The case for discussing mental health openly

Dhaka,  Tue,  19 September 2017
Published : 13 Apr 2017, 21:29:31
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The case for discussing mental health openly

Shihab Sarkar
People touched in the head are targets of ridicule in almost all societies. In backward communities, the deranged people are looked down upon or marginalised --- and even persecuted in many cases. Bangladesh is no exception. Mentally challenged people in this country are generally viewed as subjects of fun. 'Insane' males or females loitering in the streets are a common sight in the country's cities. 

This year's World Health Day on April 07 focused on mental health. The theme chosen for the occasion was 'Depression, Let's Talk'. According to various studies, a significant segment of Bangladesh's population is mentally ill with many at vulnerable stages. It has been noted that the number of mentally unsound people are on the rise in the country. According to a study, globally 322 million people of all ages and from every walk of life suffer from depression. Of them, 6.0 million people reside in Bangladesh with different psychiatric complications.  One per cent of them are children. Depression assaults people in all countries irrespective of their socio-economic status. However, the causes of this ailment vary. In the highly developed countries, too much affluence and the consequent contentment may lead to boredom. In the long run, this state of mind may result in depression.

In the low- and middle-income countries, social deprivations and obsessive anxieties create grounds for many hard-hit people to become mentally sick. They suffer from different types of psychiatric complications. In the developed countries depression, or, for that matter any kind of psychiatric malady, is free of inhibitive secrecy. Like with any physical illness, the patients in these countries do not feel embarrassed to discuss their problems. But relatives and the persons afflicted by the disease in Bangladesh are found to be reluctant to talk about the subject. In the rural areas, the female depression patients in many cases are branded as being possessed. Social stigma keeps hounding the mentally challenged people in general in the country. If they are young women, the disease invariably stands in the way of their marriage. Parents feel doomed if their daughters happen to show the symptoms of a mental disorder. Finding themselves nowhere, many of them marry their daughters off if the state of their ailments is not too severe. They hide the problem. Dire consequences await a lot of them, as mental diseases are generally progressive. If the ailment is kept untreated for long, it may turn furious. Few of the people in the rural area are aware of the fact that mental diseases are curable.

Medical research in the advanced countries has continually been breaking newer frontiers in the treatment of depression and all kinds of schizophrenia, bipolar disorder, etc. Facilities for treating mental diseases are poor in the developing countries including Bangladesh. Specialised doctors are few; those studying in the multi-branch medical discipline show little interest in pursuing career in psychiatry, as it has few prospects. Yet a few students do enroll on the psychiatry department. Many of them with brilliant results leave the country after landing highly-paid jobs overseas. The rest remain stuck in the country, trudging along with a lacklustre profession. Engaging in the practice of treating mental patients in this country turns out to be a test of patience and endurance. In a country where the general healthcare scenario is beset with scores of glaring drawbacks and irregularities, the amount of government attention drawn by a specialised area like psychiatry is understandable.

The mental health department is regarded as one of the most low-funded in the health sector of Bangladesh. Outside the public and private hospitals in the big cities, virtually no upazila-based health complexes have facilities for treating mental patients. A number of the larger hospitals and institutions are government run and have well-equipped mental health wings. They mostly cater to the needs of urban patients. Apart from the National Institute of Mental Health and Research and Bangabandhu Sheikh Mujib Medical University (BSMMU), psychiatry departments with treatment facilities are available at the government medical college hospitals. The mental health scenario, however, is dominated by the Mental Hospital in Pabna, which is the oldest psychiatric institution in the country. 

Bangladesh has of late developed basic infrasture required for treatment of mental disorders. Over the last few decades, its institutions have produced a number of expert psychiatrists. But against the fast rising patients suffering from depression, schizophrenia and other diseases, they do not seem sufficient in number. What ails the country's mental health sector the most is the lack of effective set-up and management. The system as a whole remains inaccessible to a large number of patients coming from distant rural areas. Moreover, in spite of the dedicated service of the expert doctors, the sector is beset by a dearth of enough mid-level experts. On the other hand, the urban areas these days have become used to the mushrooming growth of poorly skilled and rookie psychiatrists. These so-called experts, in fact, aggravate the mental health of many patients leading to complications.    All these point to the sorry state prevailing in the mental health treatment sector in the country.

In order to cope effectively with the challenge of mental disease treatment, the prime focus should be on the recognition of the ailment as a normal one. At the same time it has to be cleansed of the age-old social stigma and the associated inhibitions. This is important because the educated and enlightened segments of society too are not free of this prejudice. A mentally challenged adult relegated to a pariah state in the family is a common sight in the country's cities too. However, the situation is changing for the better, with the rise in awareness and compassion surrounding mental patients. Mental patients are mindlessly persecuted in the rural areas, with many facing tragic deaths in extremities. Well concerted advocacy campaigns explaining mental disorders can go a long way towards a practical way out. 

Like in many developing countries, depression, along with its complications, is largely a taboo subject in Bangladesh. Even the visits to a psychiatrist's chamber are kept in high secrecy. On the other hand, previously ill people in the developed societies are found talking normally about their treatment at mental hospitals. Mental diseases are complicated with many of its aspects still remaining unexplained. With the changes in man's life-style newer intricacies keep cropping up. The human mind cannot always take the load of these complications. Upon remaining lost in abysmal recesses, they at one point arrive on the verge of mental breakdown to collapse finally.   In many affected people, the disease remains mostly suppressed or hidden, with occasional outbursts. In many societies, they are also not spared.

Mental disorders are not the ones to be taken lightly. Like physical diseases, psychiatric ailments also take their toll on a nation's untapped potential. Unlike the developed countries, the battle of a developing nation like us ought to begin from the very elementary level. It comprises a radical change in attitude. 

shihabskr@ymail.com
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