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     Volume 9 Issue 12| March 19, 2010|

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Human Rights

Right to End the Madness

Anika Hossain

Psychiatric patients locked up in cells at the Pabna Mental Hospital.

Sanam Khan's son Shadman (not his real name) had been suffering from schizophrenia since he was 20 years old. When his symptoms started to surface, Sanam and her family were living in New York, in the U.S. Shadman was a fun-loving, outgoing person who had many friends and would spend most of his time with them. However, soon after he turned 20, Shadman became withdrawn and quiet, and became very religious. He would talk often about Islam and would pray whenever and wherever he felt like it, sometimes more than five times a day. He also read a book by the Dalai Lama at the time and started to meditate. When he went back to college to start a new semester, his counsellor called his parents to inform them that he was unable to perform well in his exams because he had a psychological illness called obsessive-compulsive disorder (OCD).

Both his parents brought Shadman back home to live with them. He continued to go to classes for some time, but always complained that people stared at him in class. At this point, his parents started to notice that he was refusing to take any calls from his friends and preferred to keep to himself. He was still praying all the time and sometimes even reciting the Azaan in public places such as bus stops and subway stations. His parents called a few of their psychiatrist friends and asked them for help. They all diagnosed her son with schizophrenia and prescribed medication, which she gave him mixed with milk every night. When he realised this, her son stopped taking the medication and became extremely angry and violent. Unable to control the situation, Sanam called a crisis centre and asked for help. This crisis centre sent over a doctor and a nurse and they were able to explain her son's illness to him and persuade him to take his medication. Soon after, Sanam and her husband moved to Holland. Her son initially did not want to leave NY, but realised he would not be able to care for himself if left alone. He moved to Holland but was not happy there. He became alone and his symptoms worsened. His parents finally decided to hospitalise him. The hospital he was admitted to was a beautiful one with large grounds and individual cottages for each patient. He started to improve soon and became an outpatient after only a few months.

After a while, Sanam and her husband moved to Pakistan. Her son continued to take the same medications for a while, but refused to do so after a few months. His symptoms returned but were not severe. When she returned with him to Dhaka, things got worse. Desperate, she contacted a mental institution in Dhanmondi and requested them to admit her son. When the clinic staff arrived to take him, she noticed they had brought ropes with them to tie him up which she thought was unnecessary since she had given him sleeping pills before they had arrived. She was shocked that they would consider restraining a patient before assessing his state of mind. When she arrived at the clinic she noticed that it was filthy and unhygienic and most of the patients were tied with ropes, which she considered a serious violation of human rights. A hospital attendant who was not a qualified treatment provider, suggested that he slip a drug into Shadman's drink and hypnotise him, which Sanam refused. Outraged by what she had seen, she had her son discharged the very next day and refused to take him to any Bangladeshi hospital since then.

Psychiatric patient at the Pabna Mental Hospital

The World Health Organization (WHO) has defined health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” Mental health, which is a significant part of our well being, has been grossly neglected in Bangladesh. Although 5 to 6 per cent of the total population of this country is affected by mental illnesses, only 0.5 per cent of the total healthcare budget is allocated toward mental health. Not only is there a lack of resources to cater to the needs of this population, the laws protecting these people are backdated and obsolete. The Lunacy Act, established in 1912 is still in affect in Bangladesh. India and Pakistan have both repealed this Act, which does not even protect the basic rights of people suffering from mental illness. The Lunacy Act suggests that all mentally ill patients must be sent to asylums instead of hospitals where they would have a better chance of recovering from their condition.

In Bangladesh, there is a total of 120 psychiatrists and 39 clinical psychologists, leaving one treatment provider for 15 lakh people. Studies have shown that there are currently 14 lakh people in Bangladesh suffering from bipolar disorder and schizophrenia. Psychiatric wards have been established in most government hospitals. Some institutions such as the Pabna Mental Hospital, Dhaka Medical College and BSMMU are making an effort to train their staff and work on various research projects involving mental health, however, the lack of a proper budget and resources prevent them from making any significant difference in the situation. The lack of doctors, trained nurses, availability of proper medication, hospital beds and resources have left mentally ill persons forcibly restrained, caged or hospitalised in dirty, unhygienic, brutal environments. Furthermore, mental health is not even included in the current healthcare policy.

The lack of awareness and knowledge about mental illness in this country also contributes to this problem. The stigma around mental illness in Bangladesh has forced the mentally ill population to the fringes of society, denying them their civil, political, economic, social and cultural rights. It also negatively impacts their access to care and chance of social re-integration, forcing them to turn to local healers for help. Mental illness has become something to fear, be ashamed of or to laugh at. This illness not only affects the patient but their families as well. Most people hide mental illness for the fear of being shunted from society. For these reasons, the psychiatry is not considered a career option for most Bangladeshis. Although attempts have been made by organisations such as the Disabled Peoples' Organisation in Kushtia which has participated in a conference that attracted media attention world wide, and attempts made by several NGO's local and international to raise awareness through rallies, consultation meetings, conferences, television programmes etc, very few changes have been made in the situation at the grass root level and the general lack of knowledge and information is still prevalent.

In order to improve this rapidly deteriorating situation, the government must start taking serious measures. Studies, suggestions and research have pointed toward certain changes, which need to be made in the immediate future. First and foremost, the government should take steps to repeal the outdated Lunacy Act inherited from the British and replace it with a new and improved act, which will incorporate the rights of the mentally ill population. It should also include mental health in its overall healthcare policy. The government must allocate more funds and resources toward mental healthcare and encourage private organisations to contribute to the cause. The government must also arrange for rehabilitation programmes and welfare funds for people suffering from severe, chronic mental illness.

Extensive research must be done on mental health and the findings, including statistics and surveys must be stored in information banks along with information about services provided for this population at a national level. Mental Health should also be integrated into the primary care system. Most people in Bangladesh do not recognise the need for or seek psychiatric help. Research shows that about 1/3 of the population of Bangladesh seeking primary healthcare services suffer from mental illness. If primary care providers receive training to recognise the basic symptoms of mental illness, proper treatment can be given at an early stage before the patients' condition worsens. The government should encourage the study of psychiatry by offering scholarships and financial aid. It should also incorporate psychology into our academic systems so it is easier for people to understand the difficulties a mentally ill person goes through, and instead or taunting them and being frightened of them, people are more sympathetic and accepting of these persons. Sensitising the media and preventing discriminatory material from being televised is also another step the government must take to reduce the stigma that surrounds this issue. Overall, establishing a more efficient health care system clean, violence free and therapeutic environments, improved admission policies at hospitals are just a few of the things the government should focus on to bring about significant changes.

Sanam Khan's son is still living in Dhaka. He has shown vast improvement since he started seeing a private psychiatrist. He has his bad patches during which he remains home and his parents do their best to take care of him. He is now working for an uncle and is trying to lead a normal life. His mother has shared her experiences in public gatherings, and with the media hoping that sharing her experience will help bring about the realisation that the madness lies more in the system than in the people seeking help from it.


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