Across the country, mental health patients face social stigma, inadequate care and even abuse – problems that have worsened since the post-coup healthcare collapse, but which long precede it.
By FRONTIER
Ma Phyu*, 38, has been grappling with mental health issues for most of her adult life. Her mother, Daw Aye Than*, said that when her daughter’s symptoms emerged around age 21, she felt embarrassed and couldn’t find any support or assistance in their small village in Magway Region’s Myaing Township.
“Eating has become a struggle for her. She used to vent her anger outside, but now she confines herself to her room, weakened and emaciated,” Aye Than said. “I find myself caring for her as if she were a young child. Her condition has deteriorated to the point where she can’t even dress herself. It’s heartbreaking to witness her suffering.”
Aye Than said for the first few years, she took her daughter to private mental health clinics, public hospitals and even tried traditional medicine. But the treatments were either too expensive or ineffective, so they eventually brought her home.
“If she becomes difficult to control, we ask the medicine man in the village to give her an injection, which makes her calm down,” Aye Than said, adding she doesn’t know what type of medicine her daughter is given.
As with many relatives of mental health patients in Myanmar, she doesn’t know what afflicts her daughter, and claims various doctors never informed her of the diagnosis. Ma Phyu’s situation is not unusual among mental health patients in Myanmar, who were largely neglected even before the 2021 military coup collapsed the public healthcare system.
There is little help for them in rural areas like Myaing, with the only state-run psychiatric hospitals located in the country’s two biggest cities, Yangon and Mandalay. But relatives of patients at the hospital in Yangon complained about the service there, which has worsened since the coup, while few can afford the better care offered at private clinics. Meanwhile, social stigma and a lack of community awareness means many patients are left untreated or treated in an abusive way that can worsen their conditions.
A woman from Nay Pyi Taw’s rural Lewe Township said her 29-year-old brother first started suffering from mental health problems in 2010, so the family sent him to the Yangon Mental Health Hospital in East Dagon Township.
“My brother was so out of control that they put him in a prison-like room, with only a toilet and a mat. They wouldn’t even give him a blanket because they were afraid he would hang himself,” she said.
She said the hospital was also corrupt – if you paid the staff, they would “pay more attention” to the patient, and for another fee the patient would be placed in a more comfortable room with fewer roommates.
“I couldn’t see my brother living like this so I brought him home,” she said, but the family didn’t have the capacity to take care of him.
He would often mutter to himself, repeating school lessons he had learned as a child, or lash out angrily and break things.
“My parents grew sugarcane, so when the harvest season came, they were busy and couldn’t monitor my brother. So they tied him up with a rope,” she said, referring to a common practice in Myanmar.
By 2022, the family’s financial situation had improved and they could finally afford to take him to a private hospital, where they saw immediate results. Not long after, she was able to bring him to her new home in Yangon, where she now lives with her husband, and continue administering the same medicine prescribed by the private hospital.
“Now he can live at home peacefully.”
Post-coup breakdown
Many civil servants walked off their jobs to protest against the military’s seizure of power in February 2021. The mass strike, known as the Civil Disobedience Movement, was first launched by healthcare workers. A mental health specialist based in Yangon estimated that of the 200 mental health doctors in the country, around half of them joined the CDM.
Ko Kyaw*, who works at the Yangon Mental Health Hospital, said the facility also lost around half of its 50 trained doctors after the coup, leaving the remaining staffers stretched thin caring for patients.
“There are typically 50 to 60 patients per ward, and two hospital staff members are responsible for caring for them in shifts,” he said. “As a result, there is a significant gap between the number of patients and the available staff. Despite these challenges, we are doing our utmost to provide care and support to the patients.”
Ko Kyaw said there is also a shortage of accommodation and food, but claimed there was adequate medicine for mental health specifically. However, he said if they suffer from other diseases, it’s the responsibility of their families to arrange for them to receive treatment elsewhere.
“The hospital solely focuses on treating mental health conditions,” he said.
But the relative of a man receiving treatment at the hospital for drug addiction said sometimes the family has to buy his mental health medication from outside pharmacies because the hospital suffers regular shortages.
The man, whose relative checked in last year, said it can also be very difficult to meet with the doctors.
“Only the assistants and nurses are always at the hospital. I don’t know if it’s because the number of doctors is low, but if patients want to see a doctor, they have to wait a really long time. I think there are a lot of patients and a small number of doctors,” he said.
Ma Wai*, in Yangon’s Hmawbi Township, said she sent her 50-year-old brother to the Yangon Mental Health Hospital more than 20 years ago, after he developed mental problems while serving in the navy at 19.
“The doctor said my brother had nerve damage, that’s all he said. They never explained more about why this happened,” she said, adding that her brother became aggressive and violent, sometimes attacking other people in the neighbourhood.
“We had to solve all these problems for him. If the person who was attacked complained, we had to compensate them. Because of this, we were always having problems and arguments with other people in the community. Only a few people understood it’s a mental health condition,” Ma Wai said.
She said he received adequate care at the Yangon Mental Health Hospital for many years, but soon after the coup, staffers started demanding that patients have their own personal attendants who stay with them in the hospital every day.
“I think this is because the hospital doesn’t have enough staff, but I don’t know for sure,” she said, adding the family was unable to send somebody to stay in the hospital with him full-time. They considered bringing him to a private clinic, but it cost K700,000 per month, around US$175 at today’s market rate, which they couldn’t afford.
So instead they sent him to a social welfare group that specialises in helping people with mental health problems, paying K100,000 per month plus the cost of medication.
While Ma Wai said she’s satisfied with the level of care, she admitted that the organisation occasionally threatens to beat her brother to make him behave.
“I think it’s just a threat,” she said. “It’s no problem if they beat my brother; we assume they would only do this because they need to.”
Social stigma and lack of support
A lack of education coupled with social stigma means many patients are treated in ways that are contrary to their needs and can even make their conditions worse. The mental health specialist in Yangon said both families and mental health facilities sometimes lock patients up because they don’t know what else to do with them.
“Without proper support, the patient becomes a burden for the family and may even cause more trouble. When the family faces difficulties, they can’t handle the burden anymore. Those who can afford it may pay for care facilities, leaving the patient there for the rest of their lives,” she said.
Particularly in rural areas, many mental health patients rely solely on their families for support and are confined to their homes, isolated from the outside world. This is both because they can cause trouble in the community and because family members are embarrassed, explained an official from a Yangon-based non-profit organisation.
“It’s rare to witness people offering comfort and support to mental health patients in our country. Often, families themselves are unaware of the need for such gestures,” he said.
Ko Kyaw agreed, appealing to charity groups and the public to volunteer at mental health facilities to help cheer up patients. He said this help could include nail cutting or hair care – tasks currently handled by staff members in addition to their medical responsibilities – and general social activities.
“It would also be wonderful if volunteers could organise activities that bring joy to the patients’ lives. Additionally, there is always a need for clothing, so it would be appreciated if people could donate clothing along with food,” he said.
Another source of stigma is the Buddhist belief that people with mental health problems are being punished for sins committed in a past life. The law, meanwhile, offers little protection against abuse. Legislation related to mental health has not been updated since the colonial era 1912 Lunacy Act, something the mental health specialist in Yangon said is urgently needed.
In June 2020, the elected National League for Democracy government announced plans for a mental health policy and strategic plan for 2020-2024, but the military hasn’t taken any further action since the coup.
The specialist said besides reversing institutional neglect, there also needs to be more public education, so that communities can come together to help patients in a more productive way even when formal care isn’t available.
“We can’t rely solely on mental hospitals; we also require health education and community-based healthcare services. Support systems are crucial, including mental health education. In other countries, children already learn about mental health in schools,” she said.
Ma Wai said if it was feasible to take care of her brother at home, she would, but she doesn’t know how.
“He is still a member of our family,” she said. “Because of the circumstances we have to send him away, but if we could keep him, we would want to treat him at home.”
*indicates use of pseudonym to allow sources to speak freely
