Time to make mental well-being a priority
Fairooz Faizah Beether, a fourth-year student of Khulna University, recently received the 2021 Goalkeepers Global Goals Changemaker Award from the Bill & Melinda Gates Foundation. Fairooz is one of the co-founders of Moner School, a youth-led platform that is working on increasing mental health awareness. The team consists of para-counsellors who offer critical primary counselling to young people, and refer them to expert mental health professionals. This initiative is very encouraging, especially when mental health still remains a taboo subject in Bangladesh.
According to the World Health Organization (WHO), "mental health is a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community." Myriad social, psychological, and biological factors determine the level of a person's mental well-being at any point of time.
On average, around 10,000 people die by suicide in Bangladesh every year, says the Bangladesh Bureau of Statistics (BBS). According to a 2018 survey on mental health jointly conducted by the government and the National Institute of Mental Health, the overall prevalence of mental disorders among the population 18 years and above is 18.7 percent.
Suicide is the second leading cause of death globally among 15- to 29-year-olds, while depression is one of the leading causes of disability, according to WHO. Mental health has been included in the Sustainable Development Goals (SDGs), which is an acknowledgement of the importance of mental health in achieving global development. The Covid-19 pandemic has led to an increased understanding of mental health issues in different parts of the world.
Mental health challenges are still a big problem in Bangladesh due to a lack of awareness as well as a shortage of trained professionals. There are only 270 psychiatrists and roughly 500 psychologists for the entire population of over 160 million. Of them, the majority are based in urban areas. The allocation for the mental health sector in the government's budget is less than one percent.
The stigma attached to mental health continues to be a problem in Bangladesh, and there are many misconceptions surrounding this issue. Some people—especially in rural areas—turn to traditional healers for cure. These practices sometimes lead to human rights violations and may have fatal consequences. In our society, in both rural and urban settings, the majority of people are not aware that anyone can suffer from mental health problems, and when that happens, we need to seek support as we do when we face physical health challenges. People are generally insensitive regarding mental health issues, which is reflected in the jokes they make. Sometimes an entire family is ostracised and isolated due to one of their members suffering a mental health challenge. This is a major reason why most people in our society tend to hide their mental issues and even remain in denial about their conditions, which only aggravates their sufferings.
For many, anyone with a mental health challenge is "mad." They think there must be something "wrong" with the person or they are to be blamed for what has happened to them. This attitude is a major hindrance towards normalising mental health, and for the survivors to disclose their states. "I told my daughter not to tell anyone that we are taking her to counselling," said a mother of a 15-year-old girl. The mother was trying to protect her daughter from getting stigmatised in society. I am aware of professionals who don't mention "depression" as a cause for their sick leave, as they fear discrimination by their colleagues. Due to the judgemental and discriminatory attitudes of society, many mental health problems remain undiagnosed or are being diagnosed very late—and the delay in treatment makes it more difficult. Most mental health issues could be treated with effective interventions. A well-respected psychiatrist in the country once told me, "I feel sad that many people in Bangladesh unnecessarily suffer from some mental health issues that are chronic manageable conditions."
Bangladesh passed the Mental Health Act in 2018, replacing a 106-year-old piece of legislation. The act aims to protect the property rights of those suffering from mental illnesses, and includes provisions for mental health services. While the act faces some criticism, increased attention on mental health through legislative action is a step in the right direction. Bangladesh finalised its National Mental Health Strategic Plan in 2020 and has started implementing it. But there is still a long way to go to ensure mental health support to all those who need it.
Mental health is fundamental to our collective and individual abilities to think, interact with each other, earn a living, and celebrate life. The awareness and protection of mental health should be regarded as a vital concern for individuals, communities, and societies. We must prioritise maintaining sound mental health if we are to remain truly healthy and realise our potential to the fullest.
The government should make mental healthcare a part of its primary healthcare system at district and upazila levels. Training should be provided to the existing medical professionals and others on mental healthcare to meet the shortage in human resources. There is a need for increased investment in mental health awareness, and for increasing access to quality mental healthcare and effective treatment options.
Having a mental health problem is not anyone's fault or failure. If there is a change in someone's behaviour or lifestyle, and they seem to be unable to function properly in their day-to-day life, then professional support must be sought for proper diagnosis and support. Nobody should feel ashamed of having mental health issues and suffer in silence.
"I can treat my bipolar mood disorder, but I cannot treat your attitudes towards me"—this is a statement from a campaign on mental health in Australia. In addition to appropriate medication (if required) and counselling, it is important to have a healthy lifestyle as well as a supportive network of family and friends to maintain a functional life while facing a mental health problem. It takes a huge amount of courage, determination, and patience to manage the condition. Let us have empathy and understanding as family members, friends, colleagues, and neighbours, and support the people who are brave enough to fight mental health issues. Let's not make our attitude another challenge for them.
Laila Khondkar is an international development worker.