State of Mental Health Services in Southeast Asia

What is the quality and availability of mental health services in the southeast Asia region known as ASEAN?  The Association of Southeast Asian Nations (ASEAN) is a geo-political and economic organization of the following countries: Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam. 

Fortunately, a recent article by Maramis, Tuan, and Minas (2011) provides a very competent and useful overview of the state of mental health services in this region.  I hope that this brief review of their article will help disseminate the important information in their paper to mental health workers in Asia, particularly those in a position to affect public mental health policy. This is in line with the fundamental purpose of Psychology Matters Asia which is to act as a portal for providing information to mental health professionals in the Asia region. 

Problems facing the mental health services in ASEAN

Marais and his colleagues begin by stating that mental health resources vary widely from country to country and that in general, "Mental health has been a low priority". The authors go on to review the various factors that affect the quality of the mental health services in the ASEAN region. They include some general factors such as widespread poverty, income inequality, rapid social and cultural changes, and urbanization with inadequate preparation for such rapid demographic change. 

Maramis et al describe more specific obstacles to improving mental health services, including a “lack of attention and investment”, and the fact that even where “legislation and policies exist, they are, at best, incompletely implemented”.  They also note that there tends to be a low outlay of money with mental health spending being “no more than 2% of the health budget”.  

Aaron Favila/AP

The authors list other problems: "There are massive workforce deficiencies; few consumer, carer, or other civil-society organisations with a focus on mental health advocacy; inadequate protection of the rights of people with mental illness; few efforts to promote mental health; little in the way of rehabilitation services or efforts to promote social and economic inclusion; and treatment services are concentrated in urban areas and often of poor quality, inaccessible, and unaffordable."

With regard to the very delicate topic of politics and mental health in this region, Maramis et al wrote "The continuing development of effective and accessible mental health systems in southeast Asia will require leadership at all levels, most importantly political leadership." They do not discuss how difficult it is to report objectively on the sometimes dire state of mental health services in some of these countries because doing so is likely to raise the ire of government officials and politicians.  Of course, this is true all over the world but perhaps particularly so in developing countries. 

They also touched only briefly on how difficult it can be to do scientific research on mental health in this region. One of the reasons is that quantitative, reliable, and valid data is hard to come by in developing countries.  Also to do research in some countries, at least for non-citizens, approval from a government agency is usually required.  This alone likely affects what one proposes to do in the grant and of course locks one into a rigid research plan. 

The investigator may self-censor the content of the final research publication for various reasons including if they want to return to do further research.  So a catch 22 situation exists for mental health workers and researchers who must balance political considerations versus the need for facing realities of how well the mental health system is functioning.  The authors in writing this paper did an excellent job of walking that tightrope.

Ways to improve the mental health services in ASEAN

Maramis et al discussed ways to improve the mental health services in this region.  They wrote "A clear and long-term focus on building community services, and redefining the roles of mental hospitals, will be essential. Greatly improved education and training capacity, and re-orientation of training curricula to community-based practice, will be necessary to prepare professionals to work in new ways and in unfamiliar settings."  

The authors point out the need for creative solutions to mental health issues which are culturally relevant and appropriate instead of just importing strategies tried in other regions of the world.  However, they do not mention a couple of "imported" strategies that in my opinion might be effective. For example, information technology such as tele-consultation might be useful to assist mental health service delivery to remote jungle areas where mental health professionals are usually not available.  Also self-help groups, although mainly a western phenomena, might be modified to suit the needs of those in large cities who suffer from addictions or other mental health problems where mental health services and financing are severely limited.

The authors iterated on the essential need to build research capacity into the mental health delivery system since it is only through such research that new strategies in service delivery can be evaluated and improved.  Finally, Maramis and his fellow authors emphasize the importance of collaboration among ASEAN countries on improving mental health services in this region, one unique and new such collaborative structure being the “International Observatory on Mental Health Systems (Minas, 2009). 

Conclusion

Maramis and his colleagues are to be congratulated for taking time to prepare their paper and successfully getting it published in the highly respected journal Lancet.  It is hoped that this short review in Psychology Matters Asia will stimulate mental health workers in Asia to read their informative paper in its entirety.

References

Maramis, A., Nguyen, V. T., & Minas, H. (2011). Mental health in Southeast Asia.  The Lancet, 377(9767), 700-702.

doi: 10.1016/S0140-6736(10)62181-2

Minas, H. (2009). International observatory on mental health systems: structure and operation. International Journal of Mental Health Systems, 3, 8.