Horror attack highlights dire need for

mental health care reform in Thailand

Apasa Seewua is taken away by police after murdering 5 children in Chiang Mai, Thailand earlier this week. Image via
Ruamkatanyu News on Facebook.

The brutal murder of five children in Chiang Mai should be a major concern for a Thai government
promoting happiness', writes James Austin Farrell

By Saksith Saiyasombut & Siam Voices Oct 01, 2015

Five children were killed this week when a 24-year-old man,

Apasa Seewua, said to have recently been released from Suan Prung Psychiatric
Hospital in Chiang Mai, entered a house and attacked them with a 19-inch meat
cleaver. One of the victims was an eight month old baby. The others were all aged less
than eight years old. One other child, as well as a pregnant mother, survived the attack
and both are reported to be traumatized but recovering in hospital. Two boys and one

girl were the injured mother's children, while the other two victims were the woman's
nephew and the son of a neighbour.
While it was reported in the Guardian that the police had said that Apasa had no
history of mental breakdowns, his father was reported as saying that his son had,
been suffering from major depression ever since his wife left him and took their
children with her. It was also reported that the father had tried to ensure that Apasa
kept taking the medication he had been given by the hospital after his release.
Police initially reported that the man had been a former drug addict, but Paritat
Silpakij, Suang Prung Hospital's acting director, was reported by the Bangkok Post as
saying that a blood test showed no sign of drugs in the man's body.
Could better out-patient psychiatric help prevent more tragedies like this happening?
In 2012 another former patient of Suan Prung Psychiatric Hospital dismembered her
five and one year children, and when police arrived at the scene of the murders it was
reported that they found she had been cooking parts of their bodies in a curry. Her
husband told police that when he left for work that day he had not noticed anything
odd about her behavior. The woman had been treated for psychotic episodes since
2007, and sometime after her release it was said that she had stopped taking her
medication.
While only three years apart, these two cases of infanticide are so extreme that
questions might be raised as to the state of mental health care in Thailand, including
ongoing out-patient treatment. It is unusual for mentally ill people to carry out violent
acts, according to reports. The US Department of Health says that, The vast majority
of people with mental health problems are no more likely to be violent than anyone
else. Most people with mental illness are not violent and only 3%-5% of violent acts
can be attributed to individuals living with a serious mental illness. Those few people
who have been diagnosed as a threat to the lives of others we would expect to be under
the closest scrutiny and kept away from the public, but perhaps in these two cases
either the patients were misdiagnosed, or their latent violent propensities were
inscrutable even to professionals.
Mentally ill people may often just fall under the radar of professional help. Only last
June a grandmother used a meat cleaver to kill her 11-year-old grandson in Lopburi.
The grandmother was said to be mentally-ill. In the same month a father in Nakhon
Si Thammarat province said to be suffering from depression poisoned his three
children and then hanged himself. Later in August 2015 in Nan Province a man shot
his wife and two children and then took his life. These acts of violence are related in
their degree of brutality, but to some extent they might also be related to untreated, or
not sufficiently treated, mental illness. Should questions be asked about mental health

in Thailand and how it is treated?

Treating mental health
In 2006 I interviewed Dr Paritat Silpakij of Suan Prung Psychiatric Hospital, who told
me that the hospital was the, Only one of its kind in the north of Thailand. There are
clinics in the provinces where out-reach doctors visit patients, he said, adding that at
the time 500 out of the 600 beds at the hospital were being used. He said in the
interview that one of his missions was to educate people in Thailand about mental
illness, but this was a difficult task given the size of northern Thailand, the number of
professional staff, and how mental illness is anachronistically perceived by many
people not educated about mental health conditions.

Image via Chiang Mai CityLife.

Only 15 percent of the patients at Suan Prung were under close observation, said
Paritat, while the majority of patients were suffering from alcohol- and drug abuserelated conditions. He said many patients suffered from anxiety and depression, but
this he believed was also partly an effect of alcohol and drug abuse. Twenty percent of
the patients he said were schizophrenic. He added that, Even though we would like to
council all our patients as much as possible, sometimes we just don't have the time and
resources, so drugs have to be administered instead.
For patients with the most intense disorders, he said that electro convulsive therapy

(electric shock treatment) often has to be used. The numbers of suicides in the north is
notoriously high, and Paritat and other mental health doctors have attributed this to
such things as financial difficulties, alcoholism, depression, changes in lifestyle people
cannot adjust to, the necessities of consumerism brought on by globalism and with it a
growing transformation in the extended family dynamic.
Importantly, due to mental illness being stigmatized, he said Thai people often repress
feelings of mental unbalance, but also in more remote areas he said that many people
just do not understand certain mental health conditions.
We would go around all the villages in the north trying to locate people who needed
our help; 10 years ago, we would find someone who had been locked in a cage or a
small room in nearly every village, he said. The locals would use traditional methods
to cure them, like offering gifts of chickens and wine to the spirit so it might release the
victim from a demonic grasp. It's taken years for us, travelling from village to village to
help these suffering people and educate the elders. It's not known if such attitudes to
mental health still exist, but it might be an indicator to how much of a challenge health
professionals still have.
His team then of 200 nurses and 14 doctors travelled around the north of Thailand
holding education seminars on mental health, hoping to foster a belief that people can
be open about their feelings but also reduce the stigma of those that are suffering.
Mental health is not treated seriously enough
In a 2013 report on mental health in Thailand it was stated that the Department of
Mental Health (DOMH) oversees, 122 outpatient facilities nation-wide which are
located in general hospitals and 17 designated mental hospitals. Thailand has no day
treatment facilities. There are 7.29 mental health workers, nurses, psychiatrists and
administrative staff for every 100,000 people in Thailand, according to the World
Health Organization (WHO). This number, states the report, is very little. It should
be mentioned that the WHO figures were taken in 2006.
The report goes on to say that psychiatric staff are not just impossibly outnumbered by
their patients, or possible patients, but many people working in mental health do not
receive adequate training. A, reason for the narrow range of diagnoses in Thailand is
that only most common disorders are addressed which are schizophrenia, mood
disorders and substance abuse while no routine provisions for follow-up community
care are provided. The limitation to the greatest public denominators and lack of
follow-up measurements beg questions providing evidence for treatment efficacy,
flexibility and adequacy.
The reason for the narrow range of diagnosis according to the report is the

centralization of public health. Bureaucratic overregulation, says the report, leads to a,

disconnectedness to clinical practice. The report suggests that, individual case
assessment, critical outcomes definition and treatment planning, is a measure that
must be taken in Thailand to treat mental illness. But with unqualified mental health
workers, and a centralized policy that regulates the standards of mental health, the
report says is not sufficient to handle cases of many mental disorders that are not
based on the medical model.

Image via Suan Prung Psychiatric Hospitals website.

In the Bangkok Post in 2012 it was reported that Deputy Health Minister Dr Surawith
Konsomboon said, 20 percent of Thais suffer from mental health problems but only 3
million went to hospital and only 1 million get regular treatment. In the same article
Surawith said, As a result of urbanisation, society will become more fragile and selfcentered, the majority of households are likely to consist only of the father, mother and
their children (fewer elderly people), with women playing the lead role in most
families.
Mental health issues have to be a major concern for the Thai government. More mental
facilities should be built, better training has to be given to a larger number of
professionals that is under constant review and embraces new methods of treatment.
Outside of the main hospitals more clinics should be treating people, while more
campaigns in support of mental health issues should be part of the public ethos.
Globalization, consumerism, or many other reasons people become mentally ill
perhaps cannot be thwarted, but better help and more innovative research is possible.
Suan Prung Psychiatric Hospital in Chiang Mai has for 20 years been providing
essential care for patients, and having been there and talked with Dr Paritat on several

occasions, as well as his head psychiatrist, on mental health issues, I was made aware
of their dedication, but also the overwhelming task they have. Once patients they have
treated leave the hospital, especially in view of the cases of the released patients who
have committed murder, outreach work is direly needed.
Developing facilities in the further reaches of Thailand, as well as educating locals on
the issues of mental health, will be a difficult undertaking. At a time of political
instability, power struggles, widespread household debt, and class schisms, perhaps
Thailand right now is collectively suffering from mental dysphoria. The mental health
system will need much support. Perhaps some of the vast amount of money spent on
happiness PR campaigns by the new government should be concentrated on more
pressing concerns of real mental health issues.
About the author:
James Austin Farrell is a journalist and fiction writer living in Thailand.
Posted by Thavam