 and nutritional mental issues. So these people who are well-renowned actors, celebrities, I mean, all of them, like John McFelves, one-time world medallist who won most of the medals in Olympics, the doctor, actor, comedians, and the princess, most renowned, well-famous writer, research searching, Abraham Lincoln. They all suffered from a mental disease and they all thrived in their life. So what are we? What are the tips for a healthy life? So we have to have a balance in what we do and we have to love what we do. We have to love what you do, learn good coping skills, take good exercises, eat fresh food, have a hobby and more hobbies. We have to, most importantly, forgive, forget and foresee. So all these three qualities will give you some sort of relief. Of course, a good sleep. And they say in WHO website, the 2022 mental health day, that people with good health will connect and they will function and they will cope and also they will thrive in life. So I found these facts on mental disorders, which are alarming and why that we should care for mental disorders. Global disease burden is 10% of substance use, mental and neurological disorders. One in five children and adolescents have a mental disorder. Isn't it alarming? It's 20%. 264 million of world population is depressed and that causes disability. Half of disorders of this type start before age of 14. We should care. 800,000 people die annually due to suicide. And that's the second leading cause of death. That's the age between 15 and 29. That's the second most leading cause. People with mental disorders die. That is not just mental disorders, but severe mental disorders. They die at least two decades before their years. One in nine people in conflict and threatened situation will suffer from moderate to severe mental disorders. So WHO speaks about the crisis situations in the world. Wars, COVID-19 and displacements. There are 84 million in the world right now displaced due to conflicts. So that's a common and non-respect for mental illness, or mental problem. Mental health workers, if we take developing countries, for 100,000 population, there are only two mental health workers. And two of the countries, there are 70 mental health workers. Less than half of the countries of 139 countries that we are talking about, or the countries registered in the world, mental health policies. And they report that they are aligned, the mental health policies are aligned with human rights. At some point of life, the mentally ill people, the people who are suffering from mental illnesses will suffer from severe violation of human rights and discrimination plus stigma taxation. So caring for mental health is very much important. If you take global economy, a trillion of US dollars is lost globally, annually, due to depression and anxiety disorders. We have most common among mental disorders, depression and anxiety. So close to 1 billion people right now are suffering with mental disorders. And due to COVID-19, we added 25% more of population with anxiety and depression. So if you take the monetary wise, financial wise, if you spend one dollar, you will get five dollars. If you spend on anxiety and depression, if you are increasing the treatment centers, the facilities, so we get five fold of investment, the perfect back to the world. So we should invest on anxiety and depression treatment facilities. Economically, schizophrenia is the most devastating mental disorder, but if you take depression and anxiety, that is the most common what we find in the population, the worldwide. In average psychiatric hospital, they absorb 66% of the health budget, the mental health budget. But all countries in the world, mostly they spend only 2% from their annual health budget to mental health. That is, that should be eye-opening and eye-catching thing that we have to think about as policy makers if we have our positions as policy makers. The loss of employment is a known risk factor for suicide and mental health problems in the world. And currently that is a global scenario. During COVID-19, after systems collapsed and treatments gaps are widened. So that is alarming fact, because two years in Sri Lanka, if I talk about Sri Lanka, we could not go to communities and we could not talk to people face-to-face and we were avoiding the social interactions. But mostly some part of the world and some of our doctors, they try to go to telepsychiatry or telemedicine methods that we can see people with video and all that. But for country like Sri Lanka, most of the people could not afford to have digital devices to access down until yeah. So one alarming fact is that what I told you earlier that 25% was added to the 1 billion population who are already suffering from mental illnesses. So that's the fact that I want to highlight here and talk to you about, so why we should care for mental illness. We just passed September 10th where we commemorated or we celebrated World Suicide Prevention Day. The team of suicide prevention day was through action, we can give them some sort of relief. So we have to give them light to action. So 800,000 people of population, 800,000 annually died due to committing suicide. So that's also another alarming fact that we have to care for mental health. But most of the time as a clinician, a person worked for mental health for 15 years, in Sri Lanka I have not seen police makers advancing towards mental health facilities or create a sort of environment suitable and conducive for to treat mental health mentally so we have to force and enforce our police makers to make good decisions. If you have some questions I can ask. So now the screen is yours. Thank you Dr. Siddharth for a wonderful presentation. Can you have any questions or comments from the participants? I think, can I say something? Yes please. Hi. Thank you for a wonderful presentation. I think this is one of the major concern which is being rising and throughout South Asian countries. We see even in the Western world also but specifically in South Asian countries because we are not very much aware plus the government itself is not spending much money. They don't think that the mental health is something which is to be taken care of. If I tell you about Pakistan, so we have very limited number of psychiatrists. So the psychiatrist ratio to patient is very low. So especially that's I think the major reason that we need to think about sensitizing and training general practitioners to tackle this issue, the rising burden of mental health because it's increasing day by day because of various reasons. COVID was one of the reasons as you mentioned and you've been saying to the policy makers needs to be sensitized by us but what they say is that there is no task force. So we need to produce the huge number of task force. That's what we are trying to, if you see all over the world, the psychiatrist ratio itself is very down. So that I think it was excellent presentation what you said. Very relative, related to current scenario. Thank you so much. Thank you for having done. Thank you for having done. To any of the other participants have any comments or questions? If I may see a few points regarding Dr. Asita's presentation, I would like to thank you for enlightening us with very few important facts about mental illness especially about the global disease burden and economic burden and how there's a gap between developed and underdeveloped countries in the accessibility of mental health care and also how mental health has affected individuals and community as a whole. I think we had a very fruitful presentation from Dr. Asita. Thank you so much. Thank you. Can we move on to the next presentation? So I'd like to introduce our next speaker. So we have Dr. Dabindah from Pakistan. He is professor and head of department of family medicine from Ikra University. I hope I'm pronouncing it right. Yeah. Yeah. And Dr. we'll be talking about mental health issues among healthcare workers. Yeah. Thank you so much. Yeah. Thank you. Just let me... I can't share the screen. Sona. I have your presentation. I'll try to share my screen. Just a second, Dr. Dabindah. I'll make you the host. I'll make you the co-host. If she's sharing, that's fine. Okay. Okay. Yeah. Sona, then you can share the presentation. But you will have to move the slides first. Whenever I'm asking, that's the issue. Please give me a few moves. Yes. Just need to download the presentation. Dr. Dabindah, you are the co-host also. So if you want, you can share the presentation yourself. So that's totally up to you. Can you see? Yes. Yes. Okay. Perfect. So thank you, Wonka and especially for inviting me for this day as I think this is one of the very important topics that we are concerned about. So Asita has been sharing about the general population. I will talk about something which is very relevant to us. So I'll be talking about mental health issues in physicians, especially healthcare workers. So I'll be more concentrating on physician. So we know that mental health is state of complete physical, mental and social well-being. And not only the absence of disease and infirmity, which is defined with WHO. So there is a term called burnout. So which is a long-term stress reaction, marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. So what happened is that a lot of physician or healthcare workers which includes the nurses, paramedics and physician, surgeon, all of us are very frequently encountered with burnout. That may lead to depression, anxiety, stress and other mental health disorders. So like you can see that day-to-day, COVID is one of the examples, but if we recognize that we are daily seeing patients, we have... So if I talk about our field, the primary healthcare physicians, we have a major role because we have been dealing with multiple issues which are complex issue at one time. So we, I think, carry the major burden. That's why there is a higher chance that we may also go into despair from any mental health disorders. So what is the prevalence or the estimate of the problems? Depression, one of the most common mental health issue among physician worldwide due to high intensity training and work overload which is there because you know that medical profession itself is a unique profession which will give you huge satisfaction but on the other hand, it demands a huge amount of work plus there is anxiety and there are huge challenges associated with this profession. So there was a recent systematic review which showed that meta-analysis which indicated that the prevalence of depression among physician worldwide was around 28.8% higher than the rest of the general population. So we are the one who are treating and if we will be suffering, so who is going to look after the overall population you don't understand the word of depression also. Similarly, suicide rate among male physician is 1.4 times higher than the general population. Female physician are at an even greater risk with a suicide rate of 2.27 times greater than the general female population. So this is an article which says about level of stress anxiety and depression among nurses working at Peshawar Medical College tribal medical university general which showed that depression was there in 78%. So 31% among them were severely or extremely depressed, anxiety in 78, again 40% and stress in 54%. So huge number. Similarly, there was another study which was conducted in Indian general of psychiatry. If you see, it says around 30% of participants were found to have depression and 16.7% of participants reported suicidal ideations. And about 2.3 of the sample experience moderate level of stress another 13% had high level. More than 90% of the participants reported some level of burnout. So we need to find out when does that burnout or the work load has started. So need to be or as a healthcare provider, we need to identify that critical point where we are at the edge of developing various mental health issues. So this was the same article says that this activity resulted in lower indulgence in recreational activities experiencing verbal or physical abuse in the hand of the factors which were physical or abused by patient caregiver feeling that seniors do not show empathy towards patient and senior do not show empathy towards them. These were the reasons which these patient people the physician felt they were the reason for causing or letting them go into depression. So there is another study which is also related to if you can see mental health awareness in a survey find depression increasing among nurses. So if you can see it says that 30% of nurses said that they are experiencing feeling of depression. In the latest survey this increased to nearly 40% of all nurses causes again the same. So mental health which may lead to sadness anxiety and depression. So this is another physician. So this is national physician burnout and depression report 2018. If you can see the speciality wise which is the most one feeling or suffering from burnout. So if you can see I have highlighted family medicine. You can see 51% which is quite high number. So emergency medicine has a 60% rate because they are working in an environment where there is huge number of patients with influx with critical conditions. So obviously it is understandable that they may have similarly if you take care of gynein infectious disease and we are also 51% that is a huge number in comparison to if you see public health, dermatology, pathology. This was a so this is a huge number and we need to see what can be done to improve this. So what is the cause of stress in the medical field? So it's the workload or the overload high expectation which may be from our cell because the physicians are usually high achievers and they have high ambitions from their profession to grow. Similarly, they have high expectations from the healthcare organization where they are working the hospitals or you know the healthcare setup they have high pressure from that side. Lack of work-life balance. There is no absolutely very little work-life balance in sufficient compensation for the embassies. So this may be one of the reasons which may lead them to take over burden or they tend to work for longer hours as compared to normal timings. Then there are at times it's been seen that there are organizations which may ask you for citations so they are also been asked to do a lot of administrative tasks. So they have to do their stress level and because they have to meet certain deadlines. Then there are unfavorable organization cultures. As I have discussed previously there is a lot of patients feel depressed or go into stress because of inappropriate or unprofessional behaviors from patients and their caregivers. Because this is maybe related as there are poor or no safety culture available in the organization and there is lack of physical or psychological safety and perceived job security. All these are the factors which may lead to stress or over burden in terms of by the physician, surgeon, nurses or their healthcare allies all of them tend to get stress or high level of stress or burnout which may ultimately lead to depression. So you see that there is a very there is a whole overlap between stress and anxiety. So in this there is a recognized maybe identifiable trigger present. Now so what is the consequences or impact of going or physician or the healthcare provider they go into depression or anxiety or stress or any mental health disorders. So there is a potential for decreased quality of care and poor outcome which is understandable if they are not feeling well themselves mentally not stable they may not be able to work to the best of care. Then there are increased chances of medical error which may threat patient safety. Similarly decreased patient satisfaction is one of the ultimate impact which may occur. Increased physician and staff turnover. So a lot of physician because of the workload they tend to leave that place and keep on switching jobs then there is an effect on patient care and safety. Patient medication may be one of the issue. Physician recommended evidence based screening and health counseling reduce when physician have poor personal health. So they themselves when they are not feeling well or not good in their health they may not be advising or you know taking care of their patient to a extent that which is asked or which is expected. Reduce workplace productivity and efficiency. Ultimately the overall efficiency of that organization goes down. And then cost of replacing a physician that may be one million or something. So all these are the factors. So ultimately the overall the one major task which we are aiming to do is the improved patient care. But in the process of improved patient care somehow we get lost because when there is a poor work-life balance the physician or the healthcare provider themselves get into that trap and not able to take care of themselves and they are highly neglected of their self-care which is very very important. So if you see this is a chart against that that's the same national physician burnout and depression report if you can see. So they said does your depression affect patient care. So this is the survey people working at 40% said that my depression does not affect my interaction with patients. Only 40% if you see down the line. So I'm easily separated with patient less engage with patients not active listening and responding less friendly with patients less motivated to be careful while taking patients. No history taking filling out the electronic health record. I express my frustration in front of patients make errors I may not ordinarily make errors that could harm patients. So if you can see only 40% are those who say that it's not affected while rest of the 60% if you can see somehow one way or the other is going to affect the patient care quality and there is a threat to patient safety which is a great impact which may create a lot of disturbance in terms of healthcare and then bear that the ultimate goal is not achieved. So this is does your depression affect your dealing with colleagues less engage with staff actively listening and responding more easily staff appear express my frustration front of staff less friendly with staff my depression does not affect my behavior in workplace only 22% while see they arrive late they are making errors they should not make take longer lunches make error that would harm staff and peers. So 22% are saying that their depression or their behavior does not affect the healthcare environment while rest of them are saying that it does affect one way or the other that is ultimately making them more fragile and that may be the concept of team building that may get hampered. So this is very important if you see the question which was why have you not sought help for burnout or depression can you read this I can deal with this without help from a professional this is the most common reason that we do because we ourselves are thinking that we are the healthcare providers we are providing medicine to each and every one we can treat ourselves that is not sufficient because we don't know we may be biased toward ourselves and we know we may not see the exact picture or the clear picture of ourselves and self treatment may itself may harm or there may be a denial phase which may the reason why we are not willing to go for consultation don't want to risk this closure to medus one time there was a student who got into health issues so actually went into depression so when he was trying to consult the hospital where he was working he was advised that do not disclose this depression thing into your work environment because once they get to know they will start blaming you and they will directly kick you out of the job so this is one of the concern which people have that's why they are not opening up their mental health issues especially when you are working as a healthcare provider concerned about it being on my insurance record and concerned about my colleagues finding out so they are not still even though we think that it is not something taboo but still inside or in our concept or in our mind we still think that this is one of the taboo and if people say that we are on antidepressant or something this will create a negative image or so weak doctor you don't know self are taking something so people may start bullying you concerned about medical health professions or others so you can see these are most harder to seek help and that may worsen the condition and there may be a chance that people healthcare provider are getting more and more mental health issues so again self care doctors are miserable at this as doctor visits for themselves self prescribed drugs will not see a doctor so I will treat myself perceived stigma around seeking help or support a lot of time when you say that I am oh doctor you were on leave so once a patient said do you also get sick so I said I am also a human being like you so if you can say you exception and this I am pertinent with current to introduce my country a beautiful small country that is land locked in eastern Himalayas sandwiched between two giant countries China in the north and India in the south and has a population of just over 0.6 million and as a gift from a golden throne universal health care are all free that means there is no privatization of any clinics to talk about mental health care in Bhutan it is integrated in the primary healthcare system to provide essential mental health care to patients mental health care is delivered in a prototype system with national referral hospital at apex two regional hospital eastern regional hospital basic health next primary healthcare physicians and community health worker we call it health assistants are responsible for managing patients in their settings patient admissions are both voluntary and involuntary so as mentioned mental health is infancy in our country too with only one mental health in patient ward in national referral hospital and only three cycle is nationwide mental health is a major public health issue in Bhutan it's all because of attitudes towards mental illness and infants by various traditional beliefs like the black magics, evil spirits witchcraft curse or karma of previous life and they resort to alternative healing practice especially religious and faith healing this contributes to stigmatization and the discrimination of people with mental disorder so to improve mental health awareness and literacy among public and healthcare worker it's very important mental health in Bhutan remains hidden largely because of belief as I mentioned and then it results in widespread stigma and discrimination neglect of care of people with mental disorder due to lack of understanding of management by healthcare provider and people even for a healthcare provider understanding of management of mental health of a patient is also not known even at provider level the topic I was given was deliberate self harm and prevention of suicide present a case on a deliberate self harm I recently encountered so to talk about deliberate self harm in suicide suicide is a top 6 leading cause of death in Bhutan and every number of suicide was 8 a month that every 90 hours we are losing one patient to suicide suicide and mental health issues in every society and can affect anyone and then it can affect all walks of life but the recent studies have shown that young adults are affected more than older populations thanks this is a case of 26 year old female presented to emergency department with the history of deliberate injunction of 18 tablets of paracetamol brought to emergency room by sister after 2 hours of injunction and that act was isolation room when no one was at home she had she had no regret of act and was feeling low hopeless and wanted to enter life retrospectively looking at the history she had depressive symptoms that she never consulted psychiatrist she had mild epigastic pain and nausea at the presentation next doctor in past medical and psychetic illness she didn't have a significant past medical history and never been to a psychiatric unit in a social history she studied till grade 10 and discontinued to depose family support she was raised at the age of 16 when she was grade 10 and by one of her relatives but she did not share that incident to any of her family member this incident still dessert and often is low hopeless and doesn't see future but she had a similar history of delirium self harm that cutting forearm during high school days next the management that we management to that patient in emergency room immediate care with administration of activity chapel supportive care supportive care when patient was admitted to psychiatric unit for the management now promoting mental health and well being is is not a single man show it is multi stakeholder approach since it has a multifactorial reason that let people to come so it's it's said that no no single approach organization prevents suicide but they should be involvement of government at the highest level non-governmental organizations local government and then even like religious bodies police personnel teachers they can also be vital role in intervention of suicide so mental problems family problems and financial problems the common reasons why commit suicide and then it to prevent suicide comes with some form of warnings verbal message shows signs of mental distress so it is very important as a healthcare worker to identify the warning signs before patient commit suicide patient once the patient who commit suicide or completed suicide will have warning signs in a form of verbal message or signs of a mental distress so in Bhutan to talk about suicide prevention so we have a national suicide prevention program under ministry of health and has launched a comprehensive suicide prevention action plan 2015 to 2018 and we have adolescent friendly health services in every hospital for cater services to adolescents who has all sorts of problem who comes to hospital and then in that focuses on the mental well-being of adolescents and the school counseling services where school counselors are taught to identify the students who are at risk of committing suicide so in nutshell a very short presentation promoting mental health and well-being is an approach where this whole of a whole of a society approach is needed thank you very much Thank you Dr. Omni for wonderful presentation Do we have any comments or questions from the participants? Do you have any method to educate and organize programs in Bhutan with teachers the counseling teachers are in the schools in Sri Lanka we have counseling teachers yes now with the recent I think it's not that old but now every school has counseling teachers so they counseling the patients students who are at risk and then mostly patients students who are into substance abuse who are financially backward and then who shows some signs of mental distress they seek advice and then they do cross referral to primary care physician to seek medical advice Thank you Dr. Omni Any more comments or questions from the participants? If I may add a few points from Dr. Omni's presentation mental health has always been an underrated issue in Bhutan I think personally we have a lot of stigma in our community and we have patients who are very reluctant to seek help because of this stigma I think being brought up in Asian community we are family dynamics work so usually even our close family members how about any stressful life events we are not able to seek professional help so in Bhutan I think we are still very lacking in promoting mental health so now we have quite a lot of programs in the ministry of health that are very active in preventing deliberate self harm and suicide so do you have any more any more comments questions from the participants? Can you close the session for today? Anup, do you have any comments? No, I don't have any questions but I just have I would like to end the session on a thank you note very, very thank you to Dr. Asitah, Dr. Omni and Dr. Tabinda for for such informative talks I think all of the presentations are very, very relevant in terms of mental health and in terms of primary care practice so thank you so much for joining and it was I think it was a much needed webinar which we webinar and a very important day that we thought that because mental health issues are always underlying and they never as Dr. Tabinda had also mentioned that even 49% of even the doctors think that they can deal with it themselves, let alone general population general people so these were the important pointers that we wanted to point it out by Dr. Asitah and Dr. Omni also pointed out important details regarding self harm and the importance of why mental health is so important what are the parameters and why is it so important and what matters regarding mental health so that's about it I think thank you so much for joining today and my apologies for the initial delay because I think there was some issue with the link so there was some problem at my understanding so that's why we had a little problem in the initial part and then I thought it went off there so thank you so much everyone thank you thank you so much I'd like to thank all our speakers Dr. Asitah, Dr. Tabinda and Dr. Omni I think we had a very successful academic session for the World Mental Health Day today so I'd like to thank all of our speakers and all of our participants I hope you have a wonderful week ahead thank you thank you so much goodnight goodnight