*Population in 2020、GNI and life expectancy are updated based on UN's 2019 data.

*Medical information is based on WHO's 2017 report Mental Health Atlas-country profile.

I.     Overview

　　Sri Lanka, formerly known as Ceylon, is located as a tropical island country at the Indian Ocean and in southeast of the South Asian subcontinent. It was renamed to the Democratic Socialist Republic of Sri Lanka in 1972. The executive and judicial capital is Kotte (near Colombo suburb), while the economic capital is Colombo.

　　The current population is about 21.41 million, and the country's land area is about 64,630 square kilometers. The terrain is mostly low-lying, flat to undulating plains, the central and southern inland area are mountainous. The main ethnic groups including Sinhalese about 73.8%, Tamils for 18% (with Indian immigrants 5.1%), local Moors for 8.3%, etc. 77% belong to Theravada Buddhists, 15% are Hindus, and  Muslims and Christians take the rest of 7.5%.

　　Sri Lanka’s economy is dominated by gem exports and agriculture. The main agricultural products are rice, rubber, coconut, coffee and many other representative cash crops in tropical regions. In 2019, the gross national income per capita was US$4,020. The country’s most important export product is Ceylon black tea. Sri Lanka is one of the top three tea producing countries in the world, and therefore the domestic economy is deeply affected by tea production. It has abundant tourism resources, but since the Tsunami caused by the 2004 Indian Ocean earthquake, the country’s coastline had been severely damaged and suffered a great loss to the tourism industry as a result.

　　Sri Lanka has 9 provinces and further divided into 25 districts. Each district is managed by the District Secretary appointed by the central government. Ministry of Health, Nutrition and Indigenous Medicine (simply and hereinafter called MoH) is the central competent authority and is responsible for formulating and implementing the national policies on health, nutrition, indigenous medicine and other related subjects within its purview. According to the Constitution, the provincial assembly is responsible for operating most of the country’s public hospitals, but a small number of ministry-level hospitals are directly managed by the central government in Colombo.

II.    Mental health policy and system

　　Sri Lanka is known for providing one of the earliest healthcare system in the world, with a free universal healthcare coverage. In addition to western medicine, it also has its own traditional medicine institution. The government promulgated the "Free Health Policy" in 1951. The public health care system is funded by the government and all the citizens can use the facilities. It covers approximately 50% of outpatient services and 90% of inpatient services. Preventive health care is free.

　　On November 11, 2005, the MoH published the "The Mental Health Policy of Sri Lanka 2005-2015" in Government Bulletin No. 1418.

　　The Mental Health Ordinance was first enacted in 1873 and revised in 1956, it now has replaced the Mental Health Act.

　　Sri Lanka plans to formulate new mental health legislation and establish a new administration bureau under the Mental Health Act to be responsible for the care standards of patients in government-owned and private hospitals.

　　Medical services are provided by the joint efforts of the public and private system. There are 555 government hospitals in Sri Lanka. Statistics in 2014 indicated that the public sector accounted for 73% of the country's hospitals and 93% of the available capacity of beds, and handled more than 90% of the inpatient and outpatient services.

　　With the increase in people's income and the demand for private medical services, Sri Lanka has begun to emerge a large number of private hospitals. It provides services that are more luxurious and expensive than those of the government hospitals', but most of them are built nearby Colombo and its suburbs.

　　Sri Lanka established the current three-tier healthcare system in 1989. Initially, the management of primary health care services was delegated to the provincial assembly. There are 68 secondary level hospitals and 18 district general hospitals, providing diagnosis and treatment facilities. At the third level, the central government manages national hospitals, teaching hospitals, and 10 larger specialty hospitals, as well as the medicine procurement, personnel recruitment and deployment, and training. The referral procedure adopts a two-way system, which can be referred upward from primary care to secondary/tertiary level, and downward referral from tertiary/secondary level to primary care.

　　Sri Lanka’s primary health care model is free across the whole island through the government health system, laying a good foundation for providing universal health coverage.

Although most primary care physicians and nurses have received formal psychiatric on-the-job training, mental illnesses are not included in the mental management and treatment guidelines for most primary care clinics are not officially approved by the government, the health department did not authorize the primary care units to prescribe psychotherapeutic drugs either. Similarly, official policy prohibits primary care unit from independently diagnosing and treating mental disorders in its system.

III.     Human Resources

　　The World Health Organization (hereinafter called WHO) recommends that the ratio of professionals in each country is 2.5:1,000. According to WHO, the proportion of various psychiatric medical professionals per 100,000 population in Sri Lanka is still low, with psychiatrists 0.52, nurses 3.28, psychologists 0.25, social workers 0.28, and occupational therapists 0.22. There is only one physician and two nurses per 1,000 patients in the country, and still a severe shortage of trained specialists, such as dentists, cardiologists, and oncologists. In particular, the medical manpower force is unevenly distributed, it is basically concentrated in urban areas, and understaffed in rural hospitals.

　　The psychiatric departments in all six medical schools have undergraduate training programs that include one to two months of clinical practice and classroom teaching.

　　The Postgraduate Institute of Medicine (PGIM) currently offers medical research diploma for master and doctor of medicine courses. The discipline committee includes relevant experts and scholars from various universities. The Doctor of Medicine program must also be successfully completed at least one year of overseas training and internship in the United Kingdom, Australia, New Zealand, Singapore or India, and recognized by the Sri Lanka Medical Council.

　　Those who have successfully completed the Doctor of Medicine (MD) psychiatric training program and passed the examination training program promoted by PGIM can obtain the certification of a Sri Lankan psychiatrist. PGIM has trained more than 70 psychiatric experts since the five-year postgraduate training program in psychiatry launched in 1981, but less than half of the numbers can remain in the  mental health service institutions in Sri Lanka.

　　According to the country’s laws and regulations, Sri Lankan citizens who graduated from overseas medical schools must pass the Examination for Registration to Practise Medicine (ERPM) at the local area, in order to verify whether they have the appropriate intellectual skills such as inquiry, clinical reasoning, critical thinking and decision-making to engage in medical implementation, those who pass the ERPM are equivalent to completing registration with the Sri Lanka Medical Council and obtaining an accredited medical degree.

IV.    Mental health system and health promotion

V.     Major issues, challenge, and opportunities

　　Mental health has been the focus of attention in Sri Lanka for some time. The country has one of the highest suicide rates in the world, with an average of 6,000 deaths each year. In Sri Lanka, nearly 100,000 people attempt suicide every year.

　　In the past, long-time civil war and conflicts, coupled with the devastating impact of the 2004 Indian Ocean Tsunami, these unstable environmental factors have put tremendous pressure on the people of Sri Lanka, increase their risk of trauma and further aggravate the epidemic of mental illness in the country.

　　Unfortunately, the distribution of domestic psychiatric medical resources is uneven. Sri Lanka psychiatrists are mostly concentrated in urban areas, and the war-torn areas that need most mental health care are also the areas with the most lack of soft and hardware facilities for mental illness.

VI.      Potential exchange issues

　　The main issues of mental health care in Sri Lanka include high suicide rate, insufficient mental professional manpower, uneven distribution of mental health facilities resources, lack of mental health training for primary medical staff, and inadequate mental health services at all levels of medical care. Potential exchange topics shall cover the suicide prevention, psychiatric manpower training and development, and promotion of primary medical care and community mental rehabilitation models.