*Population in 2020，GNI and life expectancy in 2019 are updated based on UN data. *Medical information is based on WHO’s report of 2017 Mental Health Atlas-country profile.

I.    Overview

Myanmar is the westernmost country and the largest country in Mainland Southeast Asia, and it covers an area of 676,500 square kilometers. As of 2019, the population was about 54.4 million, consisting of 135 distinct ethnic groups and at least 100 different dialects. The Bamar people, with mother tongue Burmese, form an estimated 68% of the population. Nearly 90% of the population believe in Buddhism, and about 70% of the population reside in the rural areas, Agriculture plays an essential role in Myanmar's economy, and more than 60% of the population live on it. The previous lock-down policy had resulted in a long-term economic stagnation, the Government had to perform the economic reformation for the improvement since 2011. The GNI per capita was about 1,390 US dollars in 2019.  　　Myanmar is divided into twenty-one administrative subdivisions, which include 7 Divisions, 7 States, 1 Naypyidaw Union Territory, and 6 Sub-state Autonomy. The population in 7 divisions are predominantly Bamar, while the rest States (and Sub-state) are mainly the specific ethnic minorities. 　　The Ministry of Health is the governing agency in central government which consists of 7 subordinate departments, such as Department of Planning, Medical Services, Medical Research, Traditional Medicine, and so on. 　　Public medical services are composed of Health Centers under the jurisdiction of units at all levels, scattered from cities to the countryside. In remote rural areas, there are also Station Hospitals and Rural Health Centers. The basic structure of Myanmar's national medical system is the township medical system. Therefore, the township-level health authorities are in charge of managing the medical system and also provide basic care services. Township bureaus of health are not only responsible for managing of the local medical system but also provide basic healthcare service. The government in Myanmar does not have a specific unit responsible for mental health, usually, the Department of Medical Services (Ministry of Health) will assign a special person to be in charge of mental health related administration, who normally is the director/professor of the Mental Health Department in Yangon University. 　　Myanmar has achieved the health-related Millennium Development Goals (MDGs), including the reduction of mortality rate in children under age of 5 years and PNM (Perinatal stage), the increase for contraceptive rate of childbearing age, and the reduction of infection of HIV and Tuberculosis (TB). 　　WHO indicated that Myanmar government's total medical expenditure accounting for 2.3 % of its GDP in 2014, which ranked as the lowest among the Southeastern Asian Countries. The Government aimed to reach 6% in 2020 as the national master plan. (Mental Health ATLAS 2014 Member State Profile). 　　Myanmar has committed in public to achieve Universal Health Coverage (UHC) by 2030. The main goal is to assure the access to essential health care without financial barriers for all the people. The National Health Insurance System has been included in the Myanmar National Health Plan 2017-2021 (NHP2017-2021), the main goal is to extend the accessibility to a basic Essential Package of Health Services (EPHS) to the entire population by 2020 while increasing financial protection. 　　National Health Plan (NHP) aims to provide all people with access to needed health services by 2031, and there are four pillars to be organized as the related efforts, namely human resources, infrastructure, service delivery and fund-raising. Further, the report of medical industry demand by the Chung-Hua Institution for Economic Research (CIER) revealed that Myanmar’s national medical demand is expanding yearly, however, medical institutions and professionals are required to be increased simultaneously. Moreover, medical equipment, which relies on imports, indicates an increasing year by year, and the national health insurance system has just begun, but the people still have to pay by themselves for medical service. (NHP 2017-2021 report, p6)

II. Mental health policy and system

Myanmar initiated a national mental health policy since 1993. ASEAN Mental Health System report in 2016 mentioned that a draft of the new Mental Health Act had been completed and was still under the processing to become a law. Mental health policy is included in the National Health Plan, which is revised and implemented every five years. (2016 ASEAN report, p92). 　　Mental health care in 2011 was provided with the aim of promotion of mental health, prevention of mental disorders and strengthening of access to mental health services for the people of Myanmar. The objectives are: (1). Implement strategies for promotion mental health and prevention in disorders; (2). Reduce the treatment and service gap for mental disorders by 20% (by the year 2020); (3). Develop a Mental Health Law which is appropriate to current situations in Myanmar; (4). Provide evidence-based best practices for mental health service cares by collaborating with stakeholders, international medical communities, NGOs and INGOs; (5). Ensure preparedness for mental health and psychosocial aspect of disasters; (6). Promote resource development in mental health and upgrade the hospital-based services; (7). Strengthen health information system related to mental health issues; (8). Do research for mental health.

III.   Human Resources

　　From Myanmar 's statistic data in 2013, the total mental health workforce is shown in Table 1. At present, the Universities of Medicine, and Mandalay (two universities) offer a Master of Mental Health (M. Med. Sc. - Mental Health) degree of a three-years' course. There are 20 to 30 psychiatrists graduate annually. The Universities of Nursing, Yangon and Mandalay (three universities) offer a Diploma in Mental Health Nursing of 9 months course, or a Master of Mental Health for Nursing (M. N. Sc. - Mental Health) degree. There are no training programs for clinical psychologists, psychiatric social workers and occupational therapists for mental health. There are community health workers and health volunteers, but they are not exclusively for mental health training services. 

　　There are five civilian medical schools and one medical college. All medical universities in Myanmar offer the undergraduate MBBS degree (Bachelor of Medicine and Bachelor of Surgery), which is currently at the bachelor level. A 2017 research indicated that the academia in Myanmar has to cope with the lack of cooperation and help from the global academic community as well as the long-term scarcity of resources, expertise and political commitment domestically, all the civilian schools have been using the same curriculum that has remained virtually unchanged for decades. Basic sciences are taught in the early two years, and clinical training starts in the third year. The study at undergraduate medicine school is mainly didactic, and commonly encouraged in the way of rote learning. There is a lot of room for improvement in its medical education.

IV.       Mental health system and promotion

　　Since 1990, the World Health Organization (WHO) patronized the Mental Health plan, aimed to integrate of MH services to primary care. It is mainly to let the trained primary medical staff, the social, community, and the family support take care for mentally ill patients. The NGO or the trained medical staff members will provide mental health service, and almost 40% of the primary care units will be equipped with at least one trained professional. The secondary and tertiary care institutions are to provide mental health service from 2014. 

　　Medicines are provided by the Ministry of Health for patients attending at Mental

　　Health Hospitals since 2012-13. Small amounts of drugs are furnished for primary care periodically by support of WHO. Administrative procedures for import and distribution of medicaments are controlled and regulated by Department of Food and Drug Administration, Ministry of Health. Antipsychotics (risperidone and olanzapine), anti-depressants (amitriptyline, and SSRIs), sedatives and hypnotics (diazepam, lorazepam, clonazepam and alprazolam) are included in National Essential Drugs List. 

　　Nearly 75% of the MH budget is for mental hospital expenditures (WHO, 2011). MH services are provided primarily through two psychiatric hospitals, 22 psychiatric wards of general hospitals, and 35 outpatient MH facilities (WHO, 2015). Primary care physicians can prescribe psychiatric medications and have access to MH treatment manuals, but the majority have not received training on MH within the past 5 year. For every 100,000 people, only 0.6 trained MH workers (e.g., psychiatrists, psychiatric nurses) are available, and only 16% of these workers are in outpatient settings. 

　　The World Health Organization (WHO) advocates for the integration of MH services into primary care and other community-based delivery platforms to improve access and lower cost. Data from the WHO resources indicate a lack of human resources for community-based therapeutic interventions within the formal healthcare system. The historical role of the psychiatric hospitals in Myanmar, impaired with the likelihood of prolonged hospitalization if committed, may reduce help-seeking behaviors. The use of informal service networks for MH care is not well documented, however, some anecdotal reports suggest that people in distress may receive counseling support in monastic settings and meditation centers. Most of the documented psychosocial and psychotherapeutic interventions have been provided by various non-governmental and community-based organizations, often by lay providers or community health workers. 

　　There are two mental health hospitals; one is located in Yangon and the other in Mandalay. Mental Health Hospital, Yangon, is a 1,200 bed Tertiary Care Teaching Hospital, with an outpatient department, general psychiatry units, mood disorder units, schizophrenia units, alcohol de-addiction and research unit, drug dependency treatment and research unit, forensic unit, long-stay and rehabilitation unit, and community mental health unit. 18,922 patients were attended at the outpatient department and 11,289 patients were admitted to hospitalization in 2013. 

　　Another is a 200 bed Tertiary Care Teaching Hospital in Mandalay, which is composed of a 100 bed general psychiatry unit and 100 bed drug dependency treatment unit. 6,959 patients were attended at the outpatient department and 2,379 patients were admitted to hospitalization in 2013. 

　　Some General Hospitals also provide mental health services. There are 22 Psychiatric Units attached to General Hospitals of all States and regional levels in the country with total 300 beds. Mental health services are offered for both inpatients and outpatients in 97 facilities led by consultant psychiatrists. There are eight General Hospitals in which mental health services are provided with outpatient facilities. 

　　Regarding mental health promotion, Sanofi and Myanmar Medical Association co-found together a Community-Based Intervention Program to increase the access to treatment, Pilot Launches in Yangon on World Mental Health Day.

V.    Major issues, challenge, and opportunities.

　　The United Nations (UN) describes ongoing challenges to peace and security in Myanmar as a "complex combination of vulnerability to natural disasters, food and nutrition insecurity, armed conflict, inter-communal tensions, statelessness, displacement, trafficking and migration". 

　　The large burden of mental health (MH) problems on the country is not surprising. The Global Burden of Disease study in 2015 reports that in Myanmar both depressive and anxiety disorders are among the top 10 contributors to years lived with disability, and both have increased over the past decade. 

　　In Myanmar, because of stigma and discrimination, many people still believe that mental illnesses are caused by evil spirits and still do not accept that mental illnesses are treatable. If someone becomes mentally ill or starts to behave strangely, he/she will be sent to the local healers or "Payawgasayas", and still remain untreated properly. Thus, the most important priorities are to establish a community mental health system, and to enact the mental health law. Next, in order to reduce the treatment gap, the limitation and scarcity of human resources, technical expertise, and funding are all the obstacles which need to be overcome, and to improve the access to mental health services. 

　　The treatment gap based on treatment of psychoses (facility-based) is 95.8%. The most important priority is to establish a Community Mental Health Act which covers most areas of the country as soon as possible. 

　　Limitation and scarcity of human resources, technical expertise, and funding are the obstacles to be overcome. In addition, stigmatization, discrimination, lack of knowledge regarding mental health, and poverty are also impediments to the access of the proper mental health services. 

　　A Health Management Information System has been established in the country. There is the data on six common mental disorders (psychosis, anxiety, depression, epilepsy, mental retardation and alcohol dependency) which are collected by trained  health staff members working in rural health centers. See Table 2. 

　　Source: Mental Health Project,2013*83% of Reporting Centres

VI.         Potential issues of exchange

The mental health, which has been neglected for a long time, is improved in collaboration with international organizations nearly in recent years. Few positive aspects of Myanmar culture can be utilized to assist the development of mental health, and to provide social support for people suffering from mental disorders. For example, Myanmar society is cohesive, and children, parents and the elderly are well looked after. Patience. Tolerance, goodwill, kindness and voluntarism are the elementary principles in Myanmar culture, and abuse is very uncommon in the society. 90% of the population is Buddhist and every village has at least one monastery, in which the monks and the spirituality could play the substantial roles in promotion of mental health.  　　The shortage of professional mental personnel, uneven distributions of the mental health facilities, lack of training for the medical staff and insufficient capacity of mental health services at all levels are all the major issues in Myanmar. The future potential exchange topic should be heading towards enhancing the training of mental health personnel anyway.