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

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

I.Overview

　　Thailand is a constitutional monarchy country with an area of 513,000 square kilometers and a population of near 70 million. It is composed of more than 20 ethnic groups. Three-quarters of the total population is Thai, 14% ethnic Chinese, 2.3% Malay, and the rest include Burmese, Khmer, Miao and other ethnic minorities. 95% of its population believe in Buddhism, the official language is Thai and the average life expectancy at birth is 76.8 years old. The average national income (GNI) in 2019 was US$7,260, and one of the middle-to-high-income countries in the world.

　　The administrative districts of the Thai government are divided into four levels: the first level prefecture (changwat), the second level county (amphoe), the third level town/township (tambon), and the fourth level village (muban). There are  totally 77 prefectures (including the municipality Bangkok), in which 50 counties  are administered by the capital and municipality Bangkok (one of the prefectures). According to the statistics in 2000, there were 795 counties and 81 sub-counties in Thailand, which were under the rule of those 76 prefectures.

　　The Ministry of Public Health (hereinafter called MoPH) is responsible for whole nation's health affairs and services. There are 4 permanent secretary-generals under the minister who are in charge of 8 Departments. Three of the Departments, namely medical services, mental health, and Thai traditional and complementary therapies are under the jurisdiction of the permanent secretary-general of medical affairs. Each prefecture has a public health office, and underneath districts of town/township have their regional public health offices, which are managed by the permanent secretary-general of MoPH.

　　Health services cover four levels, including the tertiary health services and the self-care. Self-care is based on the family and focuses on strengthening the ability of self-assistance and health decision-making. Primary care includes health promotion and prevention services provided in the community which contains regional health promotion hospitals, health centers similar to health clinics, and general practitioners (GP). Secondary health services include community hospitals with main specialist medical services. Tertiary health services involve general hospitals or prefecture hospitals, university hospitals, and large private hospitals, which provide more specialized treatment.

　　The medical insurance system includes public insurance, labor insurance, and private insurance. In 2001, the health insurance reform which aimed at universal coverage was promoted. In 2012, the citizen coverage rate reached 99.9%. Public health strategies and mental health are the first priority of community health promotion, i.e., working together with resources other than medical institutions, the family members and communities, for example, may use the original religious, workplace, or educational service delivery system to promote mindfulness relaxation services, and focus on early screening, treatment and tracking for effective health management. The government strives to spread disease knowledge to communities and families, it enables early detection of health problems and early treatment, and is not only caring for the patient but also paying attention to the psychological state of the patient’s family members.

II. Mental health policy and system

　　Thailand’s development of mental health has a history of more than 100 years, the Department of Mental Health under MoPH provides advice for the government with mental health policies and legislation, establish standards of care, and develop and transfer mental health technologies to all stakeholders.

　　Thailand enacted the Mental Health Act BE 2551 in 2008, the purpose is to formulate a mental health law, establish a national mental health committee, stipulate the rights of patients, and provide treatment and rehabilitation environment for the patients.

　　In 1978, Thailand added mental health to primary medical care in the policy of Health For All By The Year 2000, which shifted the focus of mental health to the community. In 2013, the MoPH reformed the mental health system, trying to integrate into the public health system at all levels. Through the use of 13 mental health centers distributed across Thailand, it is to enhance the role of primary care in mental health treatment, and hope to develop excellent psychiatric hospitals.

　　The overall mental care model, the medical system at all levels, and the local public health care system construct a network system with distinct levels and mutual cooperation, through the top-down community-oriented national health care system model, and the creation of a bottom-up community interpersonal network, it undertakes 4 major tasks

(1). Promote people's mental health；

(2). Strengthen the mental health network；

(3). Improve the quality and accessibility of the mental health care system；

(4). Establish a mental health development mechanism.

　　Through continuous development, it has achieved great performance in the prevention, diagnosis, treatment and rehabilitation for the mental illnesses in Thailand.

In the period of 2014-2015, there are five important policies to promote the effectiveness of mental health care in Thailand, which include:

(1).Improve early treatment for the children from birth to five years old. The targets include children with developmental delays and neurodevelopmental problems.

(2). Reduce alcohol and drug abuse, especially for the young with new cases.

(3). Increase and improve the social and psychological services provided by primary medical care at all levels to high-risk groups, for example, survivors of violence, patients with chronic diseases, HIV/AIDS patients, patients with alcohol and drug abuse, stress and depression.

(4).Promote the regular acceptance of mental health services for patients with mental illness, especially depression and mental illness.

(5). Provide mental health training for primary medical staff to reduce the barriers to mental health services.

The ASEAN report mentioned that Thailand’s medical and health expenditure in 2014 accounted for about 4.1% of its GDP, and mental health constituted 2.4% of the total health and medical budget. 74% of the mental health budget was spent on 12 specialist hospitals and 6 institutions, while 3% was for the mental health promotion and education.

　　As of 2019, there were 927 government hospitals, 363 private hospitals, 9,768 government medical centers, and 25,615 private clinics that provide the services for all the Thai people.

　　The Department of Mental Health of Thailand has invested a large amount of funds from the government to establish a complete set of institutions for the prevention and treatment of mental illness and rehabilitation, administers 840 mental health clinics, 18 tertiary psychiatric hospitals (including 3 specialty hospitals for children and adolescents) and 12 regional mental health centers to coordinate the national mental health medical network .It also has a leading position in guiding the country to prevent natural and man-made disasters. the directly affiliated units within the Department include the Bureau of Mental Health Technical Development, the Bureau of Social Mental Health, the Personnel unit, the Planning Office and the International Cooperation Office, and the National Top Planning Office.

Health care in Thailand can be divided into four levels:

(1).Self-Care: Through family-level care, it focuses on strengthening the ability of self-care and health decision-making.

(2).Primary Care: The community hospitals, health centers and general practitioners provide services which include mental health promotion, prevention, treatment and home visits, it mainly focus on the corresponding services for patients with mental problems.

(3).Secondary Care: Services provided by general hospitals and regional hospitals, which include outpatient and emergency, consultation, crisis management and hospitalization.

(4).Tertiary Care: The psychiatric specialist hospitals, large general hospitals,  large private hospitals, and research institutions will perform and provide medical and public health services. In addition to providing mental health promotion, prevention, treatment and rehabilitation, it also offers training and continuing education services for mental health-related professionals and more specific medical services.

　　The above-mentioned closely integrated mental health medical network has formed a mental health prevention networking throughout the country, so that patients can receive good support and care in the community for efficient medical treatment and health promotion.

III. Human Resources

　　Thailand's overall medical manpower is short and unevenly distributed, whether it is a general hospital or primary medical care, especially dentists, radiologists and medical technicians. According to the report of mental health in ASEAN countries published in 2016, in Thailand in 2013, there were 704 psychiatrists and 3,588 psychiatric nurses working full-time in hospitals; about 1,000 primary medical doctors and 7,000 nurses have received mental health training. 70% of psychiatrists work in government general hospitals, while the rest  30% work in psychiatric specialist hospitals, 46% and 54% of trained psychiatric nurses are in those two units, respectively. Psychiatrists and nurses working in private hospitals are few. There are more than 400 psychologists and social workers each, and the number of occupational therapists is the least and less than 100. If converted the ratio of the above figures to the total population, the number of psychiatrists, nurses, psychologists and social workers per 100,000 is 1.1, 5.6, 0.7, and 0.7, respectively. As for the GPs and nurses who have received training in primary mental health care, the same calculation indicate 1.5 and 11.1 separately.  WHO's Statistics for the psychiatric manpower in 2011, it estimated the number of requirements for psychiatrists and nurses, basing on prevalence and facilities, to be  1.46 and 14.85 per 100,000 people. Compared with other countries, Thailand’s current medical manpower is not enough, however, it is closer to the WHO recommendation.

　　The Thai medical education is a six-year system, consisting of 1 year in basic-science, 2 years in pre-clinical training, and 3 years for clinical training. Upon graduation, all medical students must pass national medical licensing examinations and an university-based comprehensive test. After that, newly graduated doctors are under contract to spend a year of internship and 2 years of tenure in rural areas before they are eligible for the resident positions or specialized training, where mostly are in locations outside Bangkok. Students will then receive the Doctor of Medicine (MD) degree at the end of the process. This degree is equivalent to a master's degree in Thailand.

　　There are standardized courses of training for General Practitioners' psychiatric residency, psychiatric nurses and pharmacists. Thailand's Department of Mental Health provides funding to train 20 psychiatrists each year, standardized courses are reviewed and supervised by the medical monitoring unit. Psychiatric nurses need 4 months of training, and pharmacists also have psychopharmaceutical training courses provided by specialist hospitals and superior Department of Mental Health . In addition, it was hoped that the primary medical staff could be more capable of diagnosis, treatment and promotion of mental health, there were about one-third of primary medical staff received at least two days of mental illness care training in 2013-2014.

IV. Mental health system and promotion

　　Primary medical units will have village volunteers who have received basic screening and care skills training to track cases in the community, and refer them to specialist hospitals if necessary. At the same time, it plays a supporting role in the medication behavior of patients and their families, and encourages them to take medication regularly. Community mental health emphasizes mental health promotion and prevention, and these volunteers are responsible for encouraging people to participate in activities.

　　At the community hospital level, the trained professional nurses also assist physicians in treating inpatient or outpatient persons. Mental health staff at the community hospital level are trained to diagnose at least 8 types of diseases, including severe mental illness, psychosis, common mental illness, substance use disorders, anxiety, depression, mental retardation, and suicide risk. Volunteers and medical staff provide care and social support for patients and their families, while pharmacists provide information with correct medications.

　　At the general hospital level, the role of nurses is the same as that of community hospitals, but there will be teams with various professions to provide mental health and psychiatric services. The responsibility of the psychiatrist at this stage is to provide effective and continuous care for the patients in the hospitals.

　　Rajanagarindra Institute of Child Development (RICD) established in 1994, it is a hospital that specializes in providing medical services to children suffering from developmental delay and mental health problems, such as autism, hyperactivity, cerebral palsy, learning disabilities, intellectual development disabilities, etc. RICD also promotes and supports academic and technical research and development of relevant institutions to improve child development and mental health.

　　Although it has no clear mental health promotion policy, there are still activities for health development in government units, and it is included in job descriptions of the Bureau of Social Mental Health, whose mission is to develop mental health in people and society, and to spread its knowledge. At the same time, the government uses various Community Mental Health as technical centers to support community mental health actions in the local districts across the country. Furthermore, in the Thai rural area, there have developed a Sati App to bridge the gap between the people who have a psychological need to talk to some persons and those who are willing to assist that people in need. It aims to ensure that everyone has an easy access to a mental health care plan as a driving force for social support. During the period of November 1 to 7, 2019, MoPH launched the Anti-Depression Campaign to commemorate National Mental Health Week.

V. Major issues, challenge, and opportunities

　　Thai society has been impacted by participating in international organizations such as the Association of Southeast Asian Nations (ASEAN) and other international movements, the diversified societies and cultural differences bring about mental health problems and require a variety of specific services for the needs of different ethnic groups. In addition, no manpower standards have been set for acute treatment, and meanwhile, the rehabilitation services, limited resources and social stigma in rural areas restrict the access to services for children and young adolescents with mental health problems. The above-mentioned challenges are required to improve primary medical resources and services for the response.

　　According to a 2012 study by the Department of Mental Health, the most common diseases in Thailand are mental illness, anxiety, depression and stroke. Studies have also found that approximately 20% of the Thai population suffer from some type of mental illness, and this number is predicted to increase every year.

　　Moreover, a 2013 study on the burden of disease in Thailand showed that depression is the third most common cause of DALY (Disability-Adjusted Life Year) loss for Thai women, second only to cardiovascular disease and diabetes. Among men, it is also one of the top 12 diseases. Stigmatization, surrounding mental illness (including depression), is still the main obstacle to get the assistance from family, friends and professionals.

VI. Potential exchange issues

　　In 2014, it is an important policy to promote the effectiveness of mental health care in Thailand, which can be used as a topic for future exchanges, including early childhood care, alcohol and drug abuse, psychosocial services for primary medical care, regular mental health services for patients with mental illness, mental health training for primary medical staff, etc. Early healing have been developed considerably in Thailand for a long time. After communications and contacts, the construction of teaching resources related to children's mental health and the physical and mental health care of high-risk newborns are the main topics that can be further cooperated in the future.