After nearly 75 years of sustained conflict, Myanmar’s population has suffered devastating and compounding intergenerational trauma. But rather than address that collective trauma, successive military governments have terrorized the country while also disinvesting from systems of mental health and psychosocial support (MHPSS).

Protestors hold a candlelight vigil for the victims who died in recent government crackdowns while demonstrating against the military coup, at the U.S. embassy in Yangon, Myanmar. February 21, 2021. (The New York Times)
Protestors hold a candlelight vigil for the victims who died in recent government crackdowns while demonstrating against the military coup, at the U.S. embassy in Yangon, Myanmar. February 21, 2021. (The New York Times)

The current military regime — which came to power in a 2021 coup — has escalated this trend. Not only has the junta aimed to brutalize anyone who opposes its rule, it has also further siphoned resources away from health care, including mental health care, and into oppression and violence. As a result, mental health assistance is almost entirely absent and highly stigmatized, creating an unprecedented mental health crisis in Myanmar that is plaguing communities and undermining efforts to build peace.

Addressing this crisis cannot wait until the end of the conflict, and any progress made on MHPSS issues now will undoubtedly benefit any potential future reconciliation work or negotiation efforts. Local and international stakeholders should integrate MHPSS into their support for Myanmar by working with existing community networks, especially those involving religious actors. The National Unity Government, ethnic organizations and other resistance governance actors involved in national dialogue processes can focus on both immediate humanitarian assistance needs, including mental health, as well as center MHPSS in their discussions on post-conflict transition and reconstruction.

Sustained Underinvestment in MHPSS

The mental health and psychosocial well-being of Myanmar’s population have never been prioritized in national development. In 2019, the World Health Organization found that just 1.4 percent of health care spending in Myanmar was allocated to mental health. This amounted to less than $0.05 spent per person and funded just 117 psychiatrists nationwide and 49 social workers.

This miniscule investment has likely only declined since the military took power through a coup in 2021 — and the junta’s brutal war against the population has significantly increased the need for such assistance. In 2023, as the junta increased military spending from $1.8B to $2.7B, it reduced public health expenditure from $633M in 2020 to $400M in 2023. If mental health spending decreased at the same rate, it would mean that neighboring Thailand’s per-person expenditure on mental health is now 28 times that of Myanmar.

Although the core problem lies with the junta’s war against its people and its disinvestment in an already under-resourced health care system, the issue is exacerbated by social stigma. Recent research by USIP as part of a program to support MHPSS for displaced communities reveals that social stigmas, which are often connected to religious teaching or spiritual practice, serve as powerful disincentives for individuals to seek care or for authorities to invest in MHPSS.

An Unprecedented Crisis

Since the coup, more than two million people have been internally displaced; 76,923 homes have been burned or destroyed; and at least 8,640 civilians have been killed. This is on top of the military’s history of violence and extensive human rights violations, as shown by the genocide of the Rohingya, which created the world’s largest refugee camp in Bangladesh that houses more than one million people. The crowded and difficult living conditions faced by these refugees and internally displaced people (IDP) — whether they live in camps, religious buildings or relatives' homes — can further compromise their mental health.

In the absence of basic MHPSS infrastructure or expertise, individual- and society-level mental health challenges go unaddressed. A recent survey found that mental health challenges are pervasive, with 25 percent of respondents describing “severe” or “moderately severe” depression symptoms and the average respondent showing “moderate depression.”

Another study showed extraordinarily high rates of both probable depression (61.39 percent) and probable anxiety (58.02 percent) among adults in Myanmar. These findings are further validated through programs supporting conflict-affected communities, which regularly identify mental health assistance as a primary area of need. Children are particularly vulnerable, especially because at least 30 percent are currently out of school.

The country’s civil disobedience movement, in which large numbers of doctors and civil servants refused to work under the military junta, along with the military’s efforts to withhold assistance to communities affected by conflict and natural disasters, have depleted already-scarce health care resources, leading many to rely on informal actors to meet their health needs, including mental health.

What Can be Done?

The people of Myanmar need policies and an action plan that addresses the most prevalent mental health problems and prioritizes access to care, while addressing discrimination and stigma.

Establishing a roadmap for MHPSS in Myanmar: On June 26, the U.N. General Assembly passed its first resolution on mental health and psychosocial support. The resolution urged member states to promote and improve mental health systems by integrating a human-rights perspective.

This can be a roadmap for Myanmar. Of course, the military junta is not a viable partner on MHPSS given that its primary survival strategy is to inflict suffering and mass displacement of the public — particularly as it now faces the most significant existential threat in its history.

The U.N. resolution could guide the National Unity Government, ethnic resistance organizations and local service providers as they aim to address this urgent crisis in mental health. These stakeholders could work with mental health providers and equip a cadre of community aid workers and religious actors with basic psychological first aid to address trauma caused by prolonged armed conflict and violence.

Integrating MHPSS with cultural and religious context: The U.N. resolution recognized the important role of evidence-based and culturally appropriate MHPSS. During this conflict and in a post-conflict reconstruction period, assistance must acknowledge the individual and collective impact of both sustained insecurity and acute trauma. This includes not only acknowledging where and how harm has been experienced, but also the way that harm is culturally and spiritually understood.

By integrating cultural and religious perspectives and practices, policymakers can improve the effectiveness and accessibility of MHPSS services. These considerations should be included in direct assistance as well as research and policymaking — as failing to do so can seriously hamper the effectiveness and quality of the MHPSS services provided.

MHPSS services, particularly those implemented by providers that come from outside of the cultural context, should be guided by an assessment of religious and cultural dynamics. However, it should be noted that these assessments could vary depending on the context and population in which they are implemented and therefore should be carefully contextualized through partnership with local stakeholders.

In Myanmar, these assessments could include research on explanatory models of distress and traditional healing methods. This assessment should also aim to understand the relationship between spirituality, religion and mental health — specifically, the relationship between religious belief and help-seeking behavior, the relationship between religious discrimination and mental health, and changes in religious perspectives of mental health over time.

Religion and community-based psychosocial support: Similar to the previous section, the creation of MHPSS initiatives that not only effectively incorporate religion, spirituality and cultural norms and practices but are also led by trusted religious actors are high-leverage opportunities to reach communities. Religious actors in Myanmar can provide support in places inaccessible to the international community.

For example, in the Rohingya refugee camps in Bangladesh, research found that self-help groups — such as community centers and child- and women-friendly spaces led by religious actors — enabled psychosocial support and strengthened coordination among service providers, whereas psychosocial interventions that are not spiritually grounded commonly encounter resistance from refugee populations.  

Similarly, an evaluation of a community-based MHPSS program in IDP camps in Kachin and Shan States found that using camp-based focal points, typically religious actors, helped psychosocial support programs reach a large number of people. It also highlighted how community members with linguistic and cultural links to the IDP population facilitated program roll-out with low levels of training and supervision. Religious actors serve an important role because of their moral authority, access to religious infrastructure and ability to leverage religious ritual to enhance the impact of community-based psychosocial support.

Reducing stigma: In many communities throughout Myanmar, mental health services remain stigmatized, perceived to be at odds with the culture and unlikely to help. Incorporating psychosocial support programs that focus on socioemotional and positive coping skills with extant education initiatives can help reduce stigma and foster resilience. Pro-democracy policymakers and service providers in Myanmar can support partnerships between caregivers, teachers, and religious and traditional leaders, which can open pathways to care for individuals who have experienced violence, displacement or traumatic events. Meanwhile, integrating MHPSS with cultural and religious perspectives and leaning on trusted community figures can help signal that accessing mental health services is not at odds with societal norms.

Ensuring MHPSS is prioritized post-conflict: As the pro-democracy movement and donors design immediate humanitarian assistance and post-conflict transition strategies, it’s unfortunately easy to see how MHPSS might fall off the agenda given the immense tasks ahead.

However, in order to realize a vibrant, democratic society, MHPSS and other trauma-related practices need to be prioritized — and that doesn’t have to come at the expense of other post-conflict efforts.

Transition and reconstruction could include a range of initiatives, including culturally sensitive psychoeducational workshops as well as family therapy and systemic therapy, to address the individual and collective impact of sustained violence. Additionally, promising practices that have been impactful in other contexts and could help inform efforts in Myanmar, including avoiding language that singularly links an individual’s identity with their mental health challenge, focusing on community-based interventions, psychoeducation activities within public education, engaging champions who have lived experience of mental health conditions, and fostering collaboration between mental health providers and religious institutions to reduce stigma and mistrust toward the health sector.

Psychoeducation can be highly impactful if implemented with a community-based approach and in collaboration with religious actors. Some of the key topics a community-based psychosocial and psychoeducation program could include are anxiety management, cognitive coping and restructuring, safety assessment and planning, confronting fears and trauma memories, behavioral activation, substance abuse intervention, problem-solving, and caregiver skills.

It’s Not Just About Resolving the Crisis

The most important step to protect the psychosocial well-being of people in Myanmar is to expedite the emergence of a federal, democratic and civilian-led country. But if individuals and communities are left with unaddressed psychological harm and with few forms of support, then the lingering effects of the conflict will continue to manifest in damaging ways.

During this period of conflict and during a post-conflict reconstruction, policymakers and aid providers who serve conflict-affected communities in Myanmar must consider this mental health crisis and associated stigma in their efforts. Extensive research and USIP’s past practice reveal that trauma-sensitive religious actors can be a powerful stakeholder to de-stigmatize MHPSS and provide care.

Moreover, integrating MHPSS into broader peacebuilding efforts can contribute to healing and reconciliation within communities, laying a foundation for sustainable peace. Faith-sensitive MHPSS in policymaking and aid provision is not just about addressing a mental health crisis — it’s about building a more peaceful and resilient society in Myanmar.

Carolina Buendia Sarmiento is a research analyst for the religion and inclusive societies program at USIP.

Yu Yu Htay is a program officer for the Myanmar team at USIP.

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