Good Practice: Health and Persons with Psychosocial Disabilities

BHUTAN

A Nationwide Strategy to Fight Mental Health Issues[1]

In Bhutan, as in many countries, there has been a lack of awareness, myths, and shame regarding mental health issues. Consequently, many people have had to hide their symptoms and do not access treatment. However, in an attempt to address the situation, the National Mental Health Programme launched in 1997 to provide community-based mental health care services and to educate society about mental health protection, prevention, and treatment. With a well-established national primary health care network, Bhutan is now working to train doctors, health care workers, and nurses on mental health treatment skills; to provide appropriate medication; and to integrate mental health into general primary health care services.

Implementation of the National Mental Health Programme started with visits by a mental health service team to community leaders, local health care personnel (doctors, health care workers, and nurses), and traditional healers to discuss existing practices, understand their perspectives and gain their cooperation. Following these consultations, healthcare personnel offer education and training to introduce modern mental health concepts and their advantages. The mental health team with community leaders, local health care personnel, and traditional healers, identifies potential cases in the community and provides training in basic psychiatric skills, such as diagnosing and treating common mental health issues. After interviewing and diagnosing the identified cases, the team supports the local health workers in creating individual treatment plans, which include consultations with families and gaining their involvement in supervising medications and providing emotional support. Local health workers follow-up on individual cases in clinics or through home visits. At the national level, a core team of mental health specialists visit the primary health centres regularly to monitor activities and to provide clinical supervision.

In 2017, Bhutan had 345 doctors (including specialists), 25 clinical officers, 1,264 nurses, and 600 health assistants. As of 2018, the programme trained about 86 per cent of general doctors, 25 per cent of nurses, and 75 per cent of primary health care workers.

Sexual and Reproductive Health (SRH) of Persons with Disabilities

Reproductive health goes beyond the absence of disease or infirmity. It is a state of complete physical, mental and social wellbeing in all matters relating to the reproductive system, and at all stages of life.

Persons with disabilities have the same sexual and reproductive health needs as other persons. However, although existing services and information can usually be adapted easily to accommodate persons with disabilities, there are often barriers persons with disabilities encounter to accessing them. In many cases, barriers are created or sustained as a result of stigma, ignorance and negative attitudes of society and individuals, including health-care providers. For example, it is often assumed that persons with disabilities are not sexually active and therefore do not need sexual and reproductive health services. In working to ensure that all sexual and reproductive health programs reach and serve persons with disabilities, increasing awareness regarding the needs and rights of persons with disabilities is critical.

The need for SRH services for women with disabilities is often heightened, owing to their increased vulnerability to abuse. Women with disabilities experience higher rates of gender- based violence, sexual abuse, neglect, maltreatment and exploitation compared to women without disabilities[2]. Persons with disabilities are sometimes placed in institutions, group homes, hospitals, and other group living situations, where they may not only be prevented from making informed and independent decisions about their sexual and reproductive health, but also face an increased risk of sexual abuse and violence. Persons with intellectual and mental disabilities are particularly vulnerable in this regard. Violence against women with disabilities can also take the form of forced medical treatment or procedures, including forced sterilization, which many countries and regions have documented incidences.

Women with disabilities have also often been denied the right to establish relationships and to decide whether, when, and with whom to have a family, in some cases being forced to marry. As a result of the increased risk of sexual violence, women with disabilities are also at risk of becoming infected with HIV and other sexually transmitted diseases. In crisis situations, these risks are multiplied.