On the occasion of World Mental Health Day, Professor Dr Saifun Nahar, director of the National Institute of Mental Health and Hospital, spoke to Dhaka Tribune about Bangladesh’s mental health situation, healthcare services, social stigma, mental health among children and adolescents, and suicide prevention.
Dhaka Tribune: What is the current mental health situation in Bangladesh? Which problems are most common?
Dr Saifun Nahar: According to the National Mental Health Survey 2019, the prevalence of mental health problems among adults in Bangladesh is 18.7%, while the rate among children and adolescents is 12.6%. Among people aged 60 and above, 28% experience mental health problems.
Patients with various mental health conditions visit our outpatient and inpatient departments, where we provide treatment for almost all types of mental health problems.
Among children, online gaming addiction, gambling-related problems, internet addiction and mobile phone addiction are becoming increasingly common.
How can a person tell whether they are mentally healthy or experiencing a mental health problem? What symptoms should they look out for?
There are different types of mental health problems, which can broadly be classified into neurotic and psychotic disorders. Changes in brain functioning can affect a person's thoughts, emotions, behaviour and daily life.
As a result, their ability to function in their personal, professional, family and social lives may deteriorate. In general, changes in one's daily activities and functioning can help indicate a potential problem.
A mentally healthy person can generally maintain normal functioning and productivity in their work, communication, social interactions and other activities. Significant changes in these areas, however, may indicate a mental health problem.
Many people with psychotic disorders have limited awareness of their condition, and their judgement may also become impaired. Consequently, they may not recognise the need for treatment.
People experiencing neurotic disorders, on the other hand, can often identify changes in themselves. These may include mood swings, a loss of interest in routine activities, difficulty completing tasks or a decline in the quality of their work.
Mental health problems can also manifest as physical symptoms, including loss of appetite, headaches, body aches and digestive problems. They may also affect sexual desire or functioning.
People usually seek medical attention promptly when they are physically ill, but many do not take mental illness seriously. Do social superstitions and the fear of being labelled “mad” prevent people from seeking treatment?
The mind and body are closely connected, and mental health problems can also affect physical health. For example, many patients with depression experience various physical aches and pains. Anxiety-related disorders can cause palpitations, digestive problems and headaches.
Anyone experiencing a mental health problem should seek medical attention. However, when relatives or neighbours learn that someone is receiving mental health treatment, the person may sometimes face social humiliation. We must move away from these superstitions and prejudices. Unless we break this taboo, we will not be able to address the problem effectively.
There are also many misconceptions about mental health. Some people believe that counselling alone is enough to ensure recovery, that medication must be taken for life once treatment begins, that mental illnesses are incurable, or that psychiatric medication damages the brain. We must work to dispel these misconceptions.
Patients can recover with appropriate treatment and medication taken as prescribed by a doctor. We must also strengthen public trust in doctors and mental health services.
How heavy is the patient load at the National Institute of Mental Health and Hospital?
More than 500 patients visit our outpatient department every day. Our inpatient department has 400 beds. At times, all the beds are occupied, while on other occasions, occupancy is around 80%.
We are working to improve our services further. The current government is also taking initiatives to advance mental health services.
Does Bangladesh have an adequate workforce of mental health specialists?
Our mental health workforce is still inadequate. However, compared with the past, more talented students are choosing to study this subject. We have introduced four additional courses in response to growing interest in the field. At the same time, the workforce is gradually expanding.
What types of mental health problems are most common among children and adolescents?
Children experience different types of mental health problems depending on their age. Among children and adolescents, we see cases of autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), internet addiction, gaming addiction and mobile phone addiction.
Many children are also developing problematic patterns of pornography use. Drug addiction is another concern among street children, with some becoming increasingly involved in glue sniffing and the use of readily available drugs such as yaba.
How are family instability, social media and academic pressure affecting children and adolescents?
A coordinated approach is needed to address mental health problems among children and adolescents. Conflict and other forms of pressure within the family can affect a child's mental well-being. When children regularly witness arguments between their parents, their cognitive development may be affected, and they may develop trust issues later in life.
If they struggle to manage anger and stress, they may also become vulnerable to suicidal thoughts or behaviour.
Similarly, children who experience bullying or humiliation at school, or face excessive academic pressure, may develop various mental health problems that can affect them later in life.
What initiatives are needed to prevent suicide?
People with certain personality disorders, particularly those with abrasive personality traits, may exhibit suicidal behaviour. People living with various mental illnesses, including those experiencing hallucinations or delusions, may also develop suicidal tendencies. Drug addiction can also increase the risk of suicide.
Awareness is crucial in this regard. Suicide can be prevented by identifying mental health problems early and ensuring that those affected receive appropriate treatment and support.
How accessible are mental health services outside Dhaka?
Mental health services have expanded compared with the situation 10 years ago. Through the World Health Organization's mental health programme, doctors from different districts and upazilas are receiving training to help reduce gaps in treatment services.
Doctors from areas outside major urban centres are brought in for training. After returning to their respective workplaces, they pass on their knowledge and train other healthcare professionals.
There may not be dedicated posts for psychiatrists at district- or upazila-level health complexes. However, doctors working in these areas are being trained to provide primary mental healthcare to patients. After completing their training, they return to their respective areas and provide services there.
What needs to be done to raise public awareness about mental health?
Regardless of the cause of an illness, anyone who is unwell should receive appropriate treatment. Whether mental health problems stem from personal circumstances, family issues or other factors, seeking treatment is essential.
Sometimes, people do not realise that they are experiencing a mental health problem. In such cases, family members and relatives should help them seek professional care by taking them to a psychiatrist and arranging the necessary counselling or other treatment.
How far has the initiative to integrate mental health services into primary healthcare progressed?
The government has already undertaken various projects to strengthen community mental health teams. The integration of mental health services into primary healthcare was included in earlier initiatives, and the programme is now being advanced further.
In the context of World Mental Health Day, which areas of mental health services should be prioritised over the next year?
One year is a very short time, and it is not possible to resolve all the challenges within that period. The treatment gap remains substantial. Among adults, it is 92%, while among children, it is 95%.
This means that only 8% of adults who need mental health services are receiving them, while the remaining 92% are not. Among children who need such services, only 5% receive them, leaving 95% without access to the care they need.
If everyone works together, we can bring about positive changes. However, resolving all these problems within a single year is not possible. We are continuing our efforts to improve the situation.
Public awareness remains inadequate, and many people do not give mental health the importance it deserves. Much of the problem can be addressed if people take mental illness seriously and seek treatment when necessary.
Individuals, families, educational institutions and the state must all work together to raise awareness, reduce stigma and ensure that people with mental health conditions receive appropriate care.
