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CSOs left to plug mental healthcare gap for former political prisoners

The wounds of nearly five decades of brutal military rule are slowly healing, but many of Burma’s former political prisoners are still waging a fierce war: the quiet struggle to overcome the havoc that years of imprisonment and torture has wrought on their mental health.

Activists, poets, teachers and dissidents released under successive presidential amnesties walked back into a society that, at best, didn’t understand them — and at worst, shunned and turned its back on them. Meeting these persecuted masses at the prison gates was a cripplingly underdeveloped healthcare system, so some of Burma’s former prisoners of conscience got to work.

Ex-political prisoner Bo Kyi founded the Assistance Association for Political Prisoners (AAPP), perhaps the country’s most well-known organisation for imprisoned revolutionaries, on the Thai-Burma border in 2000. From the AAPP’s Rangoon office, Bo Kyi told DVB that most of his peers couldn’t articulate their mental problems. Partnering with an international university, AAPP began training former inmates in Common Elements Treatment Approach counselling, known as CETA in the mental health sector.  

Despite working to support the mental health of his peers for nearly two decades, Bo Kyi said many are still grappling with the same issues.

Especially, what I am seeing is depression and also anxiety, because they always worry, ‘What time will I be arrested again?’ Another thing is, many former political prisoners drink,” he said.

Tales of depression, anxiety and alcohol abuse are common within the ex-political prisoner community. According to Than Than Htay, a senior AAPP counsellor, some patients struggled in silence for years before learning about mental health.

“People were not aware about mental health. During 1990 and 2000, we did not have a chance to do awareness [raising] and counselling. After 2014, many former political prisoners became familiar with the concept of ‘mental health.’ Some of them used to think that mental health is all about being insane and having to go to the mental hospital. They do not know anything about depression or trauma,” Than Than Htay said.

Extensive reporting by an increasingly liberalised news media in recent years has highlighted the miniscule funding assigned to health care under the previous, nominally civilian regime. It’s been more than a decade since the most extensive study on mental health in Burma was conducted by the World Health Organization.

But many hoped the arrival of the National League for Democracy government — itself made up of scores of former political prisoners — would see a greater emphasis placed on caring for the victims of successive despotic military juntas.  

More than a year since the NLD took power, however, mental health workers can barely conceal their disappointment.

“Daw Aung San Suu Kyi doesn’t want to talk about the past. So therefore they do not want to talk about the past. I think we need to train ourselves. We cannot rely on the government,” said Bo Kyi.

“That will be their history. Until now, National League for Democracy party did not recognise the existence of political prisoners; did not try to help the situation. They must do something on this issue.”

Spokespersons at the Ministry of Health and the Ministry of Social Welfare, when asked about a national plan for mental health care, let alone one that focuses on political prisoners, declined to comment.

Not ‘ayuu

Public awareness on mental health is improving, and veterans of the movement like Bo Kyi are quick to point out that more help is available than ever before. But mental health is still undeniably a relatively new — and somewhat awkward — topic in Burma, and most are scared to be labelled “ayuu,” or “crazy.” YMCA Yangon counsellor Su Myat said many of her clients are terrified that if they openly acknowledge mental health woes, they’ll be promptly sent to a mental hospital, which are notoriously under-resourced.

“Sometimes it is difficult to refer to the psychiatrist or even to the mental health hospital. They thought, they say, ‘We are not crazy, we don’t need to go to the hospital,’” said Su Myat.

Senior AAPP Mental Health Assistance Program counsellor Cherry Soe Myint agrees: “When you go to a mental hospital, it can be very, very crazy. Some people are naked, some are locked up with chains. It is very scary. That is the image in the heads of people in the community,” she said.

Already facing a suspicious and wary reception among many members of society, openly admitting their mental struggles has been a challenge too great for many ex-prisoners. And while much of the nation now respects the sacrifices of the iconic ’88 Generation, many from that persecuted cohort report that the acute feelings of shame and isolation followed them years after their release, complicating attempts at re-joining daily family life.

Building a framework

Than Than Htay of the AAPP, who is also an ’88 Generation activist, was imprisoned for more than 11 years for her pro-democracy ideals. Her sister and mother were also shut behind bars for their resistance work, and it was their shared experience that softened the blow when the AAPP senior counsellor returned to her community. Many others did not have that shared experience, she says.

“For me, my family members understand me. The first time I was imprisoned, my sister was imprisoned as well. Next, my mother was. Because they know what it is like to be imprisoned, they [did] understand me. For other families, they do not have such understanding family members. Some family members blame the political prisoners, saying they are the one who put the family into trouble,” she said.

Concerned civil society organisations have undertaken the bulk of caring for the country’s former political prisoners and their mental health. The current NLD-led government, despite having several former inmates among its ranks, has not yet made strides toward bringing Burma’s mental healthcare infrastructure into the 21st century.

Private clinical psychologist Hannah Kyaw Thaung said without a proper national framework and medication guidelines, general practitioners and hospital psychiatrists are dispensing inconsistent support and, alarmingly, medication regimens.

At a client level, “national treatment guidelines can help to provide a care pathway to identify and support individuals and families who live with mental health problems,” she told DVB.

“For mental health workers, guidelines provide clear standards and define models for promoting and treatment mental health to ensure safe and effective treatment.”

Bo Kyi told DVB that AAPP has no contact with the Ministry of Health and Sport, but does communicate with the Ministry of Social Welfare, Relief and Resettlement.

The veteran of the mental healthcare movement in Burma is calling for more than just national treatment guidelines — he wants a reparations policy and financial support for victims of the state-sanctioned abuses of the past. It’s a tough ask for a government that has yet to even decide on an official definition of “political prisoner.”

“Internationally, there is no set definition of ‘political prisoner’ and in Myanmar as well … [it] is a very complicated issue, and globally as well,” President’s Office spokesperson Zaw Htay told DVB.

While the spokesperson is technically correct, a political prisoner or prisoner of conscience is widely accepted to be an individual imprisoned or unjustly punished for their political activities or ideologies.

Supportive networks crucial

Many former inmates found their networks had disintegrated during their incarceration. Feuds along social and ideological lines further fractured support systems following their release. Upon returning to her hometown after two stretches of prison time, former activist Ni Mo Hlaing describes acutely feeling a lack of direction in her life as a free woman.

“If someone who was engaging in political activities applied for a job in any commercialised fields, say applying to be a salesperson, [he or she] would not get the job,” she said, describing those like herself as “shunned.”

“So, I worked as a private tutor for my survival. It is like an unwritten law that a job applicant should not have any party affiliations or engaging in any political activities,” Ni Mo Hlaing said from the Rangoon office of Sisterhood, an organisation she founded to support other former prisoners and exiles.  

She told DVB that even now, she struggles to find adequate employment opportunities and support.

“At this age, I do not know how to earn money. No chance for me to work for NGOs, as I do not have sufficient knowledge. I was ostracised by other political activists because I lack knowledge and proficiency in English. Even in NLD, I could not get a position. … There is still no sufficient support to former political prisoners.”

Critics point out that the government has yet to break ground on the development of a national mental healthcare plan. Calls to six offices in the respective ministries of Health and Social Welfare were either referred on or went unanswered.

There is little indication that the trauma and depression that thousands of the country’s former political prisoners grapple with is on the agenda in Naypyidaw, leaving the grunt work to a network of former inmates, those that care for them and private health care professionals.

“All prisoners should have mental health support — particularly when their conditions have been as dire as they have here,” said Hannah Kyaw Thaung.