by M. Tasdik Hasan and Tasnim Anwar, MSc candidates in Global Mental Health, Kings College London & London School of Hygiene & Tropical Medicine

Globally, common mental health disorders refer to two basic categories – anxiety and depressive disorders. Approximately 4.4% and 3.6% people of the world suffer from a depressive and an anxiety disorder respectively. These statistics vary in the World Health Organisation (WHO) Regions as depression rates are 3.6% in the Western Pacific Region to 5.4% in the African Region. At a global level, over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world’s population [1]. Depression, as stated by WHO, will be the leading cause of disease burden by 2030 [2]. In Bangladesh, the prevalence of mental health disorders amongst the adult population since 1974 to 2005 declined significantly between 1974 (31.4%) and 2005 (16.1%), albeit alarmingly high in 2005 [3]. The first national survey on mental health conducted in 2003-2005 revealed 16.1 % of the adult population had some form of mental disorder with a higher prevalence in women (19%) than in men (12.9%) [4]. Hossain et al, in their systematic review, show the prevalence of mental disorders including depression amongst children in Bangladesh at 13.40% to 22.9% between 1998 to 2004. [3,4]. The estimated prevalence of depressive disorders is 4.6% [5]. Unfortunately, mental health care is immensely inadequate due to a dearth of public mental health facilities, scarcity of skilled professionals, insufficient financial resource distribution and stigma.

This is underpinned by the absence of effective stewardship to effect adequate mental health policy [3,4]. With only 210 psychiatrists serving a population of 162 million, much of this population are prevented from accessing an available mental health service [6,7]. At present, there is only one national level specialised mental health facility in the country, the National Institute of Mental Health (NIMH) with limited human, research & logistical resources [6,7]. The country has long been in need of a new and comprehensive Mental Health Act, legislating established mental health care in the best interest of the Bangladeshi people, in relation to multidisciplinary action plans and care pathways. Though the drafting of an updated Mental Health Act began in 1982, there was no further progress in establishing a draft until 2002, which was revised several times [3,4]. Bangladesh adopted a mental health policy, strategy and plan as part of its’ effort in promoting surveillance and prevention of Non-Communicable Diseases (NCDs) in 2006 [8,9] and struggling to reap the best outcome from it.

Multiple challenges are responsible for this unfortunate scenario in depression and as a whole the mental health situation in Bangladesh, including dealing with old and inconsistent data related to mental health disorders. The estimated prevalence of depression is underestimated due to incomparable data between studies. Large-scale epidemiological studies are needed to update national statistics on depression, standardisation of diagnostic tools, estimation of incidence rates closer in accuracy and the burden of disease as well as the quantification of its’ impacts in the globalised language, such as DALYs.

Designing & implementing sustainable cost-effective interventions by conducting operational research to prevent & treat such disorder should be another research priority of the country. Implementation must be accompanied by ongoing research to examine feasibility, applicability and sustainability. Vulnerability should also be addressed during the design of these studies [3,4,6]. The international community must begin to make mental health a priority for Bangladesh and contribute substantial resources.

 

999 is the national emergency number in Bangladesh. 199 is the national number for ambulance and fire.

Kaan Pete Roi (http://shuni.org/) is an emotional support helpline in Bangladesh whose mission is to alleviate feelings of despair, isolation, distress, and suicidal feelings among members of the community, through confidential listening. The helpline is intended for suicide prevention and the promotion of mental health.

 

 

References

 

1. Depression and Other Common Mental Health Disorders: Global Health Estimates. (2017). [PDF] Geneva: World Health Organization, pp.8-15. [Accessed 7 Jan. 2018].
2. Lépine, J. P. and Briley, M. (2011) ‘The increasing burden of depression’, Neuropsychiatric Disease and Treatment, 7(SUPPL.), pp. 3–7. doi: 10.2147/NDT.S19617
3. Hossain MD, Ahmed HU, Chowdhury WA, Niessen LW, Alam DS: Mental disorders in Bangladesh: a systematic review. BMC psychiatry 2014, 14(1):216.
4. Anwar Islam, Tuhin Biswas. Mental Health and the Health System in Bangladesh: Situation Analysis of a Neglected Domain. American Journal of Psychiatry and Neuroscience. Vol. 3, No. 4, 2015, pp. 57-62. doi: 10.11648/j.ajpn.20150304.11
5. Gausia K, Fisher C, Ali M, Oosthuizen J: Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study. Archives of women’s mental health 2009, 12(5):351-358.
6. WHO-AIMS Report on Mental Health System in Bangladesh. (2007). [PDF] Dhaka, Bangladesh: WHO and Ministry of Health & Family Welfare. pp.1-20. [Accessed 7 Jan. 2018].
7. org.bd. (2012). Bangladesh Clinical Psychology Society. [Accessed 7 Jan. 2018].
8. Golam R., Helal U A. Mental Health Legislation and its implementation in South Asia: Bangladesh Perspective. WPA Berlin 2017 Abstract
9. DGHS: Strategic plan for surveillance and prevention of non-communicable diseases in Bangladesh 2007–2010