*Population in 2020、GNI and life expectancy are updated based on UN's 2018 data.

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

I.     Overview

　　The Republic of Maldives, commonly known as the Maldives, is one of the smallest countries in Asia, it is located in the Indian Ocean waters and at the southwest of Sri Lanka and India with 500 kilometers away in distance. It is also known as the "King's island", and is in the equatorial region of South Asia. A world-famous island country with 1,190 coral islands, constituting 26 major atolls and countless large and small reefs, to form a north-to-south pattern of length 820 kilometers and east-to west of 120 kilometers in width. Only 202 islands are inhabited, making it one of the smallest and least populated pocket countries in the world (listed in United Nations). The total area of the entire country (including oceans and reefs) is 115,300 square kilometers, however, the average sea level of most countries' area is less than 3 meters, and only 298 square kilometers of land is above certain sea level which makes the main size of the country's area. The reef islands have no rivers and hills. Male' is the capital and largest city of the country. Divehi-bas is the language, and English is also widely spoken too. Islam is the only religious belief in Maldives.

　　In Maldives, the proportion of the population under the age of 18 is 35%, while the proportion over 60 is only 5%. The life expectancy of men and women is nearly 80 years. It is a middle- and high- income country for its GNI figure, in 2019, the per capita national income was 13,196 U.S. dollars. The total health expenditure accounts for 8.01% of the total domestic product, and the per capita government health care expenditure is $336.0. World Health Organization (hereinafter called WHO) pointed out that Maldivian neuropsychiatric diseases are estimated to account for 18.7% of the global disease burden.

　　The administrative divisions of the Maldives are composed of atolls, islands and cities, and each administrative district has its own local council to establish basic terms of autonomy. In 2010, the government announced the establishment of 21 administrative districts, including 19 administrative atolls, 2 cities (Male' city and Addu city), and other islands under the Decentralization Act.

　　Mental health is under the responsibility of the Ministry of Health (hereinafter called MoH). Its mission is to ensure that the country participates in an affordable, fair and accessible way to achieve excellent quality health services and thereby achieving the healthy people.

　　Statistics released by MoH in 2018 showed that the country had one public Indira Gandhi Memorial Hospital (hereinafter called IGMH) and two private tertiary hospitals. In addition, primary health care centers are set up on inhabited islands to provide basic medical care services, and on larger islands, there are also district hospitals and atoll hospitals. There are 6 district hospitals, 4 atoll hospitals, 43 medical and health centers, and some private clinics across the country. The district hospitals and health centers provide different services and are evaluated by MoH.

　　IGMH is the largest government hospital in the capital Male’, donated by former Indian Prime Minister Rajiv Gandhi. The medical charges are the lowest in the country because it is managed by the government. It is a very modern hospital, a hospital frequently visited by local people. The second largest hospital is ADK Hospital in Male'. This is a private hospital that is very popular among middle-class citizens and tourists. Another private hospital is the Tree Top Hospital, which was opened in June 2015. It is a multidisciplinary professional tertiary care hospital with a capacity of 210 beds and more than 30 specialized services.

　　The National Drug Agency (NDA) is the agency responsible for dealing with drug problems and abuses. The Drug Treatment and Rehabilitation Centre (DTRC) provides community care using a therapeutic community model.

II.     Mental health policy and system

　　After the South Asian Tsunami in 2004, with the support of international donations, Maldives began to formulate a national mental health policy. The policy was drafted in November 2006, but little progress had been made. Due to the change of government, the policy has not been fully recognized. It was not until 2014 that a group of advocates resumed the project with financial assistance from the WHO, which attracted attention from all walks of life, and completed the existing draft in February 2015. The draft had undergone major revisions, including expanding the definition of mental health, focusing on the prevention of mental disorders and the promotion of mental health, advocating the mental health and other system-related issues. Meanwhile, it would try to promote a ten-year policy, and followed by a five-year mental health plan. This draft policy is still awaiting political approval from the MoH and other relevant stakeholders.

　　In 2015, the Health Master Plan (HMP) was formulated again, which clearly set the national health goals and principles for 2016-2025, and provided strategic guidance and direction for the public and health partners. It also provides strategic guidance and direction for the public and health partners, as a guiding principle for formulating various health plans and business plans, so as to improve people’s health and develop the country's health system.

　　MoH is responsible for formulating overall health policies and plans, as well as regulating, monitoring and evaluating health activities and results. Compared with other countries in a similar state of development, Maldives has slightly higher health care expenditures, in 2009, a universal social health insurance plan was established.

　　According to WHO data, there is currently no independent mental health law in the country.

III.     Human Resources

　　There are about 300 doctors and 750 nurses; while the total number of pharmacists, chemists, anesthesiologists, dentists and radiologists are about 560. The hospital beds in the country are 600 in total. On average, there is one physician for every 1,167 people and one nurse for every 467 people, and an average of one hospital bed for every 580 people.

　　The MoH is responsible for promoting the training of medical personnel, and implements intermediate training in the Faculty of Health Sciences under the Maldives National University. It mainly trains physicians, nurses, midwives, primary medical nurses, laboratory technicians and pharmacists in the medical schools. Advanced training and further study are at the universities abroad. Every year, nearly 200 doctors and nurses are sent overseas, and the medical training resources of other countries are used to accelerate the cultivation of national senior medical personnel.

IV.    Mental health system and health promotion

　　Maldives health care provides a four-tier referral system. In order to ensure basic health services for the people, every inhabited island in Maldives, regardless of population size, it can usually walk to a hospital or health center within ten minutes. The next is the atoll-level medical institutions and specialist hospitals; the highest level is the city and the central-level tertiary medical institutions. Medical institutions on the island can refer patients to a higher-level medical institution at the atoll, district, and central-level based hospital if required by the service availability.

　　At present, the Maldives' mental health system is poorly organized and coordinated. Mental health policies and plans are still being promoted, and therefore, there are no legislation to solve the lack of trained mental health workers. Most mental health resources are concentrated in the capital Male', while a few outer islands provide mental health services. IGMH, the only tertiary care provider, provides very limited inpatient services for mentally ill patients, it has only 4 beds allocated to mentally ill patients. No psychiatric ward, and the inadequate supply of mental care resources is the problem.

　　Because people generally have a poor awareness of mental health and mental disorders, and there is obviously to have the stigma and discrimination against patients with mental illnesses. The traditional therapists and religious leaders are usually the first choice to solve mental health problems, therefore, there is almost no promotion for the mental health so far.

V.     Major issues, challenge, and opportunities

　　Like the other developing countries, mental health is seriously neglected in Maldives. Although there have been attempts to formulate and endorse such policies, there has long been a lack of national-level mental health policies or strategies. The National Mental Health Policy currently faces the most significant challenges, including the stigmatization and the shortage of awareness of mental health at all levels, as well as the scarcity of mature mental health advocacy groups. The policy has a wide range of mental health, but the inadequacy of detailed planning and local research may also become an obstacle. The background of political instability and its impact on the health sector are also the important barriers to political recognition. Persisting in advocating for mental health and raising consciousness is very significant to ensure the successful recovery of policies. Compared with general mental health, the development of drug use services and prohibition is relatively good. With the introduction of the new "Drugs Act" (Law number 17/2011), the sentence and punishment for drug use will be a mandatory treatment plan. Especially in the management of medical service supply, psychiatric medical prevention work, and how to meet the people's mental health needs and how to provide effective high-quality treatment and rehabilitation opportunities are still major challenges at present.

VI.    Potential exchange issues

　　Due to the limited capacity of Maldives to train its own medical services, with the rapid growth of the population and the development of medical services, the demand for medical staff is increasing day by day. It is necessary to hire foreign doctors to make up for the shortage of domestic doctors. So far, the number of foreign doctors accounts for 50%, while the foreign medical staff take the proportion about 30%. The development of mental health services in the Maldives lacks leadership, coordination and integration with general health services. Therefore, in addition to the education and training of medical staff, medical management is also one of the topics that can be communicated with each other in the future.