Brain-Mind-Behaviour related health problems in the southern part of Thailand

Abstract

Due to the rapid social and economic growths in Thailand, the country overall has reached the Millennium Development Goals (MDGs) before the expected deadline of 2015. However, disparities in the development are found among under-privilege populations as well as population in some parts of southern Thailand despite the fact that the economic status of the population in this area is somewhat better off than some other parts of the country. Major factor undermining the achievement of these MDGs is substantially due to the armed conflict situation, which has occurred in the three southern-most provinces, including Pattani, Yala and Narathiwat provinces and four districts of Songkhla province since 2004. Under this hardship situation, health status, including emotional, behavioural and cognitive conditions has been much worse than the national average, especially among children who are more vulnerable to the socio-economic adversity. In addition, cultural and linguistic diversity of the population in the area plays an important role. As the area is most populated with Thai Muslims, a high number of people speak language other than Thai at home. Many students are multilingual with Thai being their second or third language. Dual educational systems, including Islamic and general studies are predominant. The illiteracy rate in the five southernmost provinces was about 9% in 2012, which was higher than average of Thais. The prevalence rate of any form of developmental delay among children under five years was 37%, also higher than that of the national level and the rates of delay in the domains of language and fine motor were 21% and 12%, respectively. The average Ordinary National Examination Test (O-NET) scores of primary and secondary school students in the five southernmost provinces were lower than the national averages in all subjects in 2011. Direct exposure to armed violence has considerably altered the psychological well-being of people in the area and hindered access to mental health services. The prevalence of emotional and behavioural problems was higher among those living in the areas of high intensity violence compared to those in the low intensity areas. The estimated stress-induced insomnia, attempted suicide and post-traumatic stress disorders (PTSD) rates among children and adults were notably high. In addition, prevalence of illicit substance use among youths and adults in the southern region was highest, compared to other parts of the country, with krathom (mitragynine speciosa, a plant-based narcotic) and krathom cocktail (4x100) being the most popularly used substances. In conclusion, people, especially children in southernmost provinces are facing many challenges rooted by complex sociocultural and political situations. High quality education and other social services are inadequate and not culturally or religiously congruent. Inequitable access of health services, educational, developmental and social services has been observed. Monitoring systems, including the analysis of routine data collection of the service stations and field surveys are limited due to information technology and security problems, available data thus do not reflect the community situation. Research and development programmes are needed in three aspects: 1) to improve the accuracy of monitoring and surveillance systems; 2) to increase the availability, accessibility and quality of mental health services and 3) to develop interventions and evaluate the effectiveness of interventions with concerns for the cultural and conditional congruency.