Aftercare support
You will spend a lot of time applying the newly acquired life skills and coping skills that you learned in your treatment programme and this will keep you happy, clean and sober. This alone can keep you so busy that some family members may even feel neglected. These are an essential part of the recovery process. Keep in mind, many families find it difficult to understand why re-entry to society after an addiction treatment programme takes up so much of your time in a successful recovery. Have patience and explain all the hard work you are doing on your sobriety to them it will pay off in the long-run.

New rules
Rules are the cornerstone of the treatment process. While in treatment, you may have grown accustomed to following rules, and come to appreciate this level of structure. After returning home, you may even suggest new family rules, the most obvious being a ban on alcohol or drugs in your home.

Roles and responsibilities
Before you went into treatment, you may have neglected certain roles and responsibilities. Other family members may have pitched in to compensate. Now that you have completed treatment, you will probably be eager to participate in family life, and resume your family roles and responsibilities. Often this change in the family dynamic can be difficult at first. Don’t worry it will get easier.

Communication
As part of the treatment process, you have learned to talk about personal issues, like relationships and feelings. Most treatment programmes stress the importance of open and honest communication. You will bring these lessons home, and encourage the rest of the family to talk and listen to one another. These conversations may be unsettling and unfamiliar at first. But open communication can help to solve problems and conflicts and, in the long-run, create a healthy home environment.

New people, places and things
While in treatment you will have learned to avoid people, places and things associated with your past drug abuse activities. This may affect your social life as a family, and may cause some conflicts in the home. Keep in mind that these challenges will be worth it in the long run.

Your feelings
Alcohol and drug abuse affects the whole family, and your feelings are important too. Make time for yourself, and talk to trusted family members and friends about your experiences.

‘Relapse’ is when a person in recovery uses alcohol or drugs. It can be a one-time occurrence or it can last for an extended period of time. Family members can help a person in recovery by looking out for warning signs a return to old behaviors, hanging out with friends who are using, unexplained absences. If you feel as though you are going to relapse or already have, contact the counselor or the doctor and ask for help.

Dr Sat Parkash

Holistic health encompasses total health of a human being in all four aspects of life — physical health, mental health, social health and spiritual health. Meditation promotes health in all these areas of life. Meditation regulates the physical responses of the body by eliminating stress and stimulating healthy hormones. It creates self-control thus enabling a person to remain free from negative influences and give the best in every role and situation. It empowers a person to deal with challenges in equanimity and positivity. Meditation alters the physiological and psychological response of the body remarkably. Reduction in heart and respiratory rate, and a drop in blood pressure suggest reduction in the level of sympathetic activity. Meditation aids the secretion of ‘healthy’ hormones such as endorphins and encephalon’s, which help, in detaching oneself from various kinds of pains. Meditation helps sustain deep relaxation even during active states of mind. Brain wave recordings of Rajyogis have shown alpha and theta waves even while they performed various mental and intellectual tasks.

The benefits of meditation go beyond relaxation response. A number of studies have critically investigated meditation for effective treatment of hypertension, diabetes, headache, anxiety, depression and heart disease. Meditation reduces the requirement of medication for pain and sleep etc. It is reported to be effective in de-addiction from drugs; alcohol, tobacco and can increase decision-making skills, overcome irrational fears, phobias and expand spiritual life.

One of the most subtle but critical factors that affect health is quality of our actions. The law of action is infallible — you reap what you sow. If we use our body to perform good and right actions then we will enjoy good health. Body is the temple in which the divine self resides. If we treat our body well then it will perform well. The seed of good actions is pure feelings and thoughts; hence, we have to make a conscious choice to nurture only pure thoughts. Everything that we suffer through our body is a debt of bad action that the soul is paying off. To enjoy good health we have to accumulate a stock of good karma by sharing the qualities of peace, love and joy in every thought, word and action.

Brain exercises
Memory is like muscular strength. The more we work out our brain, the better we will be able to process and remember information. Regularly exercising the brain keeps it growing and spurs the development of new nerve connections that can help improve memory.

Mnemonic to improve memory
Mnemonics are clues of any kind that help us remember something, usually by causing us to associate the information we want to remember with a visual image, a sentence, or a word. Common types of mnemonic devices include visual images, sentences, word, acronyms, rhymes and alliteration, joke etc.

Regular exercise
Regular exercise increases oxygen to our brain and reduces the risk for disorders that lead to memory loss, such as diabetes and cardiovascular disease. Some study found that it might enhance the effects of helpful brain chemicals and protect brain cells.

Managing stress
Stress cause release of hormone cortisol that can damage the hippocampus (important memory area of brain). Further, stress makes it difficult to concentrate.

Good sleep habits
Sleep is necessary for memory consolidation. Sleep disorders like insomnia and sleep apnea leave you tired and unable to concentrate during the day.

Not smoking
Smoking heightens the risk of vascular disorders causing stroke and constrict arteries that deliver oxygen to the brain. Indirectly it impairs brain function.

Nutrition
It is found that diet based on fruits, vegetables, whole grains, and healthy fats found in fish will provide lots of health benefits along with improving memory. Vitamins B, especially B6, B12, and folic acid protect neurons by breaking down homocysteine, an amino acid that is toxic to nerve cells. They are also involved in making red blood cells, which carry oxygen. Spinach and other dark leafy greens, broccoli, asparagus, strawberries, melons, black beans and other legumes, citrus fruits, soybeans rich in those vitamins.

Antioxidants found in berries, sweet potatoes, red tomatoes, spinach, broccoli, green tea, nuts, seeds, citrus fruits, liver destroy free radicals are highly reactive and can damage brain cells.

Omega-3 fatty acids are concentrated in the brain and are associated with cognitive function. They count as healthy fats, as opposed to saturated fats and trans fats, protecting against inflammation and high cholesterol. Cold-water fish such as salmon, herring, tuna, halibut, mackerel, walnuts and walnut oil rich in omega -3 fatty acids. Iron is also important for staying mentally sharp. It helps create hemoglobin, an iron containing protein in red blood cells, which transport oxygen to the brain. Oxygen in the brain is vital, since it helps to metabolise glucose.

If a child does not receive enough iron, it can impair brain development and lead to deficits in speech, math and reading.

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.

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.

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.