Health Wikipedia

Although mental health is crucial to the overall well-being of individuals, societies and the country, it is largely neglected and often overlooked in Bangladesh. World Health Organisation (WHO) has given utmost importance to promote mental health services and has been campaigning for the full incorporation of mental health in public health. But it is matter of great regret that many people including some of health professionals are very reluctant to give mental health a priority.

About 16.01 per cent adult and 18.35 per cent children are suffering from mental illness in Bangladesh. With this enormous disease burden, a very few number of mental health professionals are struggling to cope with mental disorders. There are only 120 psychiatrists in our country. Other mental health professionals (psychologists, psychiatric nurses etc) are also very limited in number.

WHO published an assessment instrument for mental health system in Bangladesh in 2007. It revealed — there are 0.073 psychiatrist and 0.00071 psychologist per 100000 populations. Total indoor beds for mental patients are only 813 against the whole population (0.58 bed/100000 people). With the lack of resources, we have many negative attitudes to the mental health issues.

WHO stated that mental health is more than the absence of mental illness, and it is vital to individuals, families and societies. Mental health is determined by socioeconomic factors, linked to behaviour. There are lots of impact on mental health from the global warming and climate change, but little crying we hear from the environmentalist on this issue.

Beside the individual disease burden, there is huge impact of mental health on social capital. The level of well being, physical health, knowledge and skill, productivity, quality of relationship, sexual satisfaction, trust, social cohesion all are integrated to mental health and ultimately linked with social capital. Good mental health is also an important resource for families, communities and nations. Mental health is a useful tool in the human rights framework.

Among the global disease burden, mental illnesses pose a bigger place than many of overemphasised physical illnesses. Our attitude towards mental health is running on the wrong track. It is time to change our attitude and false belief. Mental health concerns everyone as it is generated in our everyday lives at homes, schools and workplace. Positive mental health contributes to the social, human and economic capital of societies. To promote mental health, we all should move together.

Mental health is deeply influenced by external social and environmental factors. Along with physical illness, it is now well evident that extreme climatic events can cause significant psychological stress with long-lasting effects on anxiety levels and depression.

There would be more devastating permanent mental health impact on the survivors like a child, who has to face the burden of pain and stress of losing his or her family members.

Ironically, the issue is overlooked very often and the effects of climate change on mental health are relatively missing in most discussions on climate change. But experts feared that rapid change in the climate is likely to fuel up the current rising trends of mental illness.

UNFCCC 4th report on global warming stated that there is a direct association between the presence of major mental illness like acute psychosis and schizophrenia in tropical countries.

Extreme climate change events like heat stoke which manifest as delirium and other neuro-psychiatric syndromes characterised by altered consciousness to agitation, restlessness, unconsciousness and even death. Heat stroke has already caused deaths among heavy workers and rickshaw pullers in Bangladesh.

A study conducted by Jain S (2001) demonstrated the association between presence of acute psychosis, schizophrenia, mood disorders and obsessive compulsive disorders with post viral infections which is set to increase with the climate change. Post viral infection is one of the important risk factors for damaging fetal brain in the intrauterine period which causes many developmental and mental disorders among children in future.

Major population displacement after an extreme climatic event would cause social disruption, unemployment, social conflicts, mental unrest and economic burden and uncertainty as we see in Haiti following a massive earthquake.

All these factors are associated with increased prevalence of mental disorders like anxiety, depression and stress disorders. Besides, increase salinity of water in the coastal area would hamper food production which results in malnutrition and child developmental disorders.

The extreme events cause immense psychosocial stress especially among vulnerable groups like children, women and elderly. A survey among Asian Tsunami affected population by WHO revealed that 30-50% of population suffered from moderate to severe form of mental disorders.

Natural disasters have shown to result in increased domestic violence due to frustration and anger. Flood is a common natural calamity in Bangladesh. A study in the state of Orissa in India concluded that mental disorder like depression and Post Traumatic Stress Disorders (PTSD) were increased among post flood affected population after one year.

Drought is another serious consequence of climate change which causes food scarcity, hunger and malnutrition. Drought contributes to mental agony and depression among farmers due to financial hardship which increases suicide rate among them. Suicide rate was highest among farmers in drought found in an Australian study.

A recent report of Climate Change Cell of Department of Environment of Bangladesh mentioned that the annual incidence of mental disorder was 22431 per year which was higher than that of Dengue (3305 per year). It indicates the need for prioritisation of mental health in the health component of National Adaptation Programme of Action for climate change of Bangladesh.

The incidence of mental disorder is rising by and by. Wave of migration, industrialisation, individualism, changing socio-cultural norms, changing family pattern, over careerist drive and drug addiction are the important factors considered behind this rising trend. In Bangladesh, a community based research on mental illness conducted in 2005 reported that 16.1 per cent adult populations suffer from various mental disorders.

It is the scenario of only from adult population and no research has been conducted among the children. The situation is more scary when we look at the statistics that say there is only one psychiatrist for 1500000 persons. There are only 120 psychiatrists in our country that depicts the pitiable condition.

After calculation, it has been found that there are only 813 psychiatric beds in Bangladesh to serve the whole nation. That means 172000 people share one bed. In 2005 only 0.44 percent was allotted for mental health in total health budget which was obviously insufficient.

In this situation, we will observe World Mental Health Day today. This year, the World Federation for Mental Health has decided the theme “Mental health in primary care: enhancing treatment and promoting mental health”. The theme is intended to emphasise the benefits of enhancing overall health and promoting mental health by integrating healthcare services.

National survey on mental health in Bangladesh reveals, about 14 lacs people have been suffering from major mental disorders (schizophrenia, mood disorders etc.), 65 lacs people have been suffering from depressive disorder and 1 crore 18 lacs people have been suffering from minor mental disorders (anxiety, phobia , conversion disorder etc).

Besides, about 46 lacs to 70 lacs people are drug addicted. Most of these patients are found in general practice, outpatient service at hospital and primary health care centers.

Mental disorder creates a substantial personal burden for affected individuals and their families. They produce significant economic and social hardship that affects the society. Many people suffer from both physical and mental health problems. Integrated primary care services help ensure that people are treated in a holistic manner, meeting the mental health needs of people with physical disorders as well as the physical health needs of people with mental disorders.

If the mental health care is included in the primary healthcare, our mental health service will reach the outreach. Patients and families can avoid indirect costs associated with seeking specialist care in distant locations. Treatment of common mental disorders is cost effective. Investments by governments can bring important benefits.

To include the mental health component in primary health care service, it should be first included in the health policy. There is dire need of intensive attention to mental health.

There is also a need of fundamental training in mental health with ensuring the supply of common psychotropic drugs in field level. To build a healthy nation we should promote mental health by enhancing treatment facilities in primary health care system. To survive on the runway to globalisation we should not observe this World Mental Health Day only as one-day event, rather give cordial effort to realise the theme for healthy nation.