Seeking paths towards healing: mental health in Myanmar’s war

In mid-2022, Ma Nyi, a mental health professional living in Thailand, took a phone call from her cousin, a battalion leader with an anti-junta resistance force in Karenni (Kayah) State. “My guys are having mental problems,” he said. “We have to do something.” Barely beyond their teens, the young recruits under his command were facing burnout and breakdown, he said. They had struggled through arduous military training and were now enduring the unforgiving realities of war, far from their former lives and loved ones. With Myanmar’s protracted civil war continuing to take an immense psychological toll on soldiers, civilians, and the displaced, mental health professionals described to Myanmar Now the effects they have observed on people’s emotional lives, and shared thoughts on where they hope to find pathways for healing. Mental healthcare in Myanmar Even prior to the 2021 military coup, access to professional mental health support in Myanmar was extremely scarce. In a generally under-resourced healthcare system, mental health received less than one percent of the health budget, and an entrenched social stigma prevented many from seeking support. Ko Tamar, 38, spent five years as a psychiatrist at Yangon Mental Health Hospital. Following the 2021 coup, he traded his clinical practice for the revolution, joining the People’s Defence Forces (PDF) as a company leader. Even before the coup, he says, the state system was severely understaffed and underfunded, leaving mental healthcare one of the most neglected pillars of public health—particularly in ethnic and conflict-affected regions. Just two dedicated state-run psychiatric hospitals, in Yangon and Mandalay, and an estimated 200 psychiatrists served the country’s population of over 54 million. Even before the coup, local surveys suggested a massive “treatment gap,” with up to 95 percent of individuals with severe conditions like psychosis left without professional care. Ko Tamar attributed this neglect to a chronic lack of funding and persistent stigma. Ma Nyi, who trained as a counsellor in Yangon, concurred about the difficulty of accessing psychological support in Myanmar before the coup, even for those who could afford it. “If you have cancer, if you have heart disease, you can go abroad if you have the money and get treatment,” she said. “But mental health is not like that. You need language, you need cultural understanding. So a lot of people, I think, just suffer.” The coup catastrophically deepened the crisis. With Myanmar’s populace facing conflict, forced conscription, and economic collapse, psychiatrists and psychologists have been forced to choose between participating in the Civil Disobedience Movement (CDM)—the wave of protests and strikes organised in opposition to the 2021 military coup—and remaining “non-CDM” to avoid incurring punishment and keep offering their badly needed services. This agonising dilemma has caused bitter division among mental health professionals, according to Ko Tamar. Yet, according to mental health professionals including Ko Tamar and Ma Nyi, the intensifying crisis has paradoxically caused the social stigma attached to suffering from mental health issues to lighten somewhat since the Covid-19 pandemic’s onset and the military coup. Ko Tamar described the shift: “In the past, even the psychiatrists were stigmatised,” he said. “They used to call us ‘crazy doctors’. Now they are seeing us as a necessity, they see us as in demand. From that, we can see that society is changing a bit.” The change may stem from the prevalence of mental health struggles in Myanmar currently, as people see that emotional distress is a universal response to life under the junta, Ko Tamar suggested. Underscoring the weight of the collective mental health burden in Myanmar, the medical journal The Lancet found in 2024 that one in three adults reported a probable mental disorder, with up to 80 percent of probable post-traumatic stress disorder (PTSD) attributable to “political stress”. Amid this widening crisis brought on by the coup and ensuing conflict, the organisation Jue Jue’s Safe Space began operating a suicide prevention hotline in 2022, now run by 200 volunteers. The founder, Jue Jue, emphasised the importance of viewing mental health challenges as more than just an individual issue. “It's not that we’re weak and we’re suffering,” she said. “It's because we are impacted by this unjust system. It helps people to shift from being defeated to, okay, it's just a part of our environment that we live in.” Dr Tracy, a 27-year-old junior medical officer at a frontline hospital in Karenni State, is seeing this cultural shift reinforced by active education. Even in the most unstable and potentially hazardous settings, such as camps for internally displaced people, she says there are now active efforts to foster mental health literacy and encourage group counselling. “People need to know that feeling depressed or mentally unwell is not shameful,” Dr Tracy said. “Going to see a doctor or mental health professional is not disgraceful.” Jue Jue, the founder of Jue Jue’s Safe Space, explains the programmes run by her mental health organisation at an event in early 2025 (Photo: Supplied) Trauma and psychological scars Ko Tamar describes the impact of living in the resistance forces on the minds of his soldiers. After battles, some under his command would experience PTSD. “They’re not just afraid,” he said. “They have to relive their experience: the experience of a shell falling near you again and again. When a tree branch would fall on the rooftop they would be shocked and run sometimes.” In her hospital in Karenni State, Dr Tracy sees similarly heightened distress and anxiety in her patients—both civilians and members of armed groups. “As a hospital that has repeatedly suffered aerial bombing, we’re afraid even when planes circle overhead,” she said. “These situations are extremely stressful; anxiety levels rise.” For Dr Tracy, the trauma is compounded by the proximity of the conflict. Referring to the deaths of patients, a far more frequent occurrence than usual in war-torn areas, she said: “As we’ve lived in this area for some time, becoming familiar with people... those bad feelings affect us doubly, triply." She said she had seen a “tremendous increase in PTSD cases” in recent years. The providers have mental health needs of their own. Every four to six months, to prevent burnout, Dr Tracy’s hospital pauses new admissions for a full week to allow the medical team to recover their energy, seek support from experts as needed, and process the emotional toll of their work. Witnessing his peers in the PDF struggle with the weight of combat, Ko Tamar said he noticed a generational divide, with young soldiers generally showing each other more open understanding and support. “From what I saw, people are quite considerate, especially the young people. The problem is with older soldiers,” he said. “They say things like: ‘Oh, I've been there, man. It's nothing.’ It's not a good thing. Their experience is not helping sometimes.” Members of the Karenni Nationalities Defence Force (KNDF) and Karenni Army (KA) at a checkpoint near Demoso in eastern Karenni (Kayah) State in October 2021 (Photo: AFP) Marni Suu Reynolds, a researcher and PhD candidate at Chiang Mai University, emphasises the need for people to understand what trauma is and its effects. In a research paper for last year’s International Conference on Myanmar Studies, she explained that the impact is physical as well as emotional. “From a neurological perspective, trauma impacts the brain’s survival mechanisms, causing it to deviate from its baseline state even after the threat has passed,” she wrote. Aside from PTSD, Ko Tamar describes the high prevalence of depression and anxiety among his troops, as well as adjustment disorder. “Myanmar people love their hometowns a lot, and now they have to move around. This nostalgic feeling becomes depression and anxiety, and they don’t know how to explain it,” he said. In this environment, the use of cannabis, methamphetamines, and alcohol—substances usually more likely to aggravate mental health problems than ease them—is sometimes the only available coping mechanism. “When we cannot cope with the new challenges anymore, we tend to use those things,” Ko Tamar said. Also dealing with conflict, displacement, and constant insecurity, Ko Tamar observed the strain of the war on civilians, especially vulnerable groups including children, the elderly, pregnant people, and those with chronic illnesses. Despite these immense pressures, he said, the resilience of many civilians was striking. “Some communities, they’re displaced, but they would come together and talk about solving issues. Building community doesn’t seem to be directly associated with mental health,” he said, “But it has an impactful influence.” The solidarity of religious or ethnic communities can be a particularly strong buffer against mental health struggles, he added. However, religion can play a dual role in mental health, according to a 2025 report by TheHILLS Myanmar organisation, titled “Mental Health, Gender, and Conflict in Chin State”. While prayer and religious practices are a profound comfort for many, fear of social judgement and gossip can result in isolation rather than social support in Chin Christian communities, the report noted. Ko Tamar also identified silence around mental health struggles as a problem in Myanmar culture more generally. “We donate a lot, but we don't [always] share much,” he said. “This is not good for your mental health, people need to talk more about their feelings. Basically, validating their feelings is the first step”. A participant’s sketch from the research report in Chin State, where respondents were asked to map their emotions onto the body. Burmese annotations identify “hopelessness,” “trembling,” and “heart palpitations,” illustrating how psychological trauma manifests as physical discomfort or pain (Photo: Supplied) Dealing with shame Responding to her cousin’s plea for psychological support for his PDF troops, Ma Nyi began providing one-on-one online counselling to four soldiers in mid-2022. The environment proved a significant barrier. With intermittent internet and a near-total lack of privacy in the jungle camps, meaningful sessions were nearly impossible to sustain. After three months, Ma Nyi realised the individual approach was faltering. “They seemed okay for a short time,” she said, “but then relapses would happen.” Ma Nyi decided to change her approach. Recognising that many young recruits were struggling with a loss of hope and purpose—particularly while stationed away from the front lines—she began offering online group sessions in English and computer training. The soldiers attended two-hour classes with her three times a week. Soon, they requested that one of these sessions be held without an agenda—a space just to talk. “It was a kind of group therapy,” Ma Nyi said, though she noted that such labels can be counterproductive. “The participants didn’t like the phrase ‘mental health’,” she noted. As trust deepened, members of the group began to contact Ma Nyi privately, revealing burdens of guilt and shame they had previously carried in isolation. One PDF member described the death of a younger comrade who had stepped on a landmine; he was now consumed by the belief that he was responsible, plagued by having allowed the younger man to go out to a shop alone just before the fatal accident. Another issue that surfaced, to Ma Nyi’s surprise, was the deep-seated shame young men felt regarding their use of pornography. “I know that this is a common response in high-stress environments,” she said, adding: “I had to tell them, ‘You are not alone,’ because they don’t talk about it, even guys to guys.” In one case, she said, the overwhelming shame connected to this issue had caused a patient to have suicidal thoughts. As word about the benefits of Ma Nyi’s group sessions spread, she was sought out for support by other leaders from the PDF and the KNDF (Karenni Nationalities Defence Force). She began delivering training to increase fundamental mental health awareness, teaching about physiological responses to stress in life-or-death situations and other essential knowledge. The training also imparted skills in psychological first aid—practical responses to help people emotionally in the immediate aftermath of a disaster, emergency, or other traumatic event. Ma Nyi later established Calm Lab, responding to the need for mental health support combined with skills training for the future. The organisation’s programmes, focused on leadership and information technology, are aimed at helping participants become “workplace-ready”. This is particularly vital for those living with long-term battlefield injuries who wish to continue serving the revolution. “They learn these skills to support their battalions in different ways,” she said. “Every battalion has fundraising campaigns; they need to create certificates and record donations.” Screen capture of the website for the Telekyanmar programme, a telemedicine service initiative run by the National Unity Government’s Ministry of Health (NUG) New pathways to healing Although there are still major shortcomings in mental healthcare and awareness—particularly for vulnerable communities and populations in remote areas—a range of organisations has emerged to help close the gaps since 2021. The National Unity Government’s telemedicine service, Telekyanmar (the Burmese translation of “telehealth”), has become a widely used resource for the public. Individuals can access the service via Facebook or Telegram. Alongside a dedicated mental health team, users can access a suicide prevention hotline through Telekyanmar. The online service’s mental health team leader Dr Monica told Myanmar Now she oversees 16 to 20 psychiatrists and around 30 general practitioners in her team, with support from more than 40 volunteers from diverse professional backgrounds, of whom many are current or former participants in the CDM. “The psychological well-being of Myanmar people has suffered greatly since the 2021 military coup,” Dr Monica said, noting that stress, depression, and anxiety are the most common signs of this hardship “People from the areas facing unrest suffer most: loss of family members, loss of home, loss of jobs, loss of income,” she explained. “Of course, PDF and armed ethnic soldiers are no exception, and are at high risk for mental health problems.” Among the newly emerged initiatives is the Mental Health Federation, which Ko Tamar helped establish. This network of psychiatrists recruits both healthcare workers and laypeople, training them in psychological first aid and basic counselling to ensure that not every case requires a referral to a specialist. To date, the network has reached approximately 10,000 clients. “We're not teaching them any particular method or therapy,” said Ko Tamar. “We're just focusing on the first aid part: how to talk to people properly like a human being, how to be considerate, and how to validate.” On the other hand, Ma Nyi expressed concern that with many organisations now training people in mental health support, there is a risk of the profession becoming diluted. This could lead to potential ethical issues if people are providing counselling without proper training, she said. There is currently no system for state-issued accreditation to become a psychologist or counsellor in Myanmar, leaving the field unregulated. Most individuals with professional credentials in mental health have studied abroad. Artwork based on a photo taken during a Mental Health and Psychosocial Support (MHPSS) facilitation training for Myanmar journalists, medics and battalion leaders. (Photo: Supplied) Despite their differing backgrounds, all the mental health practitioners to whom Myanmar Now spoke for this article emphasised the need for a variety of approaches. There is no one-size-fits-all model for mental health, they said. In terms of offering talk therapy, both Ko Tamar and Jue Jue said they favour approaches that incorporate elements of mindfulness, such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavioural Therapy (DBT). They have found these frameworks to be particularly well-suited to patients from Myanmar. Researcher Marni Suu Reynolds highlighted the effectiveness of body-based somatic approaches to maintaining and improving mental health, adding that she had found art therapy to be an important gateway to conversations about emotions and mental health, especially when talk therapy feels inaccessible or alienating. “One-to-one counselling can be difficult, especially in Mae Sot because many people don’t have transportation,” Reynolds said. “We have to be very flexible; we have to realise that the western concept of therapy isn’t always going to be conducive.” She added that the needs of those seeking support can vary significantly depending on their location, citing the differences between Mae Sot and Chiang Mai—two Thai locales with sizeable populations of displaced Myanmar nationals—to illustrate the range of conditions. “All different approaches are needed. Sometimes that’s gardening, sometimes that’s therapy or group work, and sometimes that’s meditation. We have to have a multitude of approaches,” Marni told Myanmar Now, holding up the RISE Centre in Mae Sot as a model for this kind of holistic approach. Initiatives for psychological wellbeing don’t always need to be directly associated with mental health. “One solution is sports,” Ko Tamar said. “I promote sports—volleyball, caneball, football. What sport gives you is this dopamine high, you feel good.” “It needs to go beyond just counselling,” Ma Nyi said, emphasising that physical security and nutrition are also vital components of mental well-being. While a wide range of strategies is needed to heal the psychological wounds of Myanmar’s war, the core of the effort remains rooted in solidarity and care. “In a situation where we only have each other, we need to be there for one another even more,” said Dr Tracy. “We need to exist for each other.” Myanmar’s future remains uncertain, but there is a growing sense that this shared struggle is forging a more compassionate society. “I don't know how long the people’s resilience will last,” Ko Tamar said. “It's crumbling slowly, but destruction is the start of building anew, so we can add new values, new norms, and a new culture.” Mental health resources: Being with You A community-based organisation providing psychological support and mental health awareness services. https://www.facebook.com/share/1JVMkdq1ty/ | beingwithyou2022@gmail.com Calm Lab A youth-focused initiative combining mental health support with leadership and vocational skills training. https://calmlab.info Mind Diary An online clinic offering professional counseling and mental health consultation services. https://www.facebook.com/share/1BtE36JTUk | mind.diary.clinic@gmail.com Open-Heart Coup / Serenity Counseling Service Provides free Burmese-language emotional support groups and training in psychological first aid. https://www.facebook.com/serenitymentalhealthservice Telekyanmar A National Unity Government-supported telemedicine platform offering mental health consultations and a dedicated suicide prevention hotline. https://www.facebook.com/telehealthmm

Seeking paths towards healing: mental health in Myanmar’s war

With Myanmar’s health system in ruins and more people than ever traumatised by war, a grassroots network of clinicians is circumventing the stigma around mental health needs to build a new culture of care

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