A roundtable discussion titled “Mental Healthcare Systems and Services in Bangladesh: Addressing Rights of the Most Marginalized Population to Mental Health Services,” stressed the rights and importance of mental health services for persons with disabilities. The event was jointly organized by CBM Global Disability Inclusion, CDD, and Handicap International-Humanity and Inclusion, in association with Dhaka Tribune at a hotel in Banani.
A study titled “Prevalence and Predictors of Mental Health Conditions among Persons with Disabilities,” conducted by the icddr,b and the Centre for Disability in Development (CDD) revealed the prevalence of depressive and anxiety symptoms among persons with disabilities as 73.8% and 62.6%, respectively, while 55% are suffering from symptoms of both. Moreover, women are 3.21 times more likely to suffer from depressive symptoms compared to men, according to study.
Another study titled “Impact Analysis of Individual Non-specialized Focused MHPSS Service for the Vulnerable Population of the Rohingya Community,” conducted by Handicap International - Humanity & Inclusion, found that, after completion of the individual mental health and psychosocial counseling services, 29% of the people faced the same problems again after 6 to 10 months of discharge. It also reported that 27% of people mentioned manifesting different kinds of psychosocial problems.
It also reported that 84% of respondents effectively cope with their symptoms using the gained interventions, whereas this effectiveness has been found in 81% of the total persons with disabilities coping with their symptoms.
The keynote highlighted the challenges in the current system, field experience, and research findings (highlighted from four field researches) and made some recommendations. The keynote presented that only 0.49% of the mental health workforce has adequate training, and there are 0.16 psychiatrists, 0.34 psychologists, and 0.4 nurses for every 100,000 people. Around 302 physicians, psychologists, and counselors have been trained under the WHO’s mental health Gap training program after the Rohingya influx, as reported in the keynote. Meanwhile, the DGHS trained 10,030 general practitioners, 4,500 nurses, and sub-assistant community medical officers to provide mental health services. However, most of the workforce is concentrated in urban areas, especially in Dhaka.
Farhana Naznin, MHPSS technical specialist at Hand- icap International Bangladesh, and Taslima Akhter Keya, Coordinator at CDD, presented the keynote presentation.
Recommendation
- Establish mental health services in rural
- Raise awareness about mental health among third-gender individuals and combat reluctance to seek
- Prioritize universal health coverage to ensure mental health services for marginalized populations, emphasizing a multisectoral approach.
- Advocate for dedicated spaces for persons with disabilities in upazila health complexes and community clinics, ensuring proper design and measurement.
- Improve accessible healthcare infrastructure for persons with disabilities in Bangladesh, acknowledging ongoing improvements while emphasizing the need for continued progress.
- Collaborate with the government to make mental health services available at community clinics, emphasizing practical actions to facilitate
- Prioritize mental health support for caregivers, particularly mothers, based on observed needs and experiences working with caregivers of individuals with disabilities.
- Encourage concerted efforts by the government, NGOs, and civil society to overcome barriers in ensuring mental health services for marginalized communities, translating policy commitments into action.
What the speakers said
Dr Md Robed Amin, Line Director of Non-communicable Disease Control at DGHS, said: "Currently, we are piloting in few Upazila Health Complexes to make them disability inclusive and accessible. We also need to consider priority access to services for persons with disabilities as their rights. I hope the situation will be improving day by day. Overall, the integration of mental health in mainstream health services is very important. Moreover, to ensure the availability of mental health services at rural areas, we encourage alternative service provision for mental health through paraprofessionals, volunteers etc. However, you need to consider scalability and quality while promoting that."
Dr Avra Das Bhowmik, Director of the National Institute of Mental Health (NIMH), said: "Stigma remains a major challenge. To fight against the stigma, we are planning to train local leaders trusted by people, like religious leaders or traditional healers. In this way, they can provide accurate information to the people who need mental health services."
Nazish Arman,Chief Operating Officer of Suchona Foundation, said: "Universal health coverage is also a priority for en- suring mental health services for marginalized people. A multi-sectoral approach is something very important, and that is what wehave designed the strategic plan in mental health around."
Rajesh Chandra, Country Director of HI Bangladesh, said: "I would like to stress the necessity of concerted efforts by the government, NGOs, and civil society to address barriers and challenges in ensuring mental health services for marginalized communities. HI is commitment to translating policy commitments into actions along with the government and other actors through a multisectoral engagement approach."
Muhammad Mushfiqul Wara, Country Director of CBM Global Disability Inclusion, Bangladesh Country Office, said: "We should prioritize collaboration with the government in making the services available at community clinics. Taking practical actions in doing that should be stressed."
AHM Noman Khan, Executive Director of CDD, said: "Based on our extensive experience working with caregivers of individuals with disabilities, we have observed that a significant number of caregivers have varying degrees of mental health needs. Therefore, it is crucial to prioritize the provision of mental health support for these caregivers, particularly mothers, as this aspect is frequently overlooked."
Kamal Uddin Ahmed Chowdhury, Professor, Program Director, Nasirullah Psychotherapy Unit, Clinical Psychology Department, University of Dhaka said, I think it is more helpful to develop policies with emphasis on challenges, to facilitate mental health services and reach them. In our country mental health service physicians, doctors and experts are much fewer than required. Which cannot be increased overnight, it is important to create prevention models as much as possible.
Dr Esrat Jahan, Technical Unit Manager, HI Bangladesh, said: "According to the National Mental Health Survey 2019, 18.7% of adults need mental health services. However, especially in rural areas, mental health services are nearly nonexistent or limited and also lack of awareness of mental health rights."
Ismat Jahan Nipa, Clinical Psychologist and Head of the National Trauma Counseling Centre under the Multi-Sectoral Programme on Violence Against Women of the Ministry of Women & Children Affairs, said: "Along with the persons with disabilities, we also must think about the mental health of the third gender people. It is not enough to deliver the service to them; it is important to create awareness and get them out of the reluctance to take the service. Because now stigma is not the main obstacle, there is also a reluctance among people to serve."
Reaz Ahmad, Executive editor of Dhaka Tribune, said: "If only half percent of our total health budget is spent on mental health, we urgently need a policy intervention to increase the budget."
Akter Layek, President, Alor Chaya Protibondhi Songstha, said: "Community people do not know what mental health is. In many ways, they think it’s craziness. But the people need these services and the services should be easily accessible to them."
Abdullah Harun, the focal person of the mental health program at ADD International, said: "It is a very common scenario that there is no separate space for people with disabilities at the country’s upazila health complexes and community clinics. Even if we find it in some places, the design is not right, the measurement is not right, so it is not working. A multisectoral approach in addressing the challenges of acute workforce shortage and inadequate service delivery in mental healthcare, particularly for the marginalized groups of people is necessary."
Merina, Peer Responder, Alor Chaya Protibondhi Songstha, said: "I worked door-to-door visits at community level to identify mental health issues. I saw there how much persons with disabilities need mental health services. They are less able to discuss these issues than others."
Nasrin Jahan, Executive Director, Disabled Child Foundation (DCF), said: "Inclusive programs on mental health are needed, where everyone aged 5-30 will receive services. It will also make it easier for persons with disabilities to access this service which was difficult. Even those who go to school will understand and discuss this topic."
Rubina Jahan, Head, Clinical Services Mental Health Program, Sajida Foundation, said: "We are talking about working with rights-based mental health services. How persons with disabilities can avail those easily, we have to work hard on that, making the process accessible. Access to mental health service should not be difficult."