This month's issue of BJPsych International focuses on Bangladesh, one of the most densely populated countries in the world and geographically vulnerable to a wide range of natural disasters. Mental health has been deteriorating since the COVID-19 crisis, but few psychiatrists and clinical psychologists are available to manage the consequences

Skuse, D

English

UCL Discovery

EDITORIAL Current concerns about mental health inBangladeshDavid SkuseThis month’s issue of BJPsych Internationalfocuses on Bangladesh, one of the mostdensely populated countries in the world andgeographically vulnerable to a wide range ofnatural disasters. Mental health has beendeteriorating since the COVID-19 crisis, butfew psychiatrists and clinical psychologists areavailable to manage the consequences.Fifteen years have passed since we last publisheda country profile on Bangladesh in BJPsychInternational, so it is of great interest to find outhow that country’s psychiatric services have devel-oped since then. In this issue we include severalarticles that will bring us up to date. Back in2006, Bangladesh had only 73 psychiatrists in acountry of 123 million people; just three ofthem had trained in child mental health.1 Sincethen, the population has grown by aboutone-third, indicating that a high proportion ofthe population is now under 15 years of age.According to the updated country profile byTasdik Hasan and colleagues, mental health pro-blems in both adults and children are at unprece-dently high levels.2,3 The number of psychiatristsavailable to provide care to 162 million people hasincreased to 210 since 2005, but resourcesdevoted to mental health services remain stub-bornly low.1 The COVID crisis has made the situ-ation even worse; in particular, there are concernsabout the rapidly rising incidence of child mentalproblems, widely expressed on internet forums.New mental health legislationHasan et al provide a set of priorities for researchand service development, but note that the WorldHealth Organization’s (WHO’s) Mental HealthGap Action Programme (mhGAP) has yet to beimplemented widely in Bangladesh.2 One prom-ising development has been the provision of anew set of mental health laws, summarised byMohammad Karim and Sabuj Shaikh.4 In 2018,the colonial era Lunacy Act of 1912 was replacedby a new Mental Health Act. One provision of theAct, which may lead to an improvement in cur-rently inadequate government-run public healthfacilities (especially those outside urban areas),aims to support the development of separatemental health units in medical college anddistrict-level government hospitals. Also, in thefuture, private entities will be able to establishrehabilitation centres.Prison psychiatryWhether the 2018 Act will improve the fate ofprisoners with mental disorders remains to beseen. Al Aditya Khan and colleagues review men-tal health services in the prisons of Bangladesh.5There are no formal psychiatric services availableto prisoners provided by the government,although some prisons have third-sector supportfor prison staff and inmates, aimed at improvingemployment chances on release and dealingwith the problem of drug addiction. Many ofthe issues discussed would apply equally to pris-oners in the UK, where drug misuse and mentalhealth problems are rife. Interestingly, inBangladesh psychiatrists do not visit prisons,and mentally ill prisoners are brought by staff toattend appointments elsewhere. The authorsdraw attention to the need for a comprehensivereview of prisoner mental health using objectivescreening methodologies, and suggest that incar-ceration provides an opportunity to providetherapeutic interventions that may not be avail-able elsewhere.The future of service provisionFinally, Faruq Alam and co-authors discuss howthe provision of mental health services inBangladesh could be improved in the future.6This article also draws attention to the poor men-tal health of many transient Bangladeshi immi-grants to the UK, as well as those working in thePersian Gulf states. The country has had to copewith more than its fair share of natural disastersand other stressors, not least of which has beenthe massive influx of refugees from Myanmar inthe past few years. In some ways, these refugeeshave been better served than the indigenouspopulation because they have received interventionfrom the WHO mhGAP initiative. Apparently, theconsequent provision of psychiatrists and psycho-logical support has caused local resentmentbecause the immigrants are seen as competitorsfor scarce public service resources. Since theadoption of the country’s new Mental HealthAct of 2018, there is hope that fresh budgetingand funding will be used productively toimprove services nationally, especially in ruralareas. Improvements in crisis managementare also a priority, given the scale and fre-quency of natural disasters in this part of theworld.Declaration of interestD.S. is Editor of BJPsych International.Professor of Behavioural andBrain Sciences, Division ofPopulation, Policy and Practice,UCL Great Ormond StreetInstitute of Child Health, London,UK. Email: d.skuse@ucl.ac.ukKeywords.First received 27 Jul 2021Accepted 27 Jul 2021doi:10.1192/bji.2021.43© The Author, 2021. Publishedby Cambridge University Press onbehalf of the Royal College ofPsychiatrists. This is an OpenAccess article, distributed underthe terms of the CreativeCommons Attribution licence(http://creativecommons.org/licenses/by/4.0/), which permitsunrestricted re-use, distribution,and reproduction in any medium,provided the original work isproperly cited.BJPSYCH INTERNATIONAL VOLUME 18 NUMBER 4 NOVEMBER 2021 77Downloaded from https://www.cambridge.org/core. 17 Nov 2021 at 16:52:41, subject to the Cambridge Core terms of use.References1 Karim M, Shaheed F, Paul S. Psychiatry in Bangladesh. IntPsychiatry 2006; 3(3): 16–8.2 Hasan MT, Anwar T, Christopher E, Hossain S, Hossain MM, KolyKN, et al The current state of mental healthcare in Bangladesh:part 1 – an updated country profile. BJPsych Int 2021; 18: 78–82.3 Hasan MT, Anwar T, Christopher E, Hossain S, Hossain MM,Koly KN, et al The current state of mental healthcare inBangladesh: part 2 – setting priorities. BJPsych Int 2021;18: 82–85.4 Karim ME, Shaikh S. Newly enacted mental health law inBangladesh. BJPsych Int [Epub ahead of print] 1 Feb 2021.Available from: https://doi.org/10.1192/bji.2021.1.5 Khan AA, Ryland H, Pathan T, Ahmed HU, Hussain A, ForresterA. Mental health services in the prisons of Bangladesh. BJPsychInt [Epub ahead of print] 26 Jul 2021. Available from: https://doi.org/10.1192/bji.2021.34.6 Alam F, Hossain R, Ahmed HU, Alam MT, Sarkar M, Halbreich U.Stressors and mental health in Bangladesh: current situation andfuture hopes. BJPsych Int [Epub ahead of print] 10 Dec 2020.Available from: https://doi.org/10.1192/bji.2020.57.COUNTRYPROFILEThe current state of mental healthcarein Bangladesh: part 1 – an updatedcountry profileM. Tasdik Hasan,1 Tasnim Anwar,2 Enryka Christopher,3Sahadat Hossain,4 Md Mahbub Hossain,5 Kamrun Nahar Koly,6K. M. Saif-Ur-Rahman,6 Helal Uddin Ahmed,7 Nazish Arman8 andSaima Wazed Hossain9Mental health is a significant factor for asound and productive life; nevertheless,mental disorders do not often receiveadequate research attention and are notaddressed as a serious public health issue incountries such as Bangladesh. Part 1 of thistwo-part profile describes the current situationof mental health in Bangladesh in its widersociocultural context, outlining existingpolicies and highlighting mental illness as aneglected healthcare problem in the countryusing a narrative synthesis method. Theprevalence of mental disorders is very highand augmented in nature among differentpopulation groups in Bangladesh. A lack ofpublic mental health facilities, scarcity ofskilled mental health professionals,insufficient financial resource distribution,inadequately stewarded mental healthpolicies and stigma contribute to makingcurrent mental healthcare significantlyinadequate in Bangladesh. The country hasfew community care facilities for psychiatricpatients. Furthermore, the current mentalhealth expenditure by the Bangladeshigovernment is only 0.44% of the total healthbudget. Less than 0.11% of the population hasaccess to free essential psychotropicmedications.BackgroundBangladesh, a lower middle-income country inSouth Asia, has a population of 163 million,making it the world’s eighth most populous coun-try.1,2 Two-thirds of the population reside in ruralareas. Literacy rates are estimated at 75.62% formales and 69.90% for females.3 With only 4 hos-pital beds per 10 000 people, Bangladesh facesan immense burden of illness arising from bothcommunicable and non-communicable diseases,including mental disorders.4,5 Mental healthcarein Bangladesh is enormously inadequate owingto a lack of public mental health facilities, scarcityof skilled mental health professionals, insufficientfinancial resource distribution and societal stigma.These shortcomings are sustained by the absenceof effective stewardship to execute adequate men-tal health policies.5Despite limited documentation of the burdenof mental disorders and challenges in improvingmental healthcare, there has been no comprehen-sive review of the country’s current mental healthstate at the national level. In part 1 of this countryprofile we will (a) summarise the current mentalhealth evidence based on a literature review, (b)describe the current situation of mental disordersin Bangladesh in its wider sociocultural contextand (c) chronicle the existing mental healthcareservices and financing in the country.Current context and vulnerable groupsAdultsThe first national survey on mental health inBangladesh was conducted in 2003–2005.5 Thesecond (and most recent) nationwide representa-tive survey was conducted in 2019 (Table 1).6The coronavirus disease 2019 (COVID-19)pandemic has wreaked havoc on the mental1Consultant (Mental Health),Shuchona Foundation, Dhaka,Bangladesh. Email: tasdik.hasan@liverpool.ac.uk2Graduate Student, Kings CollegeLondon, UK3Center for Population andDevelopment Studies, HarvardT.H. Chan School of Public Health,Cambridge, MA, USA4Lecturer, Department of PublicHealth & Informatics,Jahangirnagar University, Savar,Dhaka, Bangladesh5DrPH Researcher, Department ofHealth Promotion andCommunity Health Sciences,Texas A&M School of PublicHealth, College Station, TX, USA6Assistant Scientist, HealthSystems and Population StudiesDivision, icddr,b, Dhaka,Bangladesh7Associate Professor, Child &Adolescent Psychaitry, NationalInstitute of Mental Health, Sher-e-Bangla Nagar, Dhaka,Bangladesh8Lead Coordinator for ContentDevelopment, ShuchonaFoundation, Dhaka, Bangladesh9Chairperson, ShuchonaFoundation, Dhaka, BangladeshKeywords. Mental health; mentalhealth system; mental healthpolicy; priorities; Bangladesh.First received 19 Jul 2021Accepted 2 Aug 2021doi:10.1192/bji.2021.41© The Author(s), 2021. Publishedby Cambridge University Press onbehalf of the Royal College ofPsychiatrists. This is an Open78 BJPSYCH INTERNATIONAL VOLUME 18 NUMBER 4 NOVEMBER 2021Downloaded from https://www.cambridge.org/core. 17 Nov 2021 at 16:52:41, subject to the Cambridge Core terms of use.

Current concerns about mental health in Bangladesh

https://discovery.ucl.ac.uk/10138638/1/current-concerns-about-mental-health-in-bangladesh.pdf

Current concerns about mental health in Bangladesh

Abstract

Similar works

Full text

Available Versions

UCL Discovery