Thai Public Hospitals And Suicide-attempts

[Goinghomesoon]

Unfortunately a close family member (Thai) tried to kill himself a few days ago and ended up in a government hospital on the outskirts of Bangkok. Today hospital staff told his assembled family that he is not eligible to claim treatment on the 30 baht scheme because it doesn't cover incidents of self-harm. Has anyone else run up against this and where would we go to find out if it is true? It seems a strange policy when he is someone that right now REALLY needs all the medical support he can get.

[Goinghomesoon]

An update - still hoping someone else might pitch in. Latest is the hospital insists no 30 baht coverage and bill is 15,000 baht for 3 days, which the patient - who works in a laundry shop - doesn't have. He is in the orthopedics ward because the hospital has no psych services. The treating doctor refuses to provide a referral for psych services at a different hospital because she doesn't believe he has mental health issues. Um, hello...the patient can't remember his name, is hearing voices and refuses to talk to anyone except his imaginary friends. Oh yeah and he tried to kill himself 48 hours ago. Sigh.

Edited March 17, 2009 by Goinghomesoon

[Sheryl]

Afraid I don't know whether there is in fact any special provision regarding coverage for suicide attempts in the 30 baht scheme. But I do know, for certain, that this hospital is being negligent in not referring him to a psych facility.

There is a complaint hotline run by the National Health Security Office where one can bring complaints about care under the scheme, numbre is 1330 (best to have a Thai family member call). Also see their website:

http://www.nhso.go.th/NHSOFront/SelectView...000000000000044

What level of hospital is he in? If it is not the provincial hospital then I suggets taking him out at once and bringing him to the applicable provincial hospital. If he is already at the provincial hospital matters become more difficult as it may be that a referral would be needed to move up the chain.

If you let me know the province I will see if I can find out the nearest government psych facility.

Lastly, in addition to contacting the NHSO (both to confirm if suicide is covered or not and to complain about failure to refer for pysch care), the family should speak with the hospital social worker regarding the bill problem, all government hospitals have one and they also all have provisions to provide free care to the indigent. Some paperwork would be required but it should be possible to get the fee reduced or waived.

[Sheryl]

P.S. This is the main government pysch hospital in Thailand, could contact them and see if a referral from another hosp is required or not. It's in Bangkok though:

Somdet Chaopraya Hospital

Bangkok 10600, THAILAND

Tel: 662-4370200-8

Fax: 662-4375456

Email: [email protected]

[coventry]

Unfortunately a close family member (Thai) tried to kill himself a few days ago and ended up in a government hospital on the outskirts of Bangkok. Today hospital staff told his assembled family that he is not eligible to claim treatment on the 30 baht scheme because it doesn't cover incidents of self-harm. Has anyone else run up against this and where would we go to find out if it is true? It seems a strange policy when he is someone that right now REALLY needs all the medical support he can get.

If he doesn't reside in the area that the Government hospital is in, then he has to return to the area where he is registered as living. If you get treated at a Government hospital where you don't live, then you are responsable for all costs. It's the Thai system so I understand. I'm open to correction.

If a Thai moves address then they have to inform the relevant people. Failing to do so negates their right to the 30 Baht scheme. Which sounds like why this family member is not getting help. He can't pay the 15,000 Baht he already owes so what chance has he of paying the next hospital ? Hence why they probably won't refer him ?

Edit:- Just checked with a government nurse and she says the 30 Baht scheme doesn't cover suicide attempts.

Edited March 19, 2009 by coventry

[Goinghomesoon]

Hi, thanks Sheryl that information was very helpful (thanks Coventry too although we didn't see your post til we got home tonight). We had a pretty successful outcome and used your info to maximum effect

The two most important things that we found were:

(1) the need - as usual - to engage the help of an influential Thai friend who knew the hospital system well. She advised the famly members on how to approach the situation and assisted through her medical contacts to put some selective pressure on medical staff.

(2) that every govt hospital has a Dept of Health welfare office. In this case it was hidden on the 8th floor of one of the back towers with no sign on the door. This is where patients who are destitute or unable to afford to pay in one lump sum can negotiate to make regular payments, or have their debt written down (or written off in extreme cases). The welfare office also turned out to be excellent advocates for the patient. After reviewing his file and making some calls the head of the office immediately rang the ward and requested a psych assessment. As you can imagine, this made the main treating doctor very displeased, which made the subsequent return to the ward quite unpleasant.

The best surprise of the day was that the psych was a very approachable, down-to-earth older lady. She talked to the whole family as well as the patient and actually took the time to take extensive background notes. Actually I shouldn't be surprised, but after seeing the other doctor operate it was a nice reminder that most medical staff are professionals.

Thanks to those who posted, the information was invaluable and hopefully our family member is now on the road to being stabilised.

[Sheryl]

Glad to hear it is working out. WSill be interested to hear what happens regarding the fee i.e. if it is waived or reduced.

My thai medical friends always tell me that government hospitals will reduce or waive fees for those who cannot pay, even if not covered by the 30 baht scheme, and that all that needs to be done is to contact the welfare office in the hospital, but I have no experience with seeing if it in fact proves true.

(They also tell me that these offices and this channel are greatly under utilized, supposedly an issue of pride but I suspect that many of the poor sinply don't know about it or what their rights are).

[Goinghomesoon]

Well today's outcome is that they didn't agree to reduce the bill but signed an agreement for the patient to pay the hospital from his salary over the next 7 months. So the welfare office really does work. And because they come from outside the hospital they are quite impartial, or so we found in this case. It was just really hard to find their office. If we hadn't been 'tipped off' by our friend we would never have known they were there. The social worker told my hubby they are not permitted to walk around the hospital, they are instructed that patients must find them.

Somdet Chaophraya was actually our first phone call after the patient was hospitalised. But he needed surgery to repair the physical damage from the self-harm. SC said they would not take patients who require wound care because they don't have adequate facilities or staff. They did say that once healed, if he has not responded adequately to current psych meds that we should bring him in.

[coventry]

(They also tell me that these offices and this channel are greatly under utilized, supposedly an issue of pride but I suspect that many of the poor sinply don't know about it or what their rights are).

I agree 'Sheryl'. It's more out of ignorance as my knows nothing about a 'Welfare Office' when I spoke to her about the subject.

[coventry]

Well today's outcome is that they didn't agree to reduce the bill but signed an agreement for the patient to pay the hospital from his salary over the next 7 months. So the welfare office really does work. And because they come from outside the hospital they are quite impartial, or so we found in this case. It was just really hard to find their office. If we hadn't been 'tipped off' by our friend we would never have known they were there. The social worker told my hubby they are not permitted to walk around the hospital, they are instructed that patients must find them.

Somdet Chaophraya was actually our first phone call after the patient was hospitalised. But he needed surgery to repair the physical damage from the self-harm. SC said they would not take patients who require wound care because they don't have adequate facilities or staff. They did say that once healed, if he has not responded adequately to current psych meds that we should bring him in.

How can they expect someone in a mental state to make an agreement that they will repay the outstanding bill over 7 months ? The person isn't in a fit state of mind that he can say he'll work continuously for the next 7 months. I scratch my head.

[Sheryl]

Well today's outcome is that they didn't agree to reduce the bill but signed an agreement for the patient to pay the hospital from his salary over the next 7 months. So the welfare office really does work. And because they come from outside the hospital they are quite impartial, or so we found in this case. It was just really hard to find their office. If we hadn't been 'tipped off' by our friend we would never have known they were there. The social worker told my hubby they are not permitted to walk around the hospital, they are instructed that patients must find them.

Very interesting and explains a lot.

Hopefully this thread will help spread the word a bit.

[Goinghomesoon]

How can they expect someone in a mental state to make an agreement that they will repay the outstanding bill over 7 months ? The person isn't in a fit state of mind that he can say he'll work continuously for the next 7 months. I scratch my head.

Yes Coventry I wondered the same. His long-term girlfriend apparently signed a ream of papers on his behalf. We suspect she's now his guarantor in case of non-payment. I have no doubt the hospital would have preferred the patient's signature, but when they asked him to sign his name he wrote a page-long diatribe about something entirely irrelevant.

[coventry]

'Goinghomesoon' I spoke to my wife regarding suicide in Thailand and her responce was/is "if they want to do that, just let them". They don't seem to be caring when it comes down to mental health issues. I take pleasure in that his girlfriend has stuck with him when a normal Thai would see the family member as being possesed by spirits and avoid them like the plague. Hopefully things will stabalise and turn out okay. Good luck.

[Sheryl]

'Goinghomesoon' I spoke to my wife regarding suicide in Thailand and her responce was/is "if they want to do that, just let them". They don't seem to be caring when it comes down to mental health issues. I take pleasure in that his girlfriend has stuck with him when a normal Thai would see the family member as being possesed by spirits and avoid them like the plague. Hopefully things will stabalise and turn out okay. Good luck.

There are over 60 million Thai people. Obviously the views of one or for that matter several thousand of them cannot be construed as a univeral one held by all. Thais are no more uniform in their attitudes and behavior than people from any other country. They are individuals.

Among these 60 million plus are physicians, nurses and social workers, the vast majority of whom would in most cases have an educated view of mental health -- as would, for that matter, most highly educated people.

It is true that in general awareness of mental health issues is low. This lack of knowledge I think has more to do with negative/stigmatizing attitudes than does an intrinsic lack of caring.