By Lisinka Ulatowska
The GNH Index is a measure of overall well-being within the Asian country of Bhutan. Though Gross National Happiness involves 8 other indications of well-being, Mental health is measured under two aspects of the policy. Mental health and Physical health are measured and assessed as needs of the people on 2 separate, but fluid scales. Assessment of health and mental health are in fact slightly correlated.
Context Within NORA
GNH is significant within NORA through assessing general needs of human beings regarding health and mental health procedures. Assessing these needs of human life is difficult. But the use of subjective and objective questions that weight physical health over mental health help foster the growth of mental health through increasing access to physical health needs.
Mental and physical health are two needs that are explicitly measured as domains in the GNH index. Bhutan equates mental and physical health, but assesses them differently. Physical health is measured by assessing subjective, as well as objective measures to indicate a person’s physical health status, as well as one’s opinion on how their health affects them subjectively (Center for Bhutan Studies).
Hard data on measuring mental health is scarce. Most questions asked within the GNH national survey get weighted as subjective, or lower weighted, indicators. This can possibly be an effect of the needs of mental health being difficult to separate from physical well-being as objective measures of health. In addition, many aspects of mental health can only be assessed by individual introspection, making “hard” data irrelevant.
Food as a basic need can affect the mental health of the Bhutanese people: if a people’s basic need for food and sustainable agriculture is not fulfilled, they will obviously be distressed. When sustainable agricultural practices in rural areas aren’t sufficiently supported by government intervention, then the overall happiness of an area can decrease (Shaw). Similar observations apply to other basic human needs.
Mental health care in Bhutan is based within the committed services or sales cluster in the organizational forms section. The access of healthcare is free to Bhutanese citizens, with mental health care available at primary, government owned, hospitals and care centers. Community solidarity as well as self-reliance play a very important role in fostering mental health in any society. To the extent that GNH can foster better support for mental health via these several organizational forms, it can contribute to abundance.
Clean air, water, and nutritional food are needed to further the physical health needs as well as good mental health. Physical health is the primary factor for someone to obtain a health mind and body. Energy is also needed to foster the power needed to effectively monitor physical and mental health conditions.
Cultural artifacts and preservation of these are important to the overall mental health of the citizens of a country. It is shown that people who surround themselves with like-minded people generally are happier overall. This type of resource is intangible, but gives any culture a strong sense of identity which is important for fostering mental health through community solidarity and supportive relationships.
Spirituality is important for good mental health in regards to Bhutan especially. Many of the GNH index changes have enforced Buddhist tendencies as part of the Cultural diversity and resilience plot for schools especially. When one is in touch with the spiritual aspects of their culture, it gives one a strong feeling of acceptance in the community. This is important as we are social beings by nature, meaning that if we are isolated, our mental health is likely to suffer.
Does GNH contribute to greater mental health?
Mental Health Measured by the GNH Index
The GNH Index follows 9 core principles that are all weighted equally on the same scale measuring happiness as economic progress, rather than the production of goods. One of these measurements is labeled Psychological well-being. Psychological well-being is an important focus on happiness that many governments do not take into consideration as a measurement of progress. Bhutan attempted to measure mental health levels, as well as happiness, in the 2010 survey where they sampled 7,142 people. Fifty-five government-employed surveyors conducted the survey to effectively measure progress in happiness, as well as where happiness could be increased with government aid. This is done using the mental health portion of the GNH survey which can be found in the page on Gross National Happiness.
Using GNH to improve Mental Health Access in Bhutan
With regards to mental health access around the world, many countries feature mental health care facilities within or alongside primary health facilities such as hospitals and psychiatric rehabilitation facilities. Bhutan is no exception, and even gives the Bhutanese citizens free mental health care along with primary health facilities. Measuring the happiness levels of rural areas showed where psychological well-being was lacking. Lower levels of life satisfaction were found to be apparent in mostly rural, but some urban centers. In 1997 the King Jigme Singye Wangchuck implemented the National Mental Health Programme, which aims to merge mental health care into the primary health care system.
The government of Bhutan implemented the National Mental health program to help foster the access to mental health within the primary health care system already in place. This was in part due to GNH successfully assessing where health access was needed, especially in rural areas. Almost 90% of Bhutanes have access to health care facilities, bolstering mental health. Good physical health can lead to good mental health and vice versa (Shaw). Mental health access has also grown as the government has implemented basic training programs in mental health awareness. Access to psychotropic drugs has also lowered the numbers of mental disorders within the country extensively (Mental Health Atlas 2005). Ready access primary mental health facilities are available now at all primary level hospitals in Bhutan. The access to mental healthcare is an issue that Bhutan has recognized and is striving to continue to improve by promoting mental health awareness in ways of conservation, spirituality and community, and health care access.
Mental health issues can stem from poor physical health conditions. While Bhutan prides itself in its high human development index statistics, the rural areas run into many issues with primary and mental health care access. Personnel at Basic Health Units (BHUs) in outlying areas run into shortages in training, numbers, and technology. Only .3 licensed psychiatrists for 100,000 people exist in Bhutan (Mental Health Atlas 2005). This number has slowly increased over the years, but the lack of expertise in mental health areas causes scarcity in rural communities where volunteers run basic medical practices. Personnel may often also be computer illiterate, or in areas where electricity and medical technology are scarce. The lack of applicable data storage can cause scarcity with information the government may need to accurately assess where GNH needs to be aided.
Environmental and Spiritual Connections
Environmental preservation can be connected with a variety of needs that can strengthen well-being within Bhutan. Keeping forests preserved and waterways clean of pollutants is important for the natural health of the ecosystem, and possibly the mental health of its rural inhabitants. The survey conducted in Bhutan gave results that show a sufficiency of happiness in areas of environmental health and preservation; while in the cities, the sufficiency cutoff was not met in this area, especially with regards to water pollution (Center for Bhutan Studies). Nature in Bhutan is an important part of their cultural identity revolving around Buddhist traditions. Spirituality and nature go hand in hand in this culture. The importance of keeping a healthy environment shows as a main concern within Bhutan’s political agenda (Zurick 2006). A respect for nature connects the Bhutanese with the environment and those around them.
The scarcity of transportation to outlying BHUs causes issues to arise within areas of primary and mental health access. This can be detrimental to small outlying communities with little access to treatment for depression, alcoholism , or even psychosis. The BHUs are lacking in electrical power as well as ready access to their patients that need long term treatment (Dorji 2005). The strict environmental laws concerning road building can hinder the construction of roads needed to foster the physical and mental health needs in rural areas. The lack of electrical construction leads to BHUs in extremely rural areas to ration electricity. Along with the lack of training and technology, basic logistical needs of data collection and research cannot be done in a timely manner (Glover 2006). It is possible that the strict and traditional views towards environmental preservation can hinder the production of new and helpful medical innovations that could heighten GNH.
Spirituality and community solidarity are important within the Buddhist culture that dominates Bhutan. These intangibles are seen as social factors that can promote a sense of well being through social interactions between like minded individuals. A strong sense of community in Bhutan revolves around the Buddhist religion and culture which bolsters mental health. This type of traditional mentality has influenced private school programs, and to some extent public systems as well. This strong spiritual sense has helped many assemblies form to promote spiritual as well as physical health awareness. Both sides received training in basic mental and physical health applications, spiritual and medical (Dorji. 2005). This type of education in health and spirituality can help foster growth in many areas of GNH.
This type of ingrained spirituality can also create scarcity in mental health among conservative and traditional people in Bhutan, leading to improper treatment of physical and mental disorders (Dorji 2005). The traditional medicine market in Bhutan is popular among rural families who cannot easily travel to primary facilities where treatments for long term disorders are possible. Many people also do not trust medical doctors sufficiently to divulge their feelings, or admit to symptoms of alcoholism or depression. This causes poor physical health conditions to be higher within rural communities especially in the highlands (Etsy 2006). Some people have adopted anti western culture stances, trying to protect the country from outside influences. This can hinder the free exchange of knowledge which is vital for acceptance in a community. These attitudes will not be changed by asserting the superiority of western methods, but by being ready to learn from both sides, and by patiently building trusting relationships. It is this patience that is largely lacking in the western system of medicine.
This community of people in Bhutan are trying to change the world with small steps towards becoming the first nation to measure economic progress on a scale other than money. Heightening GNH directly correlates to mental health in almost any area. Fostering the physical health access in Bhutan has greatly enhanced the levels of mental health in Bhutan (Delamothe 2006). This type of economic structure seek to measure and assess where happiness is adequate and sub-par. This causes the process to be contradictory in minor ways, fostering strengths and creating weaknesses throughout rural communities especially. Poverty and lack of development in rural Bhutan have been the focus of GNH in the recent past, however GNH and the people of Bhutan must continue to modernize health practices, access, and education to foster GNH with regards to mental health. Furthermore Bhutan must not remain static in its cultural values, and be willing to freely exchange ideas in hopes of fostering growth of needs for the people.
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