At the recent National Depression Symposium in Myanmar, AAMH had the opportunity to speak with Associate Professor Tin Oo, Head of Mental Health Department at the University of Medicine, Mandalay.
Dr. Tin Oo gave the plenary address at the Symposium and presented extensive experience in research, particularly looking at risk factors and prevalence rates in vulnerable populations such as postnatal women, older people, people and caregivers experiencing major health issues such as HIV, TB, stroke, dementia, amputation and also with medical students.
Presenting the results of these studies at the Symposium, it was striking to see the high rates of people experiencing severe depressive episodes in vulnerable populations, as well as the statistically significant association between depression and perceived stress levels, and between depression and degree of interpersonal support.
Given the data shows that depression is very common in Myanmar, AAMH asked Dr. Tin Oo what are some of the challenges for managing depression.
Dr. Tin Oo: “From the patient’s side, people from some areas find it difficult to get mental health care or difficult to get continuous mental health care, including follow up. There are many reasons for this. People who live far from mental health center may not be able to afford transportation charges. The referral system and co-operation between GPs and specialists are not well established. Many people receiving treatment for depression may need to take long term medication, but the government only supplies the medication free of charge when patient is treated at hospital. For some patients, cost of medication will be a burden. Non-Adherence in treatment is also the challenge in treatment of depression.
Like other mental illnesses, stigma and discrimination are major challenges. Because of stigma and discrimination some patients consciously or unconsciously deny the presence of depression and do not come for treatment.
Some patients, relatives and friends will not know about the nature of depression. Some people think of it as a normal process. Some believe in evil spirit. A significant portion of patients with depression go to traditional healer for help even in some educated persons.
From the treatment provider side, the mental health workforce in Myanmar is a major challenge for providing adequate services for the population. There are no specialists for psychosocial rehabilitation, and insufficient numbers of psychiatrists, psychiatric nurses and social workers, psychologists, occupational therapists trained for mental health work.
Within other health services, there is a low awareness of depression and low rates of identifying (diagnosing) of depression by GPs and other specialties. In the curriculum for medical training, the hours dedicated for Mental illness is very short. In the one year program of practical training for House surgeon, psychiatric training is not included in their schedule. So most of doctors from Myanmar are not confident in the assessment of mental illness and how to treat mentally ill patients.
Furthermore, people with physical diseases and co-morbidity with depression are not often diagnosed, and don’t receive proper mental health care. There can be a lack of technical expertise, especially in psychosocial issues. In the management of depression psychosocial intervention is very important. In some cases of depression psychosocial intervention is more effective than medication. In Myanmar, we have no psychotherapist and very little chance to get training for management of depression in psychosocial aspect.
Alcohol and substance abuse problems in depressive patients can also be a barrier to appropriate management of the depression. In Myanmar alcohol and substances use disorders are common co-morbidities with depressive disorder is also commonly seen in our daily practice. For people experiencing mental illness and alcohol/ substance misuse, there is a big challenge in management.”
Chaired by Professor Win Aung Myint, Head of Department of Mental Health, University of Medicine and Mental Health Hospital, Yangon, this National Symposium is a timely and important meeting for mental health services, with its focus on ways to respond to these challenges.