In Bangladesh, people talk less about mental health. People's attitude towards the issue is not that much positive. Stigma is associated with them having mental disorder. In this country, people with mental illness are categorised as ‘lunatics’. This adds to a destructive cycle of the patient's guilt, pain and loneliness. Because of the shame associated with mental illness, families continue to keep them who show visible symptoms of mental illness hidden from the public view. Because of common worries of lack of trust, peer pressure, and a lack of knowledge to understand mental health issues or awareness about mental-health-related services, people, mostly adolescents and youths, do not seek assistance for mental health problems. Most of the time, they do not even realise their need for help and blame themselves for the situation. The stigma associated with mental health as well as lack of access, affordability, and awareness lead to significant gaps in treatment. The international community, in the meantime, has identified Bangladesh as a country with a vulnerable record in the mental healthcare sector.
Adolescence is a transitional period from childhood to adulthood. Various physical, emotional and social changes, including exposure to poverty, abuse or violence, make adolescents (aged 10 to 19 years) vulnerable to mental health disorders. According to an estimation of the World Health Organisation (WHO), members of this group comprise 10.2% of the country’s total population, and a considerable number of them suffer from suicidal behaviour, anxiety, loneliness, lack of close friends and substance use (i.e., tobacco, cigarette, marijuana and multiple substances).
With only 260 psychiatrists serving a country of 162 million, much of the population is unable to access mental health services. There is currently only one national-level mental health institute in the country, the National Institute of Mental Health (NIMH), in Dhaka. A 200-bed mental health hospital comprises part of the NIMH, with an additional 500-bed psychiatric hospital located nearby. Moreover, an additional 15 beds exist in forensic in-patient units and 3,900 beds in residential facilities, including in-patient detoxification centres and homes for people with severe neuro-developmental disorders. A few substance misuse treatment and rehabilitation facilities are organised by private practitioners and unregulated. At the community level, 31 psychiatric in-patient units exist, which account for only 8% of the total number of hospital beds in the country. There are currently 50 out-patient mental health facilities in the country, but the majority of them are located in urban areas. Available private mental health services are too expensive for the sufferers to afford. As to why, mental disorders place a considerable economic burden for them.
Adolescents carry the future of the nation. Mental health is of great significance for their physical, cognitive, and academic progress. There is a critical need to cater to their mental health needs. Mental health requires more candour and more unashamed conversation. It is important to acknowledge that mental illness is a medical condition that should not be combined with some form of self-blame. Therefore, healing from it should be treated as a phase similar to recovering from any other physical illness. It is of utmost importance to destigmatise mental illness and be willing to talk about it, rather than taking a defensive posture and looking for an escape path. Acknowledging the extent of the issue would be the first step towards addressing the mental health crisis. The next step would be to take initiative towards making mental healthcare more accessible, with targeted interventions for vulnerable groups.
There is an urgent need to counter the notion that mental health exclusively means the absence of mental illness. As per definition of the WHO, mental health is a state of well-being, where an individual realises his/her capabilities, can cope with the normal stresses of life, work productivity and is able to contribute to their community. The global organisation recommends for providing mental health services as part of the general healthcare system. Access to mental health services is not limited to only those suffering from mental health conditions, but also to those facing challenges at a lesser intensity. Access to mental healthcare is a human right. Careful mapping and research should be done to produce quality data, which is essential to understand the size of the problem. This in turn should be utilised to implement a comprehensive approach, supported by heightened political commitment, scientific understanding and a citizen-driven movement.
Developed countries allocate 5-18% of their annual healthcare budget on mental health, but in our country, it is quite the reverse where the issue of mental health remains ever-neglected. According to relevant sources, the current mental health expenditure is only 0.44% of the total health budget. Less than 0.11% of the population has access to free essential psychotropic medications. Of all the expenditure on mental health, 67% is dedicated to mental hospitals. Daily out-of-pocket expenses for the lowest-priced antipsychotic and antidepressant medication are 5.00 taka and 3.00 taka respectively. Health insurance is a rarity and, in any case, typically does not cover drugs for mental illness. The need of the hour is an official acknowledgement that mental illness has a significant socio-economic impact on the overall health of the country, and until there is sufficient investment to promote awareness, education, and infrastructure, mental health issues will cause damage to the economy. It is an expectation of the countrymen that the government will realise the gravity of the situation and take measures to enhance allocation for mental health in the upcoming national budget for the very interest of the nation.