Every Tuesday morning, a handful of Myanmar refugees visit her office in the Thai border town of Mae Sot to talk about the terror of fleeing violence and their anxiety about the future.
The psychiatrist, who asked not to be identified, is familiar with the trauma her patients share, having fled Myanmar herself.
As the only Burmese-speaking psychiatrist in town, she hears their stories free of charge about their journey to Thailand, where they then face new stresses – risk of arrest by Thai police, the struggle to support themselves and the worry about family members left behind.
Many of them have post-traumatic stress disorder, depression or anxiety.
Thailand hasn’t ratified the 1951 U.N. Refugee Convention and so doesn’t officially recognize refugees, but allows thousands to stay in border camps. Many newcomers from Myanmar try to survive on their own, under the radar – and many don’t seek mental health help, or don’t know it exists.
“There is no future, and basic needs are not fulfilled, [not even] security because Thai police are always waiting to arrest people. So sometimes I feel like it is beyond my ability,” she said.
“I can see six to seven people in a morning once a week, but it is totally not enough.”
The Mae Tao Clinic’s psychiatric care unit where she works is one of a handful of grassroots efforts that has sprung up in the last year to address the growing need for mental health care for the thousands of displaced peoples along the Thai-Burma border.
Rising depression
Rates of depression and anxiety within Myanmar have risen since the February 2021 coup, according to one mental health services provider working in counseling that requested anonymity to protect the continuity of their work.
They found that the highest averages came from Karenni state, which borders northern Thailand, where 38 percent of surveyed individuals reported experiencing moderately severe to severe depression.
Other border regions, such as Mon and Thanintaryi States, also reported higher rates among small surveyed populations. In people under 25 nationwide, 37 percent indicated they had symptoms of moderately severe to severe depression.
The study reports that suggested treatment for a diagnosis of moderately severe depression is treatment with medication, therapy, or both.
But too often, they receive neither.
While data on the diaspora in Thailand is minimal, preliminary research by another anonymous nonprofit supporting Myanmar migrants in Thailand found only 7 percent of those on the border contacted a counselor during periods of stress.
Among the newly arrived political dissidents and refugees, nearly half reported they had no income and a third attributed mental distress to their restricted movement without documentation.
Although the Mae Tao Clinic and other community initiatives are located in Thailand, they say mental distress relating to displacement, migration and trauma are apparent on both sides of the border. The mental health services provider of the initial study told RFA the higher levels of depression in Karenni State and along the Thai border are likely due to the increased violence in the area.
“Due to more violence, there are more refugees and these refugees are more likely to be traumatized or simply feel helpless and hopeless as they had to leave their home and everything behind,” the group said.
Meeting a Need
Nyunt Naing Thein, a Myanmar counselor, trainer and technical support provider at Mae Tao Clinic, helped open the psychiatric unit in August.
“Even though I wanted to open it, we had no human capacity to do it,” he said, adding that some newly arrived migrants had already been able to access medication. “Psychiatric cases are coming up – actually, they are already in the community.”
Before the psychiatrist’s arrival, the clinic had previously been unable to prescribe medication for anxiety and depression and did not stock it.
“I convinced the woman in charge from the Mae Tao Clinic and some responsible persons of the clinic that they should buy some medication,” the psychiatrist explained.
She said medication wasn’t necessary in all cases, but it was a healthier alternative to substance abuse problems she sees growing more common. Some come in simply for a sympathetic ear. But she has also seen cases of anxiety disorders, depression, substance abuse, and less commonly, cases of psychosis that require medication.
Since the coup began, Nyunt Naing Thein has organized training for hundreds of aid workers and medical professionals on psychological first aid and basic counseling training, focused on empathetic listening, mental health awareness and emergency response to trauma.
They’ve also organized men’s and women’s groups, where people in need of social support can talk about the issues they’re experiencing.
‘Thriving’
Shortly after the volunteer psychiatrist’s arrival, Nyunt Naing Thain started working as network coordinator for a mental health and psychosocial support alliance among Mae Sot’s civil society organizations on the border.
They dubbed the organization 'Shin Than Yar', or "thriving" in Burmese, and use it to share collective resources for training.
In addition to this alliance, a recently opened community center, Joy House, has also gained quick popularity in the border town. Catering to the large number of Myanmar residents residing in Mae Sot, the center offers 11 classes a week for adults and children in art, music therapy, yoga, and cooking.
The center says despite only opening three months prior, some 250 adults and children have attended classes, with yoga sometimes spilling out of the main room and onto the porch outside.
“When I just started, people didn't really know what this therapy is. At the start, it was out of curiosity. Some people confused it with music theory, like teaching music,” said a worker named JJ who holds a biweekly music therapy class at the center.
Originally from Myanmar, he’s currently getting his master’s degree in music therapy in Bangkok. Earlier this year, he began volunteering at Joy House, bringing his guitar along for classes that have attendees use colors, movement, and singing to describe their feelings.
“Then I tried to explain how music therapy works. Some people really know and want to be in a space where they can express emotions and they can release stress,” he said. “People started to come after that. It’s like a space to get away from what they’re going through.”
Changing the Culture
The ambitious projects aren’t without challenges. While participants feel safe inside the walls of the center, JJ says that their status in Thailand can still affect their ability to come to the center. When police are out doing traffic stops and checkpoints, which can result in bribes and arrests for the city’s undocumented residents, attendance is noticeably lower.
“These days the traffic police try to keep watch of people who don’t have enough documents,” he said. “So there are weeks that people don't show up because of the police.”
Mental health can also be taboo among migrants. The Burmese-speaking psychiatrist at the Mae Tao Clinic feels that although they are able to meet a need that was previously unaddressed, there’s still more work to be done to de-stigmatize the care.
She says patients often misunderstand signs of stress for physical health or heart conditions, and more often, they simply don’t show up after being referred to her.
“Although they know I’m there, actually, most of the people don’t want to come to the clinic to see a psychiatrist because it’s like labeling them as ‘psycho’ people,” she said, adding that over 60 percent of referrals don’t show up.
Despite this, she says the border is where she is able to do the most good and hopes that the conversation surrounding mental health will continue to progress.
“It takes time,” she said about spreading the word. In the meantime, she’s continuing training at the clinic for staff. “I’m a guest here — I want to empower them. If I’m not here, they can continue the care program.”
Edited by Malcolm Foster.