Legal framework for mental health inadequate
According to the National Mental Health Survey in Bangladesh (2018-19), some 17 percent of Bangladeshi adults are undergoing mental health problems.
Amid the pandemic, mental health issues have worsened. The availability of services, however, is grossly inadequate and has been this way for long. The pandemic has only unmasked the existing crises permeating the mental health care sectors in general.
A recent report by The Daily Star reveals Pabna Mental Hospital, the main public hospital in the country, is grossly understaffed and has only 500 beds. Of the 25 allotted posts for doctors, 13 are vacant.
The higher authorities have repeatedly been urged by the hospital management to take actions, but nothing has happened.
All these information reveal how grossly neglected mental health is at the policy level.
We do, however, have a law regarding mental health which needs to be revisited. The outdated Lunacy Act of 1912 was replaced by the recently enacted Mental Health Act, 2018.
The Act entrusts the government with the responsibility of regulating, developing, controlling, expanding and co-coordinating the activities associated with mental health services. It requires forming "mental health review and monitoring committee" with deputy commissioner as the president in every district.
It obliges the government to ensure right to education, property, health and honour of the mentally ill persons and requires formulation of rules for their proper implementation.
The current irregularities at the mental health hospitals (from leaving the patients at the mercy of brokers to not rendering quality treatment) and the inadequacies of services are inconsistent with what the act in general envisions.
The fact that the grassroots level mental hospitals do not reflect what the law says, helps us perceive that there is lack of a proper monitoring scheme to oversee the effective implementation of the law.
The act further states that the government may establish mental hospital, medical college or separate unit for mental patients in the district level hospitals. It also states that rehabilitation centre for mentally ill patient may also be established with prior approval of the government.
The primary problem is that these provisions are not laid down in obligatory terms and they do not create accountability for the government in case of non-implementation.
Furthermore, the act does not address the economic burden of the mental health care system since it makes no reference to budgetary allocation.
Many experts stressed the need to rethink the definition of "mental disorder". The act fails to lay down mechanisms for ensuring the accountability of those who violate human rights of the persons with mental health issues.
Experts are also of the view that the new act fails to address mental health professionals or community focused psychiatrist and acknowledge issues such as maintaining confidentiality of patient's details.
From a legal perspective, the law needs to be made more inclusive and the budgetary allocation for mental health sector needs to be properly considered by the government, they added.
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