Thread: 600,000 Thais Mentally Ill...and Counting...

^ Crazy like Thaksin?

You know, Hitler had people killed based on being homosexual.

Originally Posted by obsidian

i agree. unfortunately the poor buy into the belief as well.

It's not just poor Thais, many foreigners that have the benefit of good educations and should know better.

One only has to look at the regular 'grief', 'birthday' and 'get well soon' threads over on Thaivisa and it's apparent those educations went entirely to waste. Indeed, some of the brown nosing of the privileged and elite by this country's foreign lickspittles is nothing short of repugnant.

Bangkok Post : Mentally ill suffer in margins amid care crisis

Mentally ill suffer in margins amid care crisis

Authorities have added new measures to address the plight of the suffering, but at present the healthcare system is swamped under a surge of patients seeking treatment

• Published: 3/04/2011 at 12:00 AM
• Newspaper section: Spectrum

Boonna Napiboon, 45, began to hallucinate two days before he stabbed another man to death and cut the dead body into pieces in front of his rental house in Nong Na Klue community in Udon Thani province's Muang district. Last Tuesday, Boonna confessed to the police that he killed 37-year-old Charnchai Namjai, a son of the house owner, because Charnchai did not hear the "radio voice" in the house, as he did. Boonna said that he became extremely angry when Charnchai refused to fix the radio for him.


LOST IN SANAM LUANG: ‘Aunt Razor’, surrounded by what she has collected from rubbish bins, is happy to receive food or clothes from social workers. PHOTO: COURTESY OF THE MIRROR FOUNDATION

Boonna had been diagnosed with schizophrenia, a chronic mental disorder, and was prescribed medication which made it possible for him to live a fairly normal life and hold a job. Whenever his medication ran out due to a lack of money or discipline, however, he would begin to hear the voices inside his head again, and go on a rampage. Fortunately he had the foresight when one of these episodes began to lock himself in the house, but Charnchai had the bad luck to let himself in after he was called by Boonna to deal with the radio voice.

After hearing of the incident, Boonna's wife returned home from a nearby market where she sells goods. She said that Boonna told her the world was going to explode and prohibited her from leaving the house for two days, until the police finally came.

The Public Health Ministry's Mental Health Department maintains 16 mental hospitals nationwide for those in need of close medical supervision and specialised treatment. There is obviously a good argument to be made that Boonna should have been in one of these institutions. But the hospitals are under pressure because of shortages in both funding and space. A department report says there has been a 20% increase in the last five years in the number of mentally ill patients admitted for treatment in its hospitals. In 2006, a total of 37,903 patients were admitted, increasing to 45,369 last year. Amphetamine addiction was determined to be the cause or a significant contributing factor in 5.79% of the 2010 cases, amounting to 2,626 admissions.


STREET TALK: Above, ‘Aunt Crying’ is seen happily chatting with an unidentified man on a pavement near Sanam Luang.

The report reveals that each year since 2006 the out-patient clinics at the department's hospitals have been averaging 100,000 new patients seeking medical treatment. In 2009, some 1,022,054 patients sought medical treatment at mental hospitals and general hospitals nationwide, mostly for anxiety disorders, depression and schizophrenia.

The department estimated two years ago that a total of 12 million Thais, approximately 20% of the population, suffer to some degree from some form of mental illness. The figure includes 1.2 million with depressive disorder, 240,000 with bipolar disorder and an estimated 600,000 with schizophrenia.


MELLOWING: ‘Aunt Razor’ is known for a bad temper, but she’s warmed to staff from the Mirror Foundation.

While anxiety and depression may sometimes be overlooked and considered part of the human condition unless symptoms are severe and prolonged, schizophrenia is usually always associated with chronic mental illness. There are also varying degrees of schizophrenia, however (see box).

According to the International Mental Health Research Organisation, globally the prevalence rate for schizophrenia is approximately 1.1% of the population over the age of 18.

Schizophrenics make up the majority of those who haunt public places such as bus stops and underpasses, the wild-eyed and dirty men and women whom society has given up on, sitting alone and talking to themselves. Unless they are fortunate they usually end up sleeping rough and eating from garbage bins.


FAMILIAR FACE: ‘Grandma Namcha’ stays between Ratchaprarop Soi 12 and Soi 20.

Family members sometimes ''protect'' relatives with acute mental illness by keeping them locked up or even under chains. A 67-year-old woman in Tambon Nong Mek in Na Chuak district of Maha Sarakham province was chained by her own son under a relative's house for 20 years to prevent her from wandering, after she had gotten lost several times.

The woman's illness came on after her husband left her and their only son. At first she received medical care at a hospital from time to time, but after her mother died this was discontinued and her illness worsened. Her son started chaining her up after he returned from military camp to find she was gone. The people in the community did not think it was a case of abuse because the son received no money from the state for her care and he needed to be free to look for work.

She doesn't make eye contact and talks only to herself. When she is having a bad episode, she spits in people's faces. Her son has to feed her, clean her and change her clothes.

Kanyamas Keowpewart, an official at the Na Chuak district hospital, said that finally the local tambon medical centre sought the hospital's help because they did not have people qualified to help the old woman.


BIG JOB: Tavee Tangseree, deputy director-general of the Mental Health Department.PHOTOS: COURTESY OF THE MIRROR FOUNDATION

''We learned of the case late in 2007. A multi-professional team worked with the people in the community to unchain this mentally ill woman,'' Ms Kanyamas said in a telephone interview.

Through the intervention of the hospital and the community, the son has in a sense also been unchained. The Nong Mek tambon administration organisation has built a small house for them. The woman is receiving medication, and although she still lives in a locked room, her conditions are much more comfortable and hygienic.

''She needs physical therapy because her muscles are weak after being chained for many years,'' said Ms Kanyamas, adding that social welfare officials have helped her to get old age and disability benefits. However, her son refuses to take her to hospital for treatment because he believes that it would not make her better.

Fai is one of the lucky ones. Also schizophrenic, he has long been a familiar figure in a Bangkok suburb, often seen walking or riding a bicycle alongside his beloved dog. From time to time, he appears at a food market five kilometres from his home, sitting and murmuring on the pavement, pleading for cigarettes or money from passers-by. But he always finds his way home. Cared for by his aunt, he has never acted in a harmful way to anyone and the people in the community are acquainted with him.

But luckiest of all are those with mental health problems who are able to access and respond to treatment. Thailand's track record leaves a lot to be desired in this area. The DMH estimates that 4% of the 12 million people afflicted with mental illness in the country, about 480,000 patients, have access to medications which may make a more or less normal lifestyle possible and also keep their illness from progressing.

Tavee Tangseree, deputy director-general of the DMH, said that about 40% of those seeking medical care at the nation's general hospitals have physical symptoms that may be associated with mental illness. For instance, a patient who has severe headaches or stomach aches is always checked for cancer or gastropathy, but these symptoms can be caused by mental illness as well. Yet patients are usually not screened for mental illness even if no obvious physical causes for their symptoms can be found.

Mr Tavee said that often people won't easily accept that they have a mental illness, and are reluctant to take medication.

Generally speaking, said Mr Tavee, one third of patients with mental disorders of any kind suffer from chronic mental illness, one third can be treated and fully recover, and another third can recover but will continue to need medication.

He noted that in the past severely ill mental patients were kept in the hospitals indefinitely. At present, however, ''new medications and methods can help them regain a normal life in society''. Mr Tavee said that patients who are institutionalised for too long lose the skills to take care of themselves.

However, he added, in long-established mental hospitals such as as Sri Thanya Hospital and the Somdej Chaopraya Institution of Psychiatry, hundreds of mentally ill patients are staying not only because of their illnesses, but also because they have been abandoned by their relatives.

Many of the mentally ill go without medication because they and their families cannot afford the high cost of drugs. To address the problem, the National Health Security Office has recently allocated a budget for the Government Pharmaceutical Organisation to produce the drug risperidone to treat schizophrenia and sertraline to treat depression. The patents for both drugs recently expired. Previously risperidone cost 58 baht a tablet and sertraline cost 38 baht a tablet. Such high prices are a big burden for poor families, especially since most patients usually take several medications. Under GPO production, both drugs cost about 3 baht a tablet.

In another positive step, at the beginning of this year, the Social Security Office included mental illness in its list of conditions covered under the programme.

Mr Tavee, who was formerly director of a mental hospital in Khon Kaen province and one in Nakhon Ratchasima province, stressed that in addition to medication, making psychiatric help available in the communities is an essential component of addressing the mental health crisis in Thailand. This enables patients to take control of their own treatment, he said. ''They are able to live full and productive lives.''

Involvement with community psychiatry programmes helps reduce instances of relapse, said Mr Tavee, and also leads to early diagnosis and timely and appropriate treatment. He noted that the number of schizophrenia patients receiving treatment at Huai Yot hospital in Trang province increased from 102 in 1996 to 167 in 2010. Significantly, the relapse rate among the patients decreased from 13% in 2008 to 4.4% in 2010.

The most common disorders

The three main mental health disorders among Thai patients who seek treatment are schizophrenia, depression and anxiety.

Schizophrenia is a condition that causes a range of symptoms, including hallucinations, delusions, muddled thoughts based on the hallucinations or delusions, and changes in behaviour.

Doctors describe the condition as a psychotic illness _ which means that a victim may not always be able to distinguish their own thoughts and ideas from reality.

The causes of schizophrenia are unknown, but most experts believe that it is caused by a combination of genetic and environmental factors.

Most studies have found a link between violence and schizophrenia, however violent crime is more likely to be caused by alcohol or other substance abuse than by schizophrenia. A person suffering from schizophrenia is far more likely to be the victim of violent crime than the instigator.

Depression is a serious condition. Medical professionals refer to it as depression, a depressive illness or clinical depression. It is not the same as feeling unhappy or miserable for a short period of time.

If you are suffering from depression, you may feel extreme sadness for a long period of time. This will be severe enough to interfere with your daily life, and can last for months.

The condition is fairly common, and roughly 10% of people will suffer from depression at some point. Women are more likely to suffer from depression than men, with around 25% of women requiring treatment at some point, compared to 10% of men. However, men are more likely than women to commit suicide, which may be because men are less likely to seek help for depression.

Anxiety is characterised by feelings of unease, worry or fear. Most people experience anxiety at some time in their life, for example feeling worried about exam results, or sitting a job interview.

Feeling anxious is perfectly normal, but people with generalised anxiety disorder (GAD) find it hard to control such feelings _ anxiety is more constant and may affect their daily lives.

There are several conditions for which anxiety is the main symptom: Phobias, post-traumatic stress disorder and panic disorder can all cause severe anxiety. GAD is a long-term condition that causes sufferers to feel anxious about a range of issues, rather than any specific event.

People with GAD feel anxious most of the time, and often cannot remember a time when they felt relaxed. Sufferers may display both psychological and physical symptoms, including feeling irritable or worried and having trouble sleeping.



PATIENTS ON THE ROADSIDE

The Mirror Foundation has initiated a project to help mentally ill people who are living in public places, a problem that has been ignored for years and it is getting more complicated in terms of the associated health and social problems.

''We always look away when we see those insane people. We don't want to offer help because we know it would be difficult,'' said Sombat Boongharm-anong, the adviser to the project, known as ''Patients on the Roadside''. To educate the public, the foundation has produced a short video on the lives of people living on their own with severe mental disorders.

The project involves an intensive study of the problem and work with the patients, with the aim to initiate an appropriate mechanism to assist this group. ''We work with state agencies and other organisations as a network,'' said Mr Sombat.

Namphueng Chairungsri, the project coordinator, said that the foundation began by surveying and studying cases in the Bangkok area for about three months. Many of them became known through a missing persons centre operated by the foundation that has since been closed.

''A total of 294 persons, mainly suffering from dementia, who were reported missing were found to be living on the streets,'' said Ms Namphueng, who added that people suffering from schizophrenia, depression and bipolar disorder are also included in their studies.

The foundation can follow only a limited number of patients closely because of staffing limitations. Normally the mentally ill persons studied by the foundation stay in one place for a long time. ''Since they do not wander to other places, it is easier for foundation workers to visit and talk to them in order to earn their trust,'' said Ms Namphueng. The people who live or work in the areas don't pay them much attention, usually giving the reason that they are busy earning a living.

Besides unhygienic living conditions, some of the roadside patients have encountered abuse. One woman, named ''Aunt Crying'' by foundation workers because she always breaks into sobs, has a crippled left leg. ''She was sexually abused,'' said Ms Namphueng.

Another patient who stays near Sanam Luang is is known as ''Aunt Razor'' because she always holds a razor in her hand, cutting up grass, leaves or vegetables she gets from a market. She always seems angry, and uses rough language. ''We were attacked during our first visits, but her relationship with the team is getting better,'' said Ms Namphueng.

The foundation workers agree that most of these patients need to be hospitalised, but convincing them to seek help is often difficult.

After getting approval from Social Development and Human Security Ministry officials, the Mirror Foundation team once tried to take Grandma Namcha, an old woman with bipolar disorder who has lived on the pavement in the Ratchaprarop area, to hospital.

''Grandma strongly resisted and our attempt failed,'' said Ms Namphueng. ''The social workers advised us to take more time with her before trying again.''