Mental health in the post-Covid Thailand: a three-university survey

Report by Pitchaya Tarajit, Anna Lawattanatrakul, and Nuttaphol Meksobhon

Cover illustration by Kittiya On-in

  • During the Covid-19 pandemic, there were frequent reports of university student suicides. Data from Thailand’s Department of Mental Health (DMH) also indicates a dramatic rise in the suicide rate during the period.
  • Psychiatrists and student spokespeople believe that many students were stressed by the sudden changes in their lives. Online classes hindered studies, increasing tensions. The strain of being locked down with family members 24 hours a day also caused relationship problems.
  • Many universities provide mental health support for students but additional services may be needed. Rather than waiting for students to ask for help, universities are being called upon to adopt proactive measures.
  • Compounding the problem, Thailand currently has a shortage of mental health professionals, limiting access to related services. While long-term solutions are possible, implementation remains challenging; it is not simply a matter of producing more doctors or increasing the number of hospital beds.

During the Covid-19 pandemic in 2020-2022, reports of student suicides often appeared alongside statistics on the number of new infections and virus-related deaths. There was, for example, the case of a 2nd-year university student who took her own life in an apartment in Bangkok's Ratchathewi district. According to a relative, the victim, who regularly stayed up until 4 am completing course work for her online classes, had not been sleeping enough. They took her to a doctor who prescribed medication and advised her to take a break from her studies but she was later found dead.

In the aftermath of her death, Athapol Anunthavorasakul, an academic in the Faculty of Education at Chulalongkorn University, expressed concern about the stresses of online classes and student suicides. He called for the University to look after student well-being, not just by reducing tuition fees but by providing financial support for anyone in need and by setting up a mental health hotline. He also recommended that teachers refrain from assigning unreasonably amounts of work and stop causing tension by expecting perfection from their students.

Did the shift from onsite to online classes caused by the Covid-19 pandemic lead to increased stress and mental health issues? Between 2019 and 2021, the suicide rate rose year-on-year from 6.64/100,000 people, to 7.37, and finally to 7.8 - a significant increase with the highest jump involving young people coping with changes caused by the pandemic. DMH data for the period indicates that in 2021, the second year of the pandemic, the suicide and self-harm rate for 25-34-year-olds was 4 times higher than that of people aged over 34 years. In the 15-24 age group, there were reportedly 439 suicides with another 956 among 25-34-year-olds.  

Mental health issues are not private concerns but rather societal problems that need to be acknowledged. Within university settings, it is important to look after the mental well-being of students to prevent crises that might eventually lead to suicide.

To better assess how the pandemic affected student mental health, ‘Prachatai’ talked with students, psychiatrists, and mental health project leaders at 3 universities; Chiang Mai University (CMU), Kasetsart University (KU) and Chulalongkorn University (CU).  We also looked at what universities are doing to address the matter and the various limitations they face.

Sudden change: the major cause of mental health issues during the pandemic

A 4th year student in the Faculty of Agriculture at Chiang Mai University (CMU), Supisara Ramasoot recalls that her mental health plummeted and she began hurting herself as a result of the hazing ceremonies she underwent as a 1st year student. She decided to speak with a psychiatrist and was diagnosed with depression in 2019.

With the spread of Covid-19 in early 2020, she declined further, suffering from panic and anxiety. She worried about catching the virus and was scared of going outside. Whenever she experiences abnormal health, Supisara was unsure if it was the virus or a side effect of her medication. Her clinic switched from in-person sessions to phone calls, so her treatment was not as extensive as before. She often did not get to meet with a doctor and her medicine came by mail.

Dr Puchong Laurujisawat

According to Dr Puchong Laurujisawat, lecturer at the Department of Psychiatry in Chulalongkorn University’s Faculty of Medicine, significant life changes often cause stress. Young people can be affected by a range of factors, from family issues to economic problems. Stress can come from being controlled by parents who do not understand what they were doing in online classes, and from having little opportunity to manage their own lives. At the same time, parents, who are also working from home, may be stressed by economic issues.

Siraphop Attohi, President of Student Government of Chualongkorn University (SGCU), and Chanakan Napharaksawong, President of Kasetsart University (Bangkhen) Student Administrative Board (KUSAB), agreed that the shift to online classes hindered student learning and felt that economic problems and governmental mismanagement gave students additional pressure.

A survey of 9,050 undergraduate students at 15 universities around the country found that over 30% regularly experience sadness. Of these, 4.3% had been diagnosed with mental problems and 4% admitted to contemplating suicide. Some 12% reported physically harmed themselves, 1.3% engaging in self-harm regularly. Most blamed stress from family and academic problems.

Because they are second homes, universities must look after their students

Supisara recalls seeing many news stories in 2020 about students who took their own lives because of stress and depression from online classes. She also remembers going to the emergency room to be treated for injuries she inflicted on herself only to discover another student in the bed next to her waiting to be treated for the same thing.

Wondering whether the university was doing enough to take care of its students, she decided to survey her classmates about mental health issues, submitting her results to the CMU’s Student Development Division, Student Council, and Student Union. The Student Council later contacted her and raised the issue in a management meeting.

Supisara Ramasoot

In Supisara’s view, the university is like a second home, a place where she and others like her, people who are only just becoming adults, spend most of their time. She believes it is wrong to leave students to look after themselves, to deal with the dramatic changes that come with tertiary education. Through no fault of their own, some have difficulty adapting.

Administrators at many universities in Thailand agree.  Kasetsart (KU), Chulalongkorn (CU) and Chiang Mai Universities (CMU) are just a few of the higher education institutions providing mental health services and workshops for students and staff.

During the pandemic, the mental health centre at KU’s Bangkhen campus had students fill out an online survey to determine which students were at risk, so an officer could reach out to them. In their Second Home project, CMU also established a channel for online consultation with psychologists.

In August 2020, after a mental health survey indicated that Supisara was at high risk, a CMU Minds unit contacted her and arranged for a psychologist to work with her and explain her condition to teachers and classmates. Some, she suspects, thought she was looking for special treatment.

“I can’t speak for everyone who is sick. Each person has their own needs. I’m sick, but I don’t want special privileges. Right now, I have issues with attending classes. I appreciate anything the teacher can do to help, without affecting other students or making things unfair,” Supisara said.

Siraphop Attohi

Siraphop believes that universities are not simply places for ensuring that students graduate and obtain degrees but should also provide services to improve society as a whole. Given that universities are a part of the reason why students have increased mental health issues, he feels that administrators should carefully consider whether they are doing enough for their students.

Because students are the ones affected, Chanakan feels that universities should pay more attention to their mental health needs.  Given the growing number of reports of students committing suicide, administrators should stop trying to hide the news and instead, talk with students to find solutions.

Many universities still rely on faculty members to keep an eye on students, and so often provided them with mental health training. However, the effectiveness of the approach depends on the individual lecturer’s attitude.

Dr. Puchong believes that teachers can help if they are open to listening to students, but if the conversation leaves students feeling more stressed, it might not help.

Meanwhile, Dr. Nuthawat Longthong, a lecturer in the Department of Psychology at CMU’s Faculty of Humanities, as well as the leader of the Second Home project, said that students are sometimes afraid to speak with their advisors and lecturers out of concerns that their studies would be effected or that lecturers would believe something is wrong with them. He notes that some students see coming to the Second Home project as something for people with mental health issues and something that should be kept secret.

Instead of relying upon teachers’ observations or waiting for students to seek consultation on their own, proactive planning to reach individuals with mental health issues may be necessary,

To provide for the mental health needs of CMU students and staff, the university launched a new one-stop mental health service centre in September 2022. It reduced patient loads at the nearby Maharaj Nakorn Chiang Mai Hospital by offering a range of similar services. The hope is to collaborate with the registrar to better look after CMU students. As academic performance is often affected by stress, the plan is to set up a warning system for students whose grades have fallen for 2 consecutive semesters. The system will provide faculty members with a pretext for talking with individuals who may be experiencing mental health or other issues.

Insufficient personnel - an obstacle to mental health care access

DMH data indicates that in 2022, Thailand had 1,037 psychologists, 1.58 for every 100,000 people in the country.   The number may be inaccurate.  Citing a psychiatric expert at DMH, Rocket Media Lab reported in July 2022 that the country had only 845 psychiatrists - 1.28 for every 100,000 people.

Dr. Warot Chotiphittayasunon, a psychiatrist and spokesperson for DMH explains that training psychiatrists is a difficult process which takes a long time. It is also expensive and there is no guarantee of employment later.  There is even a shortage of teaching staff.

Dr. Chanipha Leangcheep

In an interview with Thisable.me, Dr. Chanipha Leangcheep, a child and adolescent psychiatrist, explained why few people study psychiatry: many find studying minds - and the low compensation received by practitioners - unappealing.

Meanwhile, the cost of psychiatric treatment remains high and patients often find it inconvenient to meet with doctors during working hours as they would need to take time off from school or work. Due to the shortage of psychiatrists, patients may also need to wait months for an appointment and cannot easily change doctors. Access is better at private hospitals, but it comes with higher fees.

The same problems plague efforts to provide better mental health services for students. In response to a February 2022 request from the CU Student Council to recruit more psychologists for its wellness centre, CU approved a budget but was unable to utilise it because there were not enough qualified applicants. KU reportedly also has too few psychologists to meet the needs of its student body.

The problem reflects a shortfall of psychologists at the national level: according to a Rocket Media Lab report, the country only has 729 certified psychologists, or 1.10 for every 100,000 people. Six provinces have no psychologists at all.

When students don’t reach out, universities must reach in.

It is important to keep an eye out for students with mental health issues before their problems become too big to fix. According to Siraphop, CU administrators rely on faculty members to manage this.  He feels it burdens teachers whose hands are already full of other work. He also notes that many faculties lack the resources to care for students.

Online education during the pandemic reduced student interaction, making problems worse. To improve things, Siraphop thinks that the University should work to restore a sense of academic community by organising more activities to bring students together again, increasing human connections to provide them with more emotional support.

Nuthawat believes that university staff members must also adjust their attitudes. Students suffering from mental issues are as much in need of treatment as students with physical problems but on occasion, lecturers still refuse to accept medical certificates citing student depression as a legitimate explanation for student absences.

Supisara believes there should be an ombudsperson who asks students what kind of help they need. Options could include sick leave days, access to recordings of lectures, additional time for exams, or even separate exam sittings. She feels that students should be encouraged to communicate their needs and that teachers, in turn, should be more flexible about classroom management matters. In the case of students with severe depression who might be suicidal, she also thinks that CMU Minds should talk with them directly, not just refer them to a psychiatrist, and keep a close watch on their condition. The goal should be to help solve problems to avoid the tragedy of a young person taking their own life.

“Of course, the university can’t look after thousands of students.  But at least if there is proactive surveillance, if people work together to conduct more student surveys, or maybe allocate more money to hire psychologists for CMU Minds … it’s still better than letting children die … a long-term solution is undoubtedly better, if only for the sake of the institution’s reputation” Supisara said.

At KU, students must currently go to the university’s ‘Happy Place Center’ for counselling services. Chanakan believes that a shift should be made to proactive services in various faculties, particularly those known to cause students high levels of stress from their studies. Activities could include training students leaders and meetings with students in given programmes.

Chanakan and Supisara also feel that universities should provide educational personnel with mental health training so that they can better deal with students suffering problems.

The pandemic ends but mental health issues continue – seeking a structural solution

Mental health issues were on campus before Covid-19 arrived.  However, the pandemic did make problems more visible. Dr. Chanika and Dr. Puchong feel that structural changes offer a better long-term solution than just increasing the number of psychiatrists and hospital beds.

Dr. Chanika points out that mental illness is often related to the socio-economic status.  She believes that finding ways to improve education, job opportunities, and incomes would help to reduce mental health problems.   As mental illness often stems from causes that doctors cannot easily address and some diseases require life-long treatment, a long-term solution is to deal with problems in society. If people lead quality lives, solving mental diseases at the hospital may be unnecessary.

Dr. Puchong worries that mental health issues are likely to increase. In addition to the pandemic, people have had to face related economic problems or other issues that may not have been addressed. Meanwhile, young people feel a loss of stability in the world because they don’t know what will happen next. Facing the post-pandemic social chaos, many are losing hope and are angry with the older generation for letting things come to this point, and so no longer believe in the social values of their parents. They have also seen what other countries are like and if people there are better or worse off than they are in Thailand. Many may choose to move overseas, and even though there is now less pressure than during the height of the pandemic, under less pressure than before, society has already changed.

Despite increased social awareness of mental health, Dr. Puchong also remains concerned that relegating such problems to medical professionals will make people forget to fix the underlying problems in the system.

“Let’s say a child has a problem with stress. If we make everything about their mental state, we don’t look at what caused the stressed in the first place,” Dr. Puchong said.

For him, If society offers more hope, providing more mobility and help than it does now, if we don’t push young people to hurry their studies, to graduate quickly, if we can make them feel as if life has choices and possibilities – most won’t need to see a psychiatrist.

“Nobody is going to be okay with a life that needs a psychiatrist. If the system can create more hope, better employment … and better social welfare, fewer people will seek counselling.”

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