Three years after the Lao government adopted its first mental health policy, there is still no national plan of action or implementation strategy, say mental health experts.
"I can say that mental health is a neglected area... Laos still has two psychiatrists for six million people," said Supachai Douangchak, a technical officer specializing in mental health at the UN World Health Organization (WHO) in the capital of Laos, Vientiane.
The most recent analysis of the situation in Laos, commissioned by WHO in 2002, revealed how mental health issues were considered "completely new" for the country.
Nearly a decade later, there is scant mental health data and no dedicated mental health division in the Ministry of Health, but a drug treatment programme has been expanded to focus on mental health focus since 2009.
"They have made the [programme] name longer and added one doctor. This is a good start and we hope in the future there will be more than one [mental health] staff," said Douangchak.
There is one public mental health ward for the entire country in Mahosot Hospital in the capital with no specialists and 29 in-patient beds, said Chantharavady Choulamany, one of the country's two psychiatrists and co-author of the 2002 WHO study and project coordinator of the UK-headquarted BasicNeeds NGO, which has worked on mental health needs in Laos since 2005.
The military hospital also has a psychiatric unit.
Valium in the villages
Accessing the correct treatment remains a challenge, particularly in rural areas where the WHO study noted that valium was probably overprescribed "by medical practitioners and informal drug sellers due to its popularity in providing relief for stress".
In many cases a prescription is not even needed, said WHO's Douangchak. "If a patient complains he cannot sleep, valium is very popular. You can go to any pharmacy and buy valium without prescription...They [pharmacists] are not as strict [as with painkillers]."
Valium was the first drug the district hospital gave Bao Singthamma in Xaythani District outside Vientiane after her youngest son died in 2002. "For five years, I did not have the energy to go anywhere. My husband had to take care of the fields and kids."
She entered a BasicNeeds programme in 2007 when Choulamany diagnosed her with depression. After six months of Vitamin B1 and the anti-depressant Tryptanol - funded by selling the family livestock - things were "back to normal", said her husband.
"People told me to leave her - what kind of wife or worker was she? But I didn't want to. I had a 50/50 hope she would get better. People were surprised to see her gardening and wanted to know where she got her medication."
Almost 95 percent of patients who come in for mental health problems are prescribed valium during their first visits, said the vice-deputy of Xaythani District Hospital, Jengheu Xayliviue, and outpatient doctor, Bounpheng Latsavong.
"This is to stabilize their condition before they change medication to treat underlying conditions, which is usually within two months," said Latsavong.
Some patients drop out of treatment soon after, unable to afford the cost. He estimated the monthly medical cost for an epileptic patient - one of the hospital's main mental health disorders - at up to 45,000 kip, about US$6.
Photo: Phuong Tran/IRIN
|Gardening as therapy|
While workers earned an estimated $82 per month in 2010, according to the World Bank, 27 percent of the population lived in poverty in 2008, according to the UN Development Programme.
The government's total per capita health spending in 2008 was about $34, leaving 76 percent of health expenses paid out of pocket, according to WHO.
WHO's budget for mental health technical assistance is limited to about $10,000 a year. "We are good at giving advice, but when we talk about money, it is limited," said Douangchak.
"We need to raise awareness about the linkages between medical and psychosocial care, occupational therapy, and life skills training," Choulamany said.
Each of the country's 17 provincial hospitals has set up mental health teams comprising a doctor and two nurses who received a four-day mental health training from BasicNeeds.
The NGO is providing life skills training in 12 districts in Bolikhamxai and Vientiane provinces, which includes support groups, vocational training and therapeutic gardening projects.
"You see the impact right away, the instant gratification of planting a seed and watching it grow," said Choulamany. "But much work remains in this arena."