A Silent Emergency: Understanding Mental Health in Southeast Asia

Mental health conditions are among the leading contributors to disability worldwide, with depression, schizophrenia, and anxiety driving substantial losses in healthy life years (World Health Organization, 2024). In Southeast Asia, where an estimated one in seven people, approximately 260 million individuals, live with mental health conditions (WHO, 2024; Alibudbud, 2024; CoE-EDP & VisionRI, 2024) and nearly 90% receive no formal care (Yang, 2023). Vulnerable populations, including children, adolescents, migrants, and disaster-affected communities, bear a disproportionate share of this burden. Despite this, mental health has historically received limited and inconsistent policy attention and investment compared to other pressing health threats (Fukunaga et al., 2023). 

The World Health Organization (WHO) defines mental health as “a state of mental well-being that supports a person in managing stressors within their life and facilitates their ability to participate in their community” (WHO, 2022, p. 8). Mental health conditions span a wide spectrum of disorders such as depression, anxiety, schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), and stress-related conditions, characterized by disturbances in thoughts, emotions, behaviors, and relationships (WHO, 2007). Across the WHO South-East Asia Region, mental health conditions are the leading contributors to disability, with depression accounting for the greatest loss of health and well-being, while schizophrenia remains the single most disabling condition (WHO, 2024). 

The consequences of poor mental health are profound. Suicide is responsible for one in every 100 deaths globally, and individuals with severe mental disorders die 10 to 20 years earlier than the general population (WHO, 2024). Mental health inequities are further exacerbated by structural barriers, with disadvantaged groups experiencing greater risks and poorer outcomes. 

Yet, access to mental health services remains limited and unevenly distributed across Southeast Asia. Services are often concentrated in urban centers, while rural areas remain underserved. Early detection and intervention are delayed by persistent stigma, cultural barriers, and fragmented health systems. 

As a result, mental health has emerged as an urgent public health and development concern in Southeast Asia. The growing burden of mental disorders, combined with persistent service gaps and uneven access to care, underscores the need to strengthen mental health systems across the region. 

Against this backdrop, several key challenges shape the mental health landscape in Southeast Asia. These challenges highlight where attention, evidence, and coordinated action are most urgently needed. 

High Burden of Mental Disorders: Mental health conditions are a leading cause of disability and premature mortality in Southeast Asia, with depression, anxiety, and severe mental illnesses disproportionately affecting vulnerable populations. 

Based on the 2023 annual report of WHO on Mental health conditions in the WHO South-East Asia Region, mental disorders are consistently identified as among the leading causes of disability (WHO, 2023). The report also highlights that depression accounts for the greatest loss of healthy life years, while schizophrenia remains the most disabling condition (WHO, 2023). Suicide further intensifies the public health burden, causing one in every 100 deaths globally (WHO, 2023). Individuals with severe mental disorders also face significantly reduced life expectancy, dying 10 to 20 years earlier than the general population (WHO, 2024). 

Beyond health outcomes, mental disorders carry substantial social and economic consequences. They limit workforce participation, reduce productivity, and hinder social engagement, placing a strain on families and communities, particularly in low- and middle-income countries (LMIC) (WHO, 2017). These broader impacts underscore the interconnected nature of mental health and social well-being in the region. 

Systemic factors further compound the burden. Most countries in Southeast Asia are classified as low-income by World Bank criteria and face significant challenges in mental health care, including limited resources, workforce shortages, and underdeveloped health systems (Maramis et al., 2011). These constraints make it difficult to provide timely and effective mental health interventions across populations. 

The burden is also unevenly distributed across nations. For instance, the estimated prevalence of depression in Cambodia is five times higher than the global average (Schunert et al., 2012). More broadly, regional estimates suggest that depressive and anxiety disorders affect roughly 27% and 23% of the population, respectively (WHO, 2007). 

Many countries in Southeast Asia face substantial mental health gaps, including incomplete data and insufficient research (information gap), limited treatment coverage and inconsistent service quality (services gap), and shortages of trained personnel alongside digital inequities (resources gap). These gaps are particularly pronounced in LMIC, where research capacity is underdeveloped, and evidence-based information remains scarce (Lavis, 2009). 

Addressing these gaps highlights the urgent need for context-specific interventions, strengthened mental health systems, and targeted strategies to address the persistent burden of mental disorders across Southeast Asia. By doing so, policymakers, local governments, and Non-Government Organizations (NGOs) can develop more effective, evidence-informed mental health policies and practices, improving service delivery, targeting interventions to vulnerable populations, and ultimately enhancing mental health outcomes across the region (Tomlinson et al., 2009). 

To help bridge these gaps, there is a need for improved evidence of generation, strengthened research capacity, and expanded early intervention services. This includes training health professionals, improving access to evidence-based psychological and social interventions, and integrating mental health services into primary healthcare (WHO, 2007). 

Limited Access to Mental Health Services: Large gaps in mental health service provision and workforce capacity leave millions across Southeast Asia without adequate care, resulting in widespread unmet needs and poor health outcomes. 

Mental health disorders in Southeast Asia are compounded by significant gaps in service provision, particularly in low- and middle-income nations, where chronic shortages of mental health services and human resources persist (Maddock et al., 2021). With roughly one in seven people in the region living with a mental health condition, some countries experience a treatment gap, the percentage of individuals who require care but do not receive it, of up to 90% (WHO, 2023). 

Systemic challenges further limit access. National mental health policies exist across most countries in the region, but their effective implementation has proven difficult due to insufficient allocation of government health budgets (Sharan et al., 2017). 

On average, less than 2% of total health expenditures are dedicated to mental health, ranging from 0.06% in India to 4% in Thailand (Maramis et al., 2011; Pelzang, 2012). Moreover, 80–90% of these limited resources are directed to hospital-based services, which are typically concentrated in urban areas and remain inaccessible or unaffordable for rural populations (Olofsson et al., 2018; Maramis et al., 2011). 

The limited funding has resulted in chronic shortages of trained mental health professionals and essential services. The median number of mental health professionals in the region is 5.3 per 100,000 population, approximately half the global median (WHO, 2007), and many countries have less than one psychiatrist per 100,000 population (Parry et al., 2020). Similarly, the availability of psychiatric beds is critically low, at 0.23 per 100,000 population, well below the global median of 3.2 (Parry et al., 2020). These gaps severely constrain the ability of health systems to provide timely and effective care, particularly in underserved and rural communities. 

A range of factors contributes to these limitations, including low prioritization of mental health needs, inadequate recognition of mental illnesses within communities, absence of targeted, need-based policy assessments, limited undergraduate training in mental health, and patchy information systems (Sharan et al., 2017). With most countries directing resources primarily to hospital-based care, locally accessible and affordable services remain scarce, further exacerbating the social and economic burden of mental health disorders (Maramis et al., 2011). 

The consequences are evident in country-specific data. For example, in Indonesia, approximately 20% of the population experiences mental disorders, with depression rates notably high among adolescents and young adults, yet only a small proportion receive appropriate treatment (Basrowi et al., 2024). Across the region, rates of mental health disorders are often under-reported due to limited data collection and monitoring, masking the true scale of the treatment gap (WHO, 2016). 

In low- and middle-income nations of Southeast Asia, mental health resources are limited, and counseling services are often not systematically established (Hunter et al., 2015). Limited access remains a persistent barrier, yet innovations such as digital technologies have the potential to expand service delivery, improve treatment uptake, and enhance self-help options. 

Achieving these goals requires addressing the shortage of trained mental health professionals and insufficient funding allocations, alongside the development of innovative, scalable solutions for complex and long-term mental health needs (Maramis et al., 2011). However, even where services exist, mental health conditions are highly stigmatized, and literacy around mental health remains low across communities, further limiting the effectiveness of available care (Hunter et al., 2015). 

In this context, community-based mental health services offer an important opportunity forward. Immersed in local settings, these services can improve accessibility, acceptability, affordability, and scalability, while also fostering treatment adherence and supporting positive clinical outcomes (Kohrt et al., 2018). 

Recognizing these systemic challenges, strengthening health systems, expanding workforce capacity, increasing funding allocation, and scaling community-based mental health services have become critical priorities across the region. These efforts aim to enhance equitable access, reduce the persistent burden of mental disorders, and build resilient mental health systems across Southeast Asia. 

Psychosocial Impact of Public Health Emergencies: Public health emergencies, including pandemics, natural disasters, and humanitarian crises, have profound and lasting effects on mental health across Southeast Asia. 

The global pandemic that began in early 2020 caused widespread disruption across societies (Holmes et al., 2020). Self-isolation, implemented to control the spread of the virus, had significant psychological impacts and disrupted normal social functioning (Auerbach & Miller, 2020; Jowarder, 2023). During this period, millions of deaths occurred, and suicide rates increased, further worsening the global mental health burden (Rogers et al., 2020). 

Beyond the psychological impact, social isolation also carries serious physical health consequences, illustrating the multifaceted burden of public health emergencies. Social isolation has significant physical health consequences, whereas it is also linked to increased risks of mortality and chronic disease (WHO, 2025). Specifically, it is associated with a 32% higher risk of premature death, a level comparable to smoking or obesity, contributes to 5% of global dementia cases, increases the risk of cardiovascular disease by 29%, and raises the likelihood of stroke by 32% (WHO, 2025). 

Research examining the relationship between climate change and mental health is an emerging and rapidly expanding field (WHO, 2023), whereas, as with most disasters and emergencies, the adverse mental health impacts disproportionately affect children, young people, the elderly, women, and low-income populations (WHO, 2023). Climate change and along with resulting floods, famines, loss of homes and livelihoods, disasters and humanitarian emergencies, and economic downturns, has been observed across the South-East Asia Region. 

The COVID-19 pandemic highlighted pre-existing vulnerabilities, heightened by years of limited attention to mental health. It also emphasized the essential role of mental health in supporting overall well-being. During the first year of the pandemic, depressive and anxiety disorders increased globally by an estimated 25% (WHO, 2022), while the long-term mental health consequences of the pandemic’s economic impact remain uncertain (WHO, 2022). 

Although psychological distress is a common response to emergencies and often diminishes over time, such events also disrupt mental health services, reducing access to quality care (WHO, 2025). 

Recognizing these challenges, international frameworks have increasingly emphasized the importance of structured mental health and psychosocial support in emergencies. Armed conflicts, natural disasters, and pandemics disrupt lives in diverse ways, with significant impacts on mental health and psychosocial well-being (Inter-Agency Standing Committee, 2007). Over the past three decades, mental health and psychosocial support (MHPSS) interventions have gained recognition as essential components of crisis response (IASC, 2007). 

Psychological distress is common in emergencies, manifesting as anxiety, sadness, hopelessness, sleep disturbances, fatigue, irritability, and physical complaints (WHO, 2025). While many individuals recover over time, evidence indicates that more than one in five may develop mental health conditions such as depression, post-traumatic stress disorder, schizophrenia, or bipolar disorder, and one in 11 may experience disorders severe enough to impair daily functioning during crises (Charlson et al., 2019; WHO, 2023). 

In post-disaster contexts, health impacts are both direct, including injuries and illnesses, and indirect, through short- and long-term mental health conditions (Alibudbud, 2021). Addressing these gaps requires integrated, resilient approaches that combine service delivery, community support, and system strengthening to mitigate the long-term psychosocial consequences of crises.

Strengthening MHPSS systems, expanding community-based services, and maintaining continuity of care for vulnerable groups are vital to building resilience during public health emergencies. Such integrated approaches play a key role in reducing long-term psychosocial impacts, improving preparedness, and embedding mental health within emergency response efforts across Southeast Asia. 

Stigma and Social Determinants: Mental health in Southeast Asia is shaped by a complex interplay of social, cultural, and structural determinants, with stigma, inequities, and systemic barriers limiting access to care and contributing to persistent disparities in mental health outcomes. 

Mental health challenges in the region are influenced by rapid urbanization, rising income inequality, shifting cultural norms, and entrenched stigma, which discourage individuals from seeking care even when services are available (Hunter et al., 2015). These social and structural factors not only affect the onset and severity of mental health conditions but also shape patterns of help-seeking and treatment access across populations. 

Behavioral risk factors such as tobacco use, alcohol consumption, unhealthy diets, and physical inactivity are closely linked to mental health conditions (World Health Organization, 2024). Beyond these, most determinants of mental health lie outside the health sector, including poverty, limited education, discrimination, social exclusion, and emerging challenges such as climate change, migration, and economic downturns (World Health Organization, 2024). 

A study in Asia-Pacific Psychiatry (Andary et al., 2023) highlighted multiple barriers to accessing mental health services in the region, including societal stigma, low health literacy, internalized reluctance, cultural beliefs, inadequate training of health professionals, poor service quality, and uneven distribution of resources. Collectively, these factors limit equitable access to care, particularly in under-resourced communities. 

At the policy level, national mental health legislation exists but remains in its early stages across Southeast Asia. Public stigma and limited awareness further hinder the effective implementation of these policies and the integration of services into broader health systems (Dessauvagie et al., 2021). Addressing these social and structural determinants is therefore critical for improving mental health outcomes and expanding access to care across the region. 

Although good mental health is increasingly recognized as a prerequisite for individual well-being and sustainable national development and has been integrated into the Sustainable Development Goals (SDGs) (United Nations Department of Economic and Social Affairs, n.d.), it continues to receive limited priority in Southeast Asia. Awareness remains low, and widespread prejudice and public stigma discourage help-seeking while reinforcing exclusion (Anwar & Thamarangsi, 2017). 

Reducing stigma and discrimination against people with mental health conditions and their families is essential to expanding access to care. While some Southeast Asian countries have enacted mental health legislation to protect the rights of affected individuals (Sharan et al., 2017), resource shortages and persistent stigma remain pervasive barriers, particularly in rural areas and among minority groups (Andary et al., 2023). 

Addressing these challenges requires a multifaceted approach that combines strengthened legislation, dedicated funding, public education, and community-based services. In some contexts, NGOs and redesigned care models, such as home care and day hospital services, already provide vital screening, assessment, and treatment options (Ito et al., 2012). Ensuring equitable uptake of mental health services also depends on tackling both barriers to care and promoting enablers that encourage treatment-seeking (Centers for Disease Control and Prevention, 2025; WHO, 2024). 

Advancing equity, inclusion, and stigma reduction is essential for improving mental health outcomes across Southeast Asia. Rights-based approaches, supportive policy reforms, and expanded community-led services play a crucial role in closing treatment gaps, protecting vulnerable groups, and ensuring that this silent emergency is brought to the forefront with the strongest and most urgent response.  

 

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