October 10 is World Mental Health Day. Before saying anything about mental health let us define health. According to World Health Organization (WHO), health is the complete state of physical, mental and social wellbeing and not merely absence of disease or infirmity. So, health has three components -- physical, mental and social. We do exercises to improve our physical health, but the other components of health are neglected, underestimated and undermined.
When the question of mental health comes we knowingly or unknowingly avoid, suppress, dampen or ignore it due to lack of knowledge or social stigma. But mental health is an integral part of our wellbeing. Good health is not possible without mental health. Mental health includes the state of mind, thought, emotion, volition, behaviour etc. Without all these human life is impossible. Our drive and action, sorrow and pleasure, speech and thought all depend on intact and sound mental health. We can very well imagine that without mental health all our abilities, performance and productivity will be meaningless. So, there is no alternative except to develop sound mind and sound health.
The extent of mental health and illness is surprisingly wide and complex. In a recent survey by WHO and Institute of Mental Health, Bangladesh, it was seen that 16.01% of population above the age of 18 are suffering from some sorts of mental disorder, be it be major or minor. This rate among children and adolescents is much higher (18.4%). That is, 1/6 of the total population has mental disorder. About 1.1% of the population is suffering from major mental disorder. The rate of drug addiction is about 0.6% to 1%.
The theme of World Mental Health Day of this year is "Depression: A Global Crisis" -- an important global issue. In Europe and USA the rate of depressive disorder is 5%-10%. In Bangladesh 4.6% of total population suffer from it. Depressive disorder is the 3rd highest ranking morbidity throughout the world and it is assumed that it will be number one by 2030. About 350 million people throughout the world are suffering from depressive disorder.
Depressive disorder is an illness of the mind, and is characterised by inability to feel enjoyment and pleasure, depressed mood, low drive and initiative, despair, helplessness, hopelessness, sleep disturbances etc. All these lead to less productivity and functional impairment. Individuals suffering from depression see the world as negative in every sphere. They are pesssimistic and negativistic. Often, these thoughts lead to suicide, and that is the dangerous part of depressive disorder.
The hope and positive side of mental disorder is that, like all other illnesses in medical science, the causes (etiology), course and prognosis of this illness are known. Mental disorder can be explained in a scientific way. The causes of mental disorder can be broadly based as biological, psychological and social. Almost all mental disorders are caused due to increase/decrease /derangement of a chemical in the brain called neurotransmitter. So, mental disorder is not caused by "ghosts," "jins," "poris," evil spirits, etc., nor by Shaitan. Mental disorder can be treated successfully by medical science as the causes are known to us.
Unfortunately, due to our ignorance, social stigma, lack of facilities and expert manpower, people with mental disorder are deprived of proper health care service. They are inhumanely chained, mercilessly tortured and occasionally beaten. Sometimes they are treated by jhar-fhukur, kabiraj, ojha, baiddhya. They areforced to live a homeless, loveless life. They are called "mad" even by close relatives, which worsen the mental disease.
Despair about mental health is endless. For the whole country of 16 crore population there are only 200 psychiatrist and 2,000 hospital beds (govt. and civil) only for mental patients. About 0.44% of total health budget is spent for mental health. There is no hospital bed or even psychiatric out- patient department in the big/elite private hospitals.
Now is the time to understand the scientific basis of mental disorder. It is of paramount importance to bring the unfortunate mentally ill people to health care service. Creation of awareness among the people is an important factor in helping them. The media can play a vital role in building the awareness. Personal, familial, institutional and political commitment can bring positive change in this neglected sector, and can help build a healthy nation with sound mind.

The writer is Senior Psychiatrist, CMH Dhaka.