identified phone numbers and people for the help lines which are
handled by trained counsellors. Counsellors  can provide not only information but also counselling
online.

Kezang Dukpa also claimed that there are mental health services in Bhutan but in need of more
specialized services. He highlighted the importance of specialized services like family counselling,
relationship counselling, occupational therapists, and more psychiatric and other mental health
services, and prevention specialists.

He mentioned that The PEMA as a nodal agency will take the responsibility of keeping the
information for mental health in an integrated data system. Currently, it’s found that every
organization keeps their own records. In some cases there is only administrative record while others
only have survey records. “There is no primary source of data for the whole country at present,” said
Kezang Dukpa.

Lyonpo Dasho Dechen Wangmo cited an example of a teenager , who locks oneself up in the room.”
As parents, many won’t know how to react,  what to do and where to report. By the time they seek
medical attention from the hospitals, then it’s too late to intervene and help,” she said. Thus the
sensitization program is being carried out through the Pema Center platform that provides
comprehensive advocacy as an apex body to help people suffering from mental health issues.

“Some parents are not aware of their children’s behaviour. Some, even if they are aware, don’t know
where to report it. By the time they report it to the  police, it’s too late. Police will come when it’s
too late and so will the health personnel. That is the biggest gap.” added Lyonpo.
Lyonpo also stated that mental health issues are stigmatized in Bhutan. Thus there were occasions
where the family members would lock up or chain up the mentally ill people up instead of getting
help.
The chairperson also found some parents are defensive. Some are aware that their children
attempted suicide but refuses to get help.” We need to de-stigmatize mental health issues. It is fine
to ask for help,” she said.

Lyonpo also said that providing mental health service face some challenges when dealing with
victims of abuse, rape, incest, drug, suicide and others. She said, “We put them in a basket, called
‘sensitive basket’. And it’s difficult to  have the conversation on sensitive matters and re-victimise
the help seekers.”

“However, we need to have a small conversation. We need to talk about it, so that we can make
these sensitive issues a bit less sensitive and work on mental wellbeing,” added Lyonpo Dasho
Dechen Wangmo.