Down and out in Vietnam
Depression, suicide and alcoholism are all on the rise as urbanization, job competition and failed expectations take a collective toll on the nation's mental health
In Hanoi’s Fury Room, US$8 gets you a baseball bat and ten minutes alone in a room filled with porcelain mugs and disused microwaves. Clad in protective garb, typically young men, mostly professionals, unwind in the evenings by smashing as much as they can.
The Fury Room’s founder thinks Vietnam’s only “stress-relief” venue, as promotional material describes it, offers an important service for those weighed down by the pressures of modern life. Indeed, it may be an invaluable service, especially in a country where depression and mental illness are thought to be on the rise.
A study this year by the Institute of Mental Health at Hanoi’s Bach Mai Hospital found that almost 100 people commit suicide each day because of depression in Vietnam. If extrapolated nationwide, the statistics would mean that depression accounts for 35,600 known deaths each year.
There are now thought to be 13.5 million Vietnamese today suffering from a diagnosable mental illness, the Ministry of Labor, Invalids and Social Affairs (MOLISA) reported in December last year. This equates to roughly 15% of the entire population.
This year, the Ministry of Health claimed 3.6 million people suffered from depression, or about 4% of the population. Some experts believe that figure is underestimated.
The Fury Room offers one outlet, but prices make it exclusive to professionals, mainly those from the “9X”, or the generation born during the 1990s. Traditionally, and for greater numbers of people, stress relief is found through alcohol.
The Vietnamese are thought to be Southeast Asia’s biggest drinkers. Last year they consumed 3.4 billion liters of beer and 342 million liters of spirits, a 40% increase from 2010, according to a local study. Another study found that liver cancer kills roughly 10% of men between the ages of 50 and 69 each year, a third higher than the global average.
Anecdotally, the Vietnamese point to several factors behind the growth in depression: urbanization, increasing job competition and changing living habits related to modernization. Economic modernization, including the growth of low-paid urban-based manufacturing jobs, is likely another contributing factor, as is the increasing difficulty of accessing public services.
The average age of patients suffering from mental illness is thought to be getting younger. More than 1,000 high school students were interviewed for a study published in the BMC Public Health journal. Almost a quarter said they had considered suicide and 13% had made plans for taking their own lives. Four percent said they had attempted to do so.
There are likely many contributing factors to the suicidal tendencies. Before 2015, high school students would take a six-subject exam for graduation and then the following month sit another exam similar to the America SATs to determine their university placement.
But, in 2015, a new single standardized exam was introduced that determines both graduation and college entrance. Now with just one exam students’ futures becomes zero sum: pass or fail.
Phoung, a university graduate living in Hanoi, knows several fellow graduates who are likely suffering from depression. For some, she thinks, it is because of the stress of entering demanding jobs; for others it’s because employment is becoming harder to come by.
This year an estimated 200,000 university graduates will not find domestic jobs that match their degrees, according to local media reports.
But Phoung also thinks it is becoming easier, especially among young people, to openly discuss mental health issues.
Reports of the mentally ill being locked in cages by overwhelmed parents or purposefully ostracized from society by relatives were commonly reported by the region’s media in previous years.
The government has been proactive in some instances. The National Community Mental Health Care program was put in place in 2001 to expand mental health resources at primary health centers and is now present in most of Vietnam’s communes.
Health resources for depression sufferers, however, are still nascent. In 2011, it was reported that there was just one trained mental health practitioner for every 100,000 people in the country. Experts say the figure isn’t much higher today, despite greater awareness of the problem.
The government has been forthcoming about its shortcomings. MOLISA estimates that only 30% (maybe even as few as 20%) of patients suffering from a mental illness receive any treatment.
If they do, it is mostly with pharmaceutical drugs, not therapy. But such drugs are not free for all Vietnamese people and for those without insurance they can be costly, as much as half of an average worker’s daily wage.
The state of national finances means things are unlikely to improve. Vietnam’s health insurance funds are running low, sources say, while the cost of healthcare continues to spiral.
Local media reports say that this year the national health insurance fund will collect US$3.5 billion in revenue but is expected to pay out US$3.7 billion in claims.
The health ministry partly blames this on unnecessary tests and treatment, perhaps an indication that accessing healthcare will become even more challenging in the coming years.
Years ago, experts began talking about a possible pension crisis hitting as soon as 2021, when the country’s social security fund is likely to go into deficit. By 2034, the fund could be completely depleted, they contend.
And as Vietnam’s healthcare system becomes less financially secure and austerity measures scale back of services, resources for mental health treatment will likely be the first to suffer.