According to WHO, approximately 450 million people in the world are suffering from mental health problems related to depression. A study by the National Institute of Mental Health of Bangladesh revealed that 16% of people in Bangladesh suffer from depression. So the net evaluation is, the number of patients suffering from depression in this country of 16 crore people is more than 2 crore.
According to doctors, depression is a mental and physical disease at the same time. Almost every person in Bangladesh has been under stress during the Covid-19 pandemic. Among them, 34.9% of young men and women are under various types of stress. 70.8% of people suffering from such mental instability physically harm themselves.
As a result of various mental pressures, suicidal tendencies have also increased. The number of suicides committed increased during the pandemic. Many people are working to identify the causes of suicide and find solutions to mental health issues. From March 2020 to February 2021, a total of 14,436 suicides have occurred in the country. Data from 322 suicide case studies revealed that 49% of those who committed suicide were between the ages of 20 and 35, and 57% of them were women.
Now the question arises: How favourable is the environment of the country for the patients suffering from depression and mental health issues? Are the current policies sufficient?
In this regard, the National Mental Health Policy (NMHP) 2022 aims to guarantee a regulatory framework for mental health services and other treatment and care providers, as well as to ensure that the general public and those who have a mental illness are protected from the frequently devastating effects of mental illness.
Visions of this policy
People in Bangladesh do not have access to the essential mental health care and treatment they need. One of the main goals of NMHP is to ensure that all individuals with mental disorders receive treatment based on the integration of mental health services into primary healthcare (PHC). Additionally, NMHP is essential for the community integration of people with mental illnesses, the delivery of high-quality care, and the expansion of community-based access to care.
Community-based mental health care expands access to mental healthcare within the city, improving quality of life, acceptance, reducing associated social stigma and violations of human rights, preventing chronicity, and increasing the likelihood that physical and mental health comorbidity will be identified and treated early on.
Woefully, barely 10% of persons with mental disorders in the country receive treatment, whereas approximately 16% of the population is affected. Others go untreated because of social stigma or high medical costs -- roughly 70% of which are covered directly by the sufferers or their loved ones. Less than 1% of the country's gross domestic product, or less than 6% of the national budget, goes toward the healthcare industry, and of that, less than 1% goes toward mental healthcare and services. Unfortunately, due to corruption -- healthcare is known as one of the most corrupt government sectors -- not even this tiny allocation is implemented properly.
Loopholes in the policy
From my point of view, the NMHP 2022 is a significant advancement in the promotion, defense, and preservation of mental health rights in Bangladesh, but there are some certain restrictions also.
- Although acknowledging the value of mental health patients' rights to health, property, dignity, education, etc, the policy does not include a comprehensive list of these rights. Additionally, there are no provisions for the violation of these rights when treating such patients, which is challenging due to unfavourable social situations. Although the Rights and Protection of Persons with Disabilities Act of 2013 recognizes the rights of people with mental disabilities, a separate legislation must be drafted to safeguard the rights of people with mental diseases that do not qualify as a mental disability.
- The details regarding patient confidentiality and the associated responsibility of medical professionals for breaching confidentiality are not covered.
- The topic of community-based treatment for mental health patients -- social rehabilitation and integration, which is thought to be more beneficial than institutional care -- is not acknowledged.
- The law does not stipulate how well mental healthcare professionals should be trained on patients' human rights. Service providers have expressed some reservations about the inclusion of clauses on criminal culpability for delivering a fake certificate of mental illness. Some people argue that such a law requirement may deter psychiatrists from examining and treating patients, preventing them from accessing mental health care treatments, because Bangladesh does not even have one psychiatrist per million residents. However, this is acceptable given that the government allows for the easy fabrication of fake certificates, which has major consequences for the exercise of property rights, inheritance, guardianship, custody, and other marital rights, as well as criminal culpability.
To sum up, the government and the courts will need to take the lead in this regard. Only creating new legislation is not sufficient. Government may consider creating a special court or tribunal, such as a mental health tribunal, with a judge who has received specialized training, along with or without a psychologist and/or psychiatrist, to address various mental health-related concerns.
However, all concerned members of the society have a common but differentiated responsibility to promote and protect their human rights. If we continue to disregard or violate the human rights of these citizens with mental illness -- who make up a sizeable portion of the population, we will never be able to create the ideal society based on the rule of law and human rights.
Shrabani Paul is a freelance contributor.