Mental health in Bangladesh: A generational far cry

Mental health has been traditionally a taboo subject in Bangladesh, and frequently overlooked at the policy level. The country has undertaken the first ever National Mental Health Policy 2022 this June, which is highly appreciated- better late than never! The mental health issue is one of the crucial targets of the SDG 3 (Health and Wellbeing: Ensure healthy lives and promote well-being for all at all ages). The target mentions-

• By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being

Among the health-related issues, the SDGs talk about, suicide comes directly among the thirteen topics, and several other topics cover mental health. At a global level, one of the largest disease burdens in 2017 comes from mental and substance use disorders (5 per cent). While the SDG-related official website, Our World in Data, observes that mental and substance use disorders form the top four health burdens across many upper-middle and high-income nations, in contrast with low-income or lower-middle-income ones, such as Bangladesh, it can be easily argued that lack of reported events of mental health issues is not a proof of the lower level of burden, rather it is simply an ignored issue in this country, where healthcare is a luxury itself, and mental healthcare is costly and stigmatized.

The Budget 2022-23 mentions the mental health issue as an “In addition”, where it explains the plan in one line: the project for the development and expansion of Pabna Mental Hospital to international standards and the establishment of full-fledged mental health unit at every divisional level medical college are going to be taken up. Furthermore, the budget envisions a plan to establish Bangabandhu Health City at Mohakhali, where it might be assumed that mental health will be a sub-section, regardless of size. The budget does not mention the specific allocation for mental health, which is nothing new for a traditional budgetary document. For instance, if someone looks for similar data in past observable budget speeches, i.e., publicly available ones online, the disaggregation is mostly absent, showing the level of importance it is being given by the respective authorities entrusted with the financial blueprint of the year. The mental health budget was specifically mentioned in the 2020-21 budget, with only 100 crores in allocation, which was the impact of the pandemic-related public concerns regarding mental health. As praiseworthy as it was as a starting step, the continuation of that effort has been absent, at least from budget speeches.

National Mental Health Policy 2022 is an adequate document in terms of contextualizing the mental health scenario in Bangladesh. According to the document, the budgetary allocation for mental health is on average, barely 0.50 per cent of the total health sector budget. As always, the policy document seems promising, but requires strong implementation and monitoring and evaluation of progress.

The country has been riddled with suicides, albeit from apparent “successful” or “youth” cohorts, who are dying due to mental health issues stemming from the socio-economic reality that is crippling the young generation. Unfortunately, what society does not understand, as proven by the floods of Facebook statuses after one dies, the kind of talk or intervention required to prevent suicide is not realistically available, not in the family, or surrounding friends and acquaintances. Suicidal thoughts are serious mental health conditions, requiring serious and unstigmatized interventions, medically. As we have learnt to accept the allopathy over homeopathy, or herbal solutions, which work in the long run perhaps, societal and informal interventions, are far less effective to solve suicidal tendencies.

Unfortunately, only DU has a department named Clinical Psychology, and Education & Counselling Psychology, where a bunch of therapists are being produced each year, the number is far less than optimal, and mostly private solutions, meaning costly, for a low-income or lower-income category of person.

Furthermore, the level of stigma around the apparent solutions provided in the universities is neither confidential enough, nor convenient due to information gap among students, teachers and everyone else. After all, nobody wants to be labelled as a “cuckoo” and people usually think that they need to be suicidal to access help, which should never be the case. Psychotherapy has the ability to help everyone, according to their necessity, and de-stigmatization needs to be performed by the upper portion of the pyramids, the teachers, and parents need to speak more openly and share their stories with the students or kids to encourage them to take help, since educational institutes are more or less like Hogwarts, help is always there once someone tries to access it!