As a Bangladeshi-American medical student planning on pursuing the specialty of psychiatry, it became natural for me to ponder and question the condition of mental health back home in Bangladesh. Needless to say, I didn't have to search long, for there is a lack of documentation and research initiatives when it comes to mental health disorders.
While this is the scenario in most countries, even in a developed country like America, where mental health is largely ignored by many doctors and scientists, the optimist in me was definitely not expecting such a wide and hideous gap in care in the Bangladeshi mental health system. In fact, when I inquired about the ongoing active mental health research in the psychology department of the prestigious University of Dhaka, I was stunned to know that the elite educational institution simply had none in the works.
Through my own research, I came across a World Health Organisation (WHO) report that utilised the WHO Assessment Instrument for Mental Health Systems published in 2007. This report aimed to give Bangladesh a baseline knowledge with regards to the status of the mental health system in the country. I found some of the findings and statistics to be quite outrageous and unacceptable, but they must be made known to all Bangladeshi citizens.
First of all, while there is a coordinating body known as the National Institute of Mental Health in Dhaka, which promotes public education and awareness, there is no specific mental health authority in the country and mental health services are hardly organised. In addition, no human rights review body exists in the country to inspect mental health facilities, highlighting concerns of human rights abuse and misuse of power over the helpless.
To give you a more in-depth analysis of the status of mental health in Bangladesh, let me share a few more alarming statistics. According to the WHO report, mental health expenditures from the government health department is very insignificant and equated to less than 0.5 percent of the total national health expenditures in 2005. A national survey conducted in 2003-2005 reported that 16.05 percent of the adult population in Bangladesh are suffering from mental health disorders. I am sure that this number is highly underestimated, considering the stigma associated with reporting mental illness and also perhaps due to the lack of resources available to reach out to more remote populations in the country.
Furthermore, this WHO report pointed out some of the root problems in medical education. Approximately, a meagre 4 percent of the training for medical doctors in Bangladesh is devoted to mental health. For example, almost no primary healthcare doctors have received any refresher training in mental health. The number of professionals that graduated in 2006 from academic and educational institutions in psychiatry per 100,000 graduates is 0.0036 psychiatrists. Moreover, a large portion of these graduated psychiatrists emigrate out of the country. To make matters worse, very few primary care doctors actually refer patients to mental health specialists to begin with.
All of these findings from the WHO report highlights how disconnected Bangladeshi doctors are from the mental healthcare needs of their patients. I would go even as far as to state that the country is in a mental healthcare crisis. I understand that my statement will face criticism from people who state that while people are starving in the country, why should resources be allocated to mental health? But, I argue that mental health is tied not only to the wellbeing of Bangladeshi citizens but also to the productivity of the country. I recognise that Bangladesh is a developing country, but there is no excuse for us to not make progress in creating protective mental health policies and foster a learning environment inclusive of mental health.
It is no secret that mental illness is a sensitive topic for many Bangladeshi people, especially because of the discrimination that still strongly exists today. The fear and shame of being labelled a pagol, or crazy person, is enough to prevent people from seeking treatment. There is even stigma towards doctors pursuing an interest in psychiatry, which is not adequately stimulated. But, I think it is time for the educated Bangladeshi youth and citizens to rise up and demonstrate the courage to ignite the change needed desperately in this country with regards to mental health.
It is 2017; the future is here today. Thus, it is time that we as a nation and as a society give mental health the attention and priority that it deserves. We can no longer wait on our past tendencies and inherent biases to detract from the development of the resilient people of beautiful Bangladesh.
The writer is a medical student of the Florida State University College of Medicine, USA.