The silent crisis: Overcoming barriers to mental health care access in Bangladesh
Bangladesh suffers from a 91% mental health treatment gap, which is unlikely to be filled in the near future unless we find alternative pathways to expand mental health services and care
Bangladesh struggles with natural and manmade disasters, poverty, social stigma and a growing refugee population. Each of these factors can negatively impact mental health conditions.
World Mental Health Day was celebrated on October 10th with the tagline "Mental health is a universal human right." Although mental health is a human right, unfortunately, there is an extreme shortage of resources in mental health services, and the shortage of mental health professionals stunts the nation's capacity to provide mental healthcare.
It is pertinent that we understand the crisis Bangladesh is in, accept that the stressors will not disappear, and find alternative, practical and doable initiatives that will address today's challenging conditions and lead to better access to mental health care in the future.
At every stage of life, mental health is important. It not only affects how we think, act and feel, but also how we cope with stress, interact with others and live a healthy life.
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Mental health disorders cover a large spectrum, including psychiatric issues like bipolar and schizophrenia to post-traumatic stress disorder (PTSD), anxiety and depression. There is a lack of awareness and education on mental health issues. As a result, many symptoms and early detection opportunities are easily missed.
This is even more so for psychosomatic conditions. Depression is identified as a leading cause of disability worldwide. About 5% to 25% of people go through depressive disorder during their lifetime.
Women are found to be more vulnerable to depression. Research shows that they are four times more likely to suffer from depression than men. The reason for this is a combination of biological factors, gender-specific roles, domestic violence and social acceptance of it.
Social stigmas around masculine norms also affect the mental health of men. This disorder not only affects the person who is going through it, but also their family and friends. Still, we do not see people getting the necessary attention. In low and middle-income countries, the situation is especially worse.
One of the primary and alarming problems in access to mental healthcare is the limited number of professionals in this field. The need is enormous, but the number of skilled professionals to provide the service is very low.
According to WHO, in 2020, 0.49 people worked in mental health facilities or private practice for every 100,000 people; among them are 0.07 psychiatrists, 0.182 other medical professionals with little to no training in psychiatry, 0.19 nurses, 0.007 psychologists, 0.002 social workers, 0.002 occupational therapists, and 0.028 other medical or mental health specialists.
Bangladesh also suffers from a 91% mental health treatment gap, and this gap is unlikely to be filled in the near future unless we find alternative pathways to expand mental health services and care.
Understanding society is crucial to implementing an effective and successful alternative. Bangladesh has its own dynamics, cultural norms and values. For example, in our family dynamics, it is common to have adult children living with parents, but that is not the norm in many other societies.
So when family dynamics lead to mental health issues, it is mandatory to understand the context in which the family resides and then to address the issue. We must consider that a model or process practised in one country and social context may not work in another country and context.
The BRAC Institute of Educational Development, Brac University (BRAC IED) has developed the BRAC Paracounsellor model. The core of this model is to develop community-based mental health and psychosocial support services. To do this, young women from communities are trained as paraprofessionals to provide service in their communities so that the people there can manage day-to-day stresses.
It is designed to be culturally relevant and takes into account the needs of the community. This model is currently successfully implemented in different parts of Bangladesh, including the Rohingya camps in Cox's Bazar.
As we suffer from an acute shortage of mental health professionals, it is necessary to create professionals who can work in this field. However, the reality is that there is no quick way to increase the number of skilled psychiatrists and psychologists since it requires rigorous training over many years to be able to create a pool of professionals.
Instead, we can develop paraprofessionals who can provide preventive and early mental health care and strengthen the referral process. Through strengthening the referral process, it is possible to channel some of the clients towards early care and also give opportunity to those who need more advanced clinical care to access necessary diagnosis and treatment.
The common practice for developing countries is to take practices and initiatives of the global North and replicate them in their own countries. A core problem in doing this is contextualising it since the problems to be addressed are bred in a different context. This is even more complex when addressing mental health issues.
In Bangladesh, we see the prevalence of stigma, social discrimination and isolation due to misconceptions about mental health issues. When we develop psychosocial support providers, we need them to be aware of this social setting.
As much as we need to grow professionals in this field, we also need to develop skills like empathy, active listening and non-judgmental attitude in teachers, care providers, administrators and social workers so that they can play an active role in preventive and early care for mental health issues.
The skills necessary to be a good psychosocial support provider can be developed with rigorous training. BRAC IED has been able to develop paraprofessionals through this process who have been providing effective and impactful service in many districts in Bangladesh and among the Rohingya population.
By developing skilled psychosocial support providers, it will be possible to reduce the existing treatment gap and provide early mental health care.
Erum Mariam, PhD is the Executive Director of BRAC Institute of Educational Development (BIED), BRAC University. Tabassum Amina, PhD is a Assistant Professor and Lead of Mental Health and Psychosocial Support Team, BRAC Institue of Educational Development, BRAC University.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
