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Mental health stigma a barrier to care in Bangladesh

  • Published at 12:26 pm April 15th, 2021
Mental Health

As many as 14,436 people in Bangladesh took their own life in a year since March 2020, 70% more than the lives claimed by coronavirus during that period

Mental health challenges in Bangladesh have remained unmet due to lack of awareness and shortage of mental health professionals, experts say.

According to a 2018 survey, the overall prevalence of mental disorders among the population 18 years and above was 18.7%, while prevalence of disorders was highest among those 60 years and older at 20.2%, Turkish state news agency Anadolu reports.

The survey was jointly conducted by the government and the National Institute of Mental Health (NIMH), one of two specialized mental hospitals in Bangladesh.

According to Bangladesh Bureau of Statistics (BBS), on average, 10,000 people commit suicide in Bangladesh every year.

A study published last month found that 14,436 people in Bangladesh took their own life in a year since March 2020, 70% more than the lives claimed by coronavirus during that period.

The study said 49% of suicide victims were between 20 to 35 years of age.

"We recently provided mental health support to some 11,000 people, mostly women and adolescents, at the community level during the pandemic," Rifat Sharmin, a clinical psychologist at the Community Empowerment Program of Brac, a non-governmental organization, told Anadolu Agency.

"We learnt from field experience that it still remains a stigma and taboo, especially in rural Bangladesh. Moreover, it is also a tough job to provide support to patients."

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She said the group faced immense discomfort and non-cooperation from victims' families and the public.

"They don't want to share their personal issues of distress and mental problems, fearing being stigmatized in society, whereas community leaders also create barriers.  

"If we do not provide proper mental health treatment and support during childhood then it will become difficult during adulthood for the patients," she said.

Shortage of mental health professionals

Helal Uddin Ahmed, associate professor of child, adolescent and family psychiatry at NIMH, said the country has a very limited number of mental health specialists.

He said there are a total of 270 psychiatrists while there are not more than 500 psychologists in the country at present to serve the vast number of mental health patients. 

"And, another major concern is, those health services are mostly urban based." 

He said the country must address the shortcomings because long-term mental health ailments can reduce life expectancy by 10 years on average.

The government should make mental health care a part of its primary health care system in districts and sub-districts, Sharmin suggested.

Echoing Sharmin's views, Helal Uddin said: "We need to extend the mental health care facilities to general hospitals rather than establishing specialized hospitals as people feel discomfort to go to specialized mental hospitals fearing being stigmatized. All government hospitals should run mental health departments so that people can avail treatment in general hospitals. 

"One of the major concerns is that mental health is widely ignored in the Bachelor of Medicine, Bachelor of Surgery (MBBS) curricula since 2012 which caused a huge dearth in the country's healthcare system. 

"We must make it mandatory to incorporate mental health courses at MBBS level because only this only can help address the crisis of shortage of specialists in the country," he said.

In the meantime, the NIMH associate professor said, a separate program should be launched with the Health Department to provide training to existing medicine specialists and others on mental health care to extend the service to locals.

Efforts to produce more specialists

A National Mental Health Policy and Mental Health Strategy Plan is in the pipeline which would ensure patients' rights and determine policies on how the sector and system will run properly, said Helal, who also worked on the proposal.

AM Pervez Rahim, joint secretary and concerned official with the Ministry of Health, said establishing a legal framework is crucial for properly dealing with the service and ensuring patients' rights.

"Thus, the government rectified and replaced the 1912's Lunacy Act, which had been enacted by British colonial rulers, with a new one, named Mental Health Act 2018. And, it is a big jump to ensure a strong mental health care system," he said.

"Meanwhile, we have three tiers in the government health care system and providing mental health care was only limited to tertiary level [medical college hospitals]. Now we are working to provide the service to the primary level [sub-districts] across the country," he said.

"As a signatory of the SDG [Sustainable Development Goals], we are cordially working to meet universal health coverage by 2030 in the country that requires ensuring not only physical health but also mental and social health," said Rahim.

Meanwhile, the coronavirus pandemic has had a massive impact on mental health, especially on minors and children, and increased the suicidal tendency, according to recently studies released in the country.

"In an effort to mitigate the problem, we are set to deploy mental health consultants to all primary and high schools across the country, run awareness programs, and open hotline supports and so on," said Rahim, who is a mental health specialist.