Why do young people feel so tired of life?

Have you ever asked yourself if, in the last two weeks, you felt like you'd be better off dead or had thoughts of hurting yourself? Or if you felt down, depressed, or hopeless? These are tough questions, but they are important. When you look around, you might sense the despair in the air. Think about the mother who just lost her son in the civil unrest-what is she going through? Or the daughter waiting at home for her father who was just arrested-how is she feeling? And what about friends who have drifted apart over political debates? Thousands of more examples can be given as such! All of these emotions can lead to anxiety, stress, or depression, and when these feelings intensify, they can even lead to suicidal thoughts.

The collective level of stress, anxiety, and depression is rising alarmingly. With the increasing burdens, responsibilities, and crises, our minds are overwhelmed. Many mental health disorders go undiagnosed. The World Health Organization (WHO) has classified stress as the "Health Epidemic of the 21st Century". In Bangladesh, the need for mental health care is significant, as shown by the high prevalence of common mental health disorders. According to the Bangladesh Mental Health Survey (2018-2019), one in five adults faces at least one form of common mental health disorder, with a slightly higher prevalence among women. A 2021 study by the National Institute of Mental Health of Bangladesh found that 5.0 per cent of Bangladeshi adolescents and youths had suicidal ideation, and 2.0 per cent had made suicidal plans or attempts. Why are so many young people feeling so tired of life so early? We need to figure that out.

The next question is how we support those struggling with their mental health to get better access to care. The health system of Bangladesh is not yet fully prepared to provide comprehensive mental health care due to resource constraints. Despite the high burden, only 9% of those with pre-diagnosed mental health issues receive treatment. Early detection and treatment are necessary, but the number of available psychologists and psychiatrists is very low. According to WHO reports, Bangladesh has an estimated 260 psychiatrists (approximately 0.16 per 100,000 population), 700 nurses providing mental health care (0.4 per 100,000), and 565 psychologists (0.34 per 100,000), mostly concentrated in urban areas. Yet, 70 per cent of the population lives in rural areas. Are we offering them sufficient access to mental health care?

Providing in-person mental health care with limited resources and specialists is difficult. Tele-mental health can be a good solution to reach more people in need. Bangladesh has established good network coverage, which can be leveraged for telehealth counselling services. Evidence suggests that digital psychological interventions for mental health problems in developing countries are effective when usual care is minimal. Integrating telepsychiatry models like collaborative care into primary care settings has been recommended through evidence.

Recognising this need, the Non-Communicable Disease Control (NCDC) Programme of the Government of Bangladesh (GoB) initiated the tele-mental health service titled "Wellbeing Centres" in six public hospitals, with support from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in 2022. These centres have provided over 5,000 counselling sessions through an online platform till now. A study supported by Global Affairs Canada (GAC) suggested the feasibility and usability of these centres in improving access to mental health care services. The study was funded by the Department of Foreign Affairs, Trade and Development (DFATD), through Advancing Sexual and Reproductive Health and Rights (AdSEARCH) by icddr,b, project. The study explores the introduction of a Well-being Centre for women during antepartum and postpartum periods to increase access to mental health services through implementation research in health facilities. A deeper dive is needed to understand the drivers of the success of these centres during their initial phase. The care was specialised, trained psychologists and psychiatrists provided online counselling and treatments to the patients. These services did not only have good quality, but they were also free of charge. One beneficiary mentioned, "I was always anxious and afraid of everything. I couldn't concentrate on my work. I had to travel a lot and spent a lot of money to receive care from mental health hospitals in Dhaka. In these wellbeing centres, I get care free-of-cost and the doctors listen to me patiently." While psychiatry departments in public hospitals exist, people need more than medications and prescribed care -- they want to be heard when struggling. This is what psychologists are for. They patiently listen!

Utilising psychologists more extensively can provide much-needed support to individuals struggling with mental health issues, offering professional guidance and therapeutic interventions that can significantly improve quality of life. However, the current shortage of mental health professionals highlights the urgent need for more trained psychologists to meet the rising demand by leveraging the power of telehealth. The rising recognition of mental health's role in overall well-being has urged a call to action for increased mental health care services including both psychologists and psychiatrists, and investment in mental health research.

A new 2024 commission on youth mental health in The Lancet Psychiatry reported only 2.0 per cent of global health budgets are dedicated to mental health care. Increased investment in mental health programmes and research is essential to develop innovative treatments, understand the underlying causes of mental health disorders, and implement effective prevention strategies. By directing more resources towards mental health research, we can uncover new insights and create evidence-based policies that address the needs. Encouraging investors to fund mental health initiatives in Bangladesh not only supports scientific advancements but also promotes a healthier, more resilient society. Together, these efforts can help bridge the gap in mental health care, ensuring that everyone has access to the support they need to lead gratifying lives.

Aniqa Tasnim Hossain works as an assistant scientist at icddr,b. She is a public health researcher and a statistician by training. Sumaiya Nusrat is a medical doctor with a passion for data, holding both an MBBS and a Master's in Applied Statistics.

Currently she is serving as a project

research physician at icddr,b.

[email protected],

[email protected].