While Bangladesh and the sub-continent grapple to “flatten the curve” of the Covid-19 pandemic, the signs and symptoms of yet another epidemic are beginning to surface: The collective demise of the country’s mental health.
Although mental health has never been a priority in Bangladesh, we must proactively tackle this impending crisis to identify, track, and manage those at risk, much like the virus itself, to soften the devastating assault to our wellbeing, and save lives.
Covid-19’s impact to our mental health is neither surprising nor unpredictable. Indeed, historical periods of extraordinary societal stress and uncertainty invariably moved in tandem with a collective breakdown of our mental wealth. The Covid-19 pandemic is simply another name to add to the list.
Most recently, with widespread effects on our economic futures and livelihoods, the 2008 global financial crisis triggered a dramatic spike in the rates of mental ill-health with over 10,000 additional suicides attributed to the recession from 2008 to 2010.
Similarly, large scale traumatic events or natural disasters are almost always accompanied by increased depression, substance use disorder, and post-traumatic stress disorder.
Is our collective experience of Covid-19 any different?
The obvious distinguishing feature of our pandemic experience is that it has been anything but “collective.” Enforcement of national lockdowns and strict social distancing rules for months have moved us to uncharted territories. Many have been forced to embark on this journey alone.
While the immediate ramifications of social distancing on our mental health are serious and require attention, the more harrowing sentiment predicts that this will be eclipsed by the impact of what is to follow.
The very real threat to our economic prosperity and the intense uncertainty surrounding our present and post-lockdown livelihoods has not only exacerbated the incidence of stress, anxiety, and depressive symptoms, but also the loss of lives.
While these “black swan” events impact almost all facets of society, the rather unjust reality is that they tend to disproportionately burden those who are already marginalized, both economically and socially.
One of the most vulnerable groups, the millions of “urban poor” inhabiting the bustling slums centred in Dhaka. In Bangladesh, the urban poor largely comprises of slum-dwellers who work as day labourers, including rickshaw pullers, bus drivers, and garments factory workers, with an average income of around $3 per day.
Although no official register exists, there have been a number of case reports in the media and academic literature of suicides across Bangladesh directly related to Covid-19, virtually all from the poorest and most vulnerable members of our society.
One such case, reported on April 16, described a 30-year-old auto-rickshaw driver who took his own life as he was unable to provide food for his family during the lockdown due to loss of income.
Given that high-income economies with comprehensive social welfare systems such as Australia predict up to a 25% surge in suicides due to the pandemic, one can imagine what prolonged lockdowns may do to the urban poor in Bangladesh.
Therefore, we must acknowledge the seriousness of this issue and develop coherent and proactive policies at both the national and local levels.
Firstly, and perhaps most importantly, we must provide financial assistance to ensure their basic daily needs are met. The prime minister’s planned distribution of Tk2,500 to 5 million families most affected by the Covid-19 outbreak through mobile financial services such as bKash is certainly a step in the right direction.
NGOs, private institutions, and public fundraising campaigns on social media have also played a role in distributing food to those most in need. However, further comprehensive funding and financial reassurance, such as debt relief, will be necessary to ease the economic burden on those most susceptible.
Secondly, a comprehensive suicide prevention policy should be adopted including establishing an emergency task force of mental health and public health experts to devise evidence-based interventions that can be implemented nationwide.
This is not an idealistic requirement to consider after we control the virus. Instead, the gravity of the potential death toll needs to be given its due attention and policy efforts should be implemented simultaneously with our fight against Covid-19.
Thirdly, a national register of suicides related to Covid-19 should be considered. Although this would be difficult to implement, harnessing technology could provide timely data and accountability mechanisms to track and monitor up to date suicide statistics.
This would enable resources to be mobilized on an individual level to prevent further deaths since people linked to suicide are more at risk themselves. It would also be vital for public health resource allocation and the flattening of the overall mental health curve.
Riashad Monjur is a Bangladeshi-Australian final year medical student currently working in the Mental Health Unit (MHU), Gosford Hospital, Australia.
