Pol Snr Sgt Maj Prateep Dinsakul woke up one day and suddenly found himself unable to speak. Seeing no warning sign of disease, his family took him to Srithanya psychiatric hospital in Nonthaburi for preliminary evaluation.
"The doctor said I had depression," Prateep recalled of his diagnosis. "Sometimes I had to be locked up. I had to take a six-month break from work."
Almost a decade has passed since the beginning of his medicinal therapy. The now 51-year-old father of one, who has served as a police officer patrolling Bangkok neighbourhoods for over 30 years, said continuous treatments were key to keeping his conditions at bay. Attending psychiatrists at Srithanya Hospital and Police General Hospital, Prateep is still required to take medication on a daily basis.
Prateep is only one example of patients falling prey to depression -- currently a worrying healthcare concern especially among police officers. But he is still fortunate to have been able to keep his illness in check. In the worst cases, due to officers' access to guns and weapons, uncontrolled depression could potentially lead to attempted suicide more easily than for other people.
"Police have guns," Prateep said. "So if we want to end our lives, it's easier than for other people."
Depression and depression-related suicide are an ongoing healthcare issue that has been put on a discussion table not just in Thailand but also on a global scale. Last year, the World Health Organization (WHO) set depression as the theme of its anniversary day, which falls in April. Then in October, the WHO launched a one-year campaign called "Depression: Let's Talk" encouraging more people with depression, in all countries, to seek and get help. According to WHO data, more than 300 million people of all ages suffer from depression worldwide.
In Thailand, according to the 2017 figures from the Excellence Centre for Depressive Disorder under the Ministry of Public Health, an estimated 1.7 million Thais are reported to suffer depression. Of this number, around 700,000 patients have chances of committing suicide and are being monitored. This shows an alarmingly steep rise from only 340,000 Thais reportedly suffering depression in 2009 -- more than a threefold increase.
Depression among police officers has been more seriously discussed lately. Based on data from the Department of Psychiatry and Narcotics under the Police General Hospital, last year there were more than 500 cops visiting the department for a psychiatric consultation. Around 170 of them were later found to be suffering from depression -- a disturbing hike from only 108 in 2015 and 143 in 2016.
Director of the Police General Hospital Pol Lt Gen Dr Witoon Nitiwarangkul said although people from all different types of occupations could somehow end up a victim of depression, the illness among police officers should properly and urgently be addressed because at its worst the mental sickness can lead to suicide, which is more possible among cops than people in general due to their access to guns.
"The suicide rate among cops is three times higher than for other people not because they are more stressed but because they have a means to successfully do it. For others to kill themselves, they have to find a way and tools, which might fail," said Pol Lt Gen Dr Witoon. Statistics from the Police General Hospital from 2008 to 2016 found that almost 300 Thai officers committed suicide.
Dr Chaichana Jaroonpipatkul, a psychiatrist at the Police General Hospital, explained that depression differs from usual mood fluctuations in that depression is when sadness goes deep beyond our control and greatly affects work, school and daily life. Depression has no known causes in many cases but it can occur for a variety of reasons.
"Internal factors include genetics in which people with a family history of mental illness may be at higher risk. It can also be caused by an imbalance of neurotransmitters in the brain. But many external factors are responsible for the development of depression too such as work-related pressure, stress, financial crisis, divorce, bereavement and other personal problems," said Dr Chaichana.
The WHO categorises depression into two types: recurrent depressive disorder and bipolar affective disorder. The former involves repeated depressive episodes in which patients experience depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. This could also bring about anxiety, sleep abnormality, appetite loss, feelings of guilt and low self-worth and poor concentration. The latter is basically a mix between manic and depressive episodes.
Attending police officers at the Police General Hospital's Department of Psychiatry and Narcotics is Dr Thaniya Banjongjit who has seen cops feeling depressed for a variety of reasons, from career stumbles and job promotion to work shifts, stressful assignments and other personal issues.
"We are not saying police are more stressed than other occupations," commented Dr Thaniya. "What we fear is that they have guns. And when stress meets guns, it could mean danger not just to themselves but also others around them including their family members and friends."
A number of Thai cops still have a misconception about depression, added the psychiatrist. They believe depression is a stigma. Police who are diagnosed as such are thought to be insane and would probably be shunned by fellow cops and supervisors as well as others in society.
"There are still a lot of police officers out there who do not know they are likely to have depression and they do not want to visit a psychiatrist for fear it's going to affect their career. This is the misunderstanding that still needs to be clarified and educated," she said, adding that cops from any subsections, be they traffic police, patrol police or even desk police, have an equal chance of succumbing to stress and depressive disorder.
Psychiatrist Dr Pongkwan Yimsaard of the Police General Hospital, however, shares good news -- depression can be curbed and cured. Depressive cops can lead normal lives once they take medication that helps to keep their symptoms calm.
"Normally we use a combination of medication and psychotherapy," said Dr Pongkwan. "Today antidepressant medication has fewer side effects compared to the past, thanks to research and development."
To provide a way for depressive police officers to get psychological consultation and treatment if needed, the Police General Hospital recently launched a Facebook page dedicated to helping those prone to developing depression. Titled "Depress We Care", the page allows cops to send private messages or questions, which will be attended to by psychiatrists around the clock. Their identity will be kept confidential. The service is available only for police officers for now. The hospital also has a 24-hour 081-932-0000 hotline for officers suffering depression.
"It's a channel where officers can discuss their problems directly with psychiatrists where everything is kept secret and their supervisors and peers know nothing about it," said the hospital director. "After being treated, depressive cops can get back to work and live their normal lives. But if left untouched, the problem can go from bad to worse."
In the meantime, key to solving this national healthcare concern is that people's negative attitudes towards depression must be changed.
"Depression is like any other disease where the sick need treatment and encouragement," said Dr Pongkwan. "For those who are not sure if they have depression, they can just come for a talk with a psychiatrist. Treating depression is somehow not that complicated. It's definitely worth the effort."
