O V E R V I E W
Bangladesh is a densely populated country located in South Asia. Similar to its bordering countries there is a huge stigma attached to mental illness and mental wellbeing in general. Stigma is defined as a mark of disgrace that sets a person apart from others. When a person is labeled by their illness they are no longer seen as an individual but as a part of a stereotyped group. Common labels for those with mental illness are — mad, crazy, or psychotic. These constant negative connotations towards health can lead people to feel embarrassed or misunderstood, thus preventing them from seeking the care they need. Now that brings me to the question, Should we truly be upset at those who enforce these stigmas, or is the lack of education and understanding to blame? Moreover, is this problem even being actively prioritized and addressed by the Bangladeshi government? Only a small percentage of people in Bangladesh seek professional treatment. Some are in utter denial while others take dangerous routes. Unfortunately for some, professional treatment has been replaced by non-evidence-based “treatments” such as traditional healing practices, homeopathy, etc. As a result of these factors, illnesses are left undiagnosed and the stigma continuously grows larger and larger. Without a doubt, these problems are a challenge to combat as they are deeply rooted in the cultures of many.
What YOU need to know:
To find a possible solution we must first understand the problems at hand. Here are the 5 main issues Bangladesh is currently facing in terms of mental healthcare:
1. There aren’t enough mental health facilities to accommodate the population & there is a shortage of mental healthcare workers:
Despite having a population of around 163 million there are only 50 outpatient mental health facilities available, 4% of which are for children and adolescents only. The scarcity of mental health facilities available for the ENTIRE country is alarming especially in comparison to its ever-growing population. In addition, these facilities only treat about 26 users per 100,000 of the general population. It is evident that the country is in need of dire change. Bushra Sultana, a psychiatrist at PHWC, one of the leading counseling centers says that private health sectors lack the capacity to treat patients effectively because there are very few mental health professionals (about 220 psychiatrists in the whole country), scarce inpatient services which deliver quality care, and accommodation. Facilities that do deliver quality care tend to accommodate either the wealthy or foreigners due to high price ranges. This places the more impoverished percentage of the population at a substantial disadvantage causing them to take dangerous routes.
2. Lack of education:
By discussing mental health more openly we can create a more empathetic and understanding society. As the local education system avoids conversations surrounding mental health, the local psychiatrist explains that the only way to help those who may be struggling is to first remove the stigma attached to mental illness and accept it as any other medical condition. It will be difficult to treat people if you don’t believe that they are worthy of being treated or. She also adds that rather than relying on the education system to teach us, we must actively learn and spread our knowledge with peers and family members.
3. Due to the stigma, people are afraid to seek help:
In 2019 the National Institute of Mental Health conducted a survey to explore the mental health scenario in Bangladesh. According to the survey, 14% of children aged 7 to 17 suffer from mental health issues and a large majority of them — 94.5% do not seek medical attention. Moreover, when people face problems with mental disorders 5.7% of them think if they visit psychiatrists, they might be treated as mad. This not only reflects the stigma but the lack of trust citizens have towards their healthcare system. “Guided by theory on stigma, a Likert-type scale was developed to measure 7 factors of attitudes toward people with mental illness: interpersonal anxiety, relationship disruption, poor hygiene, visibility, treatability, professional efficacy, and recovery.” The survey conducted by the NIMH also indicates that mental illness is highly stigmatized as the average stigma score the country received was 4.5 out of 7 on the stigma scale.
4. Lack of prioritization from the government:
Ms. Sultana explained how the government fails to allocate enough funds towards mental health making it inaccessible and also quite expensive. There is a need for the development of adequate infrastructure, logistics, and workforce support, as well as the establishment of multidisciplinary teams of management and clinical services. She encourages organizations in the private sectors to take the initiative to create an infrastructure that doesn’t depend on government funds and is still sustainable as a mental health service.
5. The rise in malpractice as a result of non-evidence-based treatments:
Of the 56% of treatment seekers, 33% avail of treatment from private psychiatrists, while 23% approach Ayurvedic, homeopathy, or neuropathy psychiatrists. ADD international says in their article Tackling mental health stigma: “With such scarce infrastructure, clinics, or services to access for support, it can be difficult to know who to turn to. In this void of information, dangerous myths spread quickly. Myths about evil spirits; about people with a mental illness being possessed by the devil.” One example of the dangers of seeking non-professional aid is that there are some practices where the patient is buried with soil up until their necks and left there for 48 hours to purge out demons. This is only one example of the many dangers of non-evidence-based treatments. Traditional healing does have its benefits however because of the trust between the healer and their client. This trust may uplift their mood and give them the impression that they are better. However, when it comes to mental illness especially in severe cases these treatments can be fatal. Eradicating traditional healing practices or homeopathy is a challenging task due to its long history and cost-effectiveness. Traditional healing practices however are widely used as primary healthcare in rural areas of Bangladesh, whereas in the more developed area it is still used but less due to their increased accessibility.
M Y R E S P O N S E
Taking all these factors into account I decided that the most productive way of reducing the stigma and helping make mental healthcare more accessible to people of Bangladesh is to create a helpline. At first, I had the idea of creating an app where the general public can connect with mental health professionals virtually. Through this, they will be able to ask questions and ultimately seek the help they need. Although, I believe that this is a great idea it would only benefit the wealthier side of the population which is not my main aim so I decided to scratch this idea as it only caters to a small proportion of society and my main goal is to find a viable solution that may help the entire population. I learnt that in Bangladesh, there is an app called Maya that caters mostly to women by providing them with a safe space to talk about any issues ranging from reproductive health to mental health. I believe that this is a great idea, however as it is an app it requires a smartphone or device able to connect to WIFI and. Many people in my local community have access to phones but not all have access to smartphones. I figured that with a helpline, those who can’t afford smartphones or internet access/don’t have them are still able to call. One option would be to partner up with Maya and have my helpline complement their app, that way those with access to smartphones and those with regular phones will still be able to receive help. This will be a better way to maximize the outreach.
So, how will this work?
CALL — GET ADVICE — SEEK THE NECESSARY HELP
- To spread the word posters including the helpline’s number will be posted around the country and informational posts will be shared on social media. Moreover, the poster would be in both Bangla (the national language) and English
- A helpline is a toll-free number and a mental health professional will be on the receiving end. Professionals from abroad will be included & there will be both English and Bangladesh speakers available to help
- In addition to this, I would create a website where people could get access to more information as well as a diverse group to advocate for mental health. While living here, I have barely heard conversations about mental health as it is such a taboo topic. By advocating the government may finally allocate the necessary funds and as a result make these facilities more accessible and potentially even more cost-effective.
s a m p l e p o s t e r
H O W C A N Y O U H E L P ?
To reduce the stigma surrounding mental health we must make efforts to normalize it in our society. We can do so by:
- Educate yourself & others about the importance of mental health
- If you are comfortable with it share any stories of your experiences
- Have open conversations with families and peers about any concerns you may have
- Listen to and support others with mental illness
- Seek help if you need it — talk to your school counselor, tell a trusted adult, try therapy, etc.
a d d i t i o n a l r e s o u r c e s
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Thank you so much for reading my project. Before you go, in the comments please let me know:
- Does your country have a stigma around mental health? If so what ideas do you have to help your community?
- Does your country have a shortage of mental health facilities and professionals? How can we possibly advocate for better care and access to care?
- What ideas do you have to make healthcare more accessible especially to the less privileged members of society?
If you have any further questions or comments please feel free to let me know in the comment section. Thank you!