In the Kingdom of Bhutan, a country in south-central Asia about the size of West Virginia and Maryland combined, access to mental health care is scarce. There is only one full-time, Bhutan-born psychiatrist in its population of just under 800,000 people.
Mental health is a well-established concept within Bhutan’s unique focus on the well-being of its citizens known as Gross National Happiness. Resources for those with mental health challenges in Bhutan have become a national priority over the past ten years, and Dr. Kurt Kraus, professor of counseling, has been an integral part of the conversation.
“The culture in Bhutan has been to care for individuals with psychological, social, and educational needs at a family or com-munity level,” he said. “There isn’t an infra-structure for professional services available in Bhutan, and establishing one that fits the cultural, geographic, and political realities is distant. In fact, the hope I have watched develop is to strengthen the knowledge and skills of volunteers, family members, and paraprofessional people in mental health service delivery.”
According to Kraus, Bhutan only recently began to see itself as a modern country. Evolving from an absolute mon-archy to a democracy in the past decade has marked a monumental commitment to the modern era. Elders in Bhutan recall growing up without electricity or cars, and, Kraus added, “A drive on any of Bhutan’s emerging roadways is a quick reminder they only recently were mere dirt paths for yaks and ponies.”
The country is deeply rooted in Buddhism and tradition. An explosion of modernization, with the opening of Bhutan to the “outside world,” is not simple, Kraus said. In terms of mental illness, many believe it to be the result of bad karma, influenced by ghosts and spirits. The country’s sudden thrust into the twenty-first century has caused many psycho-social concerns.
Kraus had traveled professionally to Bhutan twice with leaders from the National Board for Certified Counselors, Inc., by invitation of the Ministries of Health and Education and the royal family. He met several political leaders, including the director of the Gross National Happiness Commission, who encouraged him to return and stay longer.
That opportunity came in 2014, when Kraus received a Fulbright Award to work and study in Bhutan for six months. The award provided Kraus with the funding he needed to continue his work on a broader scale. Fulbright scholars travel abroad to teach and research in their area of expertise, but also act as cultural ambassadors. Kraus received the only US Fulbright Scholar position to Bhutan and was assigned to Royal Thimphu College, where he taught social psychology and fundamentals of counseling. He also worked extensively with the administration on mental health policy and delivery of services to students.
In his Fulbright application, Kraus stated that he hoped to help the country “create an intricate balance between the physical remoteness of the nation and the explo-sion of technology that has the capacity to connect Bhutan to the world in ways never experienced before.”
The people of Bhutan didn’t experience the invention, evolution, and widespread adaptation of computers, the Internet, or mobile devices. One day, these innovations were nonexistent; the next, they were readily available.
“With the acceptance of high-speed communication, it was all so new and star-tling,” Kraus said, “and with that, the pres-sures of modern society began to show up.”
Kraus knew that he couldn’t come to Bhutan expecting to implement an American model or product. “It would be outrageously insensitive in a cultural way, but also impractical in every way,” he said. “I chipped away at the elements of what I proposed, but found myself doing things that were abso-lutely needed. I wanted to do whatever they thought would be the best use of me.”
Thankfully, the flexibility of the Ful-bright allowed him to address concerns as they arose. In April, a life-threatening incident at the college made his mission painstakingly clear.
Royal Thimphu College is a remote campus with fewer than 1,000 students. In recent years, a growing number of students had committed or attempted suicide.
While Kraus was teaching there, a young woman attempted to end her life. Her con-cerned friends wondered why she hadn’t been to class, and their actions saved her from an overdose. The young woman was transported to the nearby hospital, where she worked with the psychiatrist and a team of mental health volunteers and emerging professionals.
“Her trajectory could have had a much worse outcome,” Kraus said.
Officials at the college had few strategies to prevent or address suicide. Students had too few psycho-social supports or resources at their disposal when struggling with anxi-ety, despair, or depression.
“I was invited to teach faculty, adminis-tration, and students about risks of suicide and pinpoint signs,” Kraus said. “It propelled me to work with the administration to provide strategies, envision resources to develop, and build prevention methods related to unmet mental health needs including suicide prevention.”
Kraus helped to train faculty and students to identify those dealing with a wide range of difficulties. Many embraced that “suicide prevention is not somebody else’s job,” Kraus said.
“Compassion is a core ideal in Bhutan’s culture and paramount in Buddhism—we all bear responsibility in caring for those in need and in distress.”
Kraus continues working remotely with Royal Thimphu College and Jigme Dorji Wangchuck National Referral Hospital officials to develop mental health strategies. Bhutan is a country that is developing its mental health system from the ground up, and Kraus hopes to remain part of the process. He said he’s grateful that he’s been accepted as a credible, trustworthy resource and plans to return in the spring.
“I returned home with a deeper value of this fascinating culture trying to navigate the modern world,” he said. “Clearly, I have brought back a much clearer understanding of how Bhutan hopes to build its mental health framework while fully embracing its culture, history, and direction.”
For more information on Kraus’ Fulbright experience in Bhutan, e-mail him at firstname.lastname@example.org.