"Figures don't lie" -- so goes an old adage. Earlier in the year, a National Mental Health Survey (2018-2019) stirred up an uproar in the media. The survey was jointly conducted by the communicable disease programme of the Health Department of Bangladesh and the National Institute of Mental Health and Hospital. It indicated that among 163.05 million people of Bangladesh, at least 20 million are suffering from different types of mental health illnesses. This dire report leads to multiple gloom-ridden questions. What are the treatment opportunities Bangladesh has for this sheer number of people affected? Is proper treatment a plausible option in Bangladesh? If this is the number for the people who can be diagnosed with a mental health disorder, then how many are there who have the potential for becoming another statistic in the survey if not given proper care? Where are they now? And how they are coping with their day-to-day lives?
Well, these definitely open "the box". Because this is not the first time a survey results elicited so much commotion. According to one systematic review in 2014, the prevalence rate of mental health disorders in Bangladesh was from 6.5 per cent to 31 per cent and 13.4 per cent to 22.9 per cent for adults and children respectively. According to the WHO's report in 2017, more than six million people suffer from depressive disorders in Bangladesh. The number of people who experiences anxiety disorders is even greater. It is almost seven million people. And the list goes on. Among children aged seven to 17, almost 14 among 100 experiences mental health disorder. Adolescents or teenagers are at high risk too. Considering suicide is the second leading cause of death for adolescents and young adults in the world, Bangladesh has a lot on its plate. Among boys, four per hundred and among girls six per hundred consider committing suicide every year. In total, every year almost 10,000 people are dying from suicide in Bangladesh. More specifically, among one million deaths in females, 8.7 deaths are caused by suicide. And among male, the number is 6.8. The gender difference regarding vulnerability is very prominent in these numbers.
However, for the treatment opportunities, the numbers are strikingly worrisome. According to one survey conducted by the National Institute of Mental Health and Research in 2016, there are 790 places and 220 psychiatrists for the people around the capital, including the mental health hospital in Pabna. The numbers of outpatient and inpatient facilities are 50 and 31 respectively. Another study titled New Mental Health Act in Bangladesh: Unfinished agendas, shows that for one million population, there are only 0.073 psychiatrists. Even though the number of clinical psychologists, counselling psychologists, school psychologists, industrial psychologists, para counsellors, and other psychology-related professionals is increasing every year, the required number to serve the target population is still a far-fetched dream to achieve.
Even with this scanty number of resources, are people seeking services? The study mentioned at the beginning revealed that 92.3 per cent either do not look for any treatment or they do not have the opportunity to receive any. And from those who receive the treatment, many of them neither continue nor comply with the treatment. Sadly, all these numbers indicate a lack of awareness and negligence for mental health in Bangladesh. The negative impression about mental health illness goes a long distance. It is so deeply rooted in the culture that the image which follows after hearing a person with a mental disorder is a person covered in dirt all over the body with a foul odor, who would lack decent clothing while walking aimlessly across the road, who might be talking to herself/himself, etc. Not to mention, there is a lack of proper resources to educate and aware general population. Even in the media, having mental health issues is not represented as a normal or natural incident. Rather it is characterised as the worst possible occurrence for a person. While it is almost incurable and more horrific than the death itself it creates fear, misconception, and stigma regarding mental health problems and increase the barrier to seeking any support when needed. In Bangladesh, many people who have mental health-related issues try to hide themselves. Some families keep the person hidden in the house and do not want to share this information with others. The study titled, "Mental Disorders in Bangladesh: A systematic review" showed that people who require mental health treatment experience negative attitudes from his/her environment. It often seems that people with mental health concerns are being physically, emotionally, and sexually abused by the people in their surroundings. However, according to the WHO (2001), one in every four people will have a mental health-related problem once in his/her lifetime. Furthermore, the stress in everyday lives can cause severe distress. A person does not need to be diagnosed with a mental health disorder to receive a service.
Among all this negative information, one positive news is that the government of Bangladesh has started taking steps to ameliorate the situation. For an example, the 105 year-old Lunacy Act, 1912 was amended and replaced recently by a more contemporary law Mental Health Act, 2018. However, the licencing for mental health services may take sometime to see the light. Encouragingly, the government officials are talking about issues and taking steps regarding mental health issues in the media. This definitely is a promising sign for the future.
Bangladesh has a long way to go to ensure adequate services for everyone. It is high time that people started talking about mental health issue. More conversation will create more awareness. And more awareness will lead to proper care and better services. To achieve that, more steps should be taken. The professionals should also step up to guarantee transparency about their roles and services; so that the general people can have a clear idea about the whole process. This will lead to conviction that anyone can suffer from mental health-related problems. And it is perfectly okay to seek professional support to better cope with this situation disregarding taboos and stigmas.
It is imperative that people change their attitude towards mental health. Still, like Pandora's box, hope remains as the last resort for a better future.
Farzana Zafreen, assistant clinical psychologist, M.Sc. (Clinical Psychology, DU), M. Phil part-1 (Clinical Psychology, DU). She is currently working as "PSS officer" in Save the Children. She can be reached at
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