With a large number of mentally ill patients remaining outside medication in resource-starved countries such as Bangladesh, the World Health Organisation (WHO) is now mulling 'cost-effective community based approach' to change the situation.
"It (mental health) needs a dual approach -- we have to reach out to the people and at the same time should have tertiary support," WHO South-East Asia regional adviser on mental health and substance abuse Dr Vijay Chandra said on Saturday.
"Bangladesh has tertiary support in Bangabandhu Sheikh Mujib Medical University and National Institute of Mental Health. Now it needs to reach to the people.
"Community clinics can play a role in this regard," he told after a three-day regional meeting of 11 countries wound up in the capital on Saturday.
According to Bangladesh Association of Psychiatrists, there is vast gap between the number of patients and mental health services in the country.
Available data suggest at least three in 10 Bangladeshis suffer from some form of mental illness.
A pilot project in Dhaka's Sonargoan upazila showed the gap is 92 percent when it comes to experts required for treatment only of children's epilepsy -- a brain condition that leads sudden unconsciousness and sometimes to have fits.
"The picture is almost the same for rest of the country," National Institute of Mental Health director Prof M Golam Rabbani, said. "There are only 190 psychiatrists for over 150 million people, so healthcare providers at community settings can help narrow down this gap."
GOVT WORKING ON THE BASICS
The Awami League government has appointed healthcare providers at its prioritised community clinics, one for every 6,000 families. So far, 10,320 clinics are ready to offer services while the health ministry hopes that a further 3,000 clinics will become 'fully functional' by next July.
The government is also creating awareness about the 'long-neglected' mental health problems and developmental disorders.
The first-ever autism conference in this region was held in Dhaka this July, with Prime Minister Sheikh Hasina and India's Congress party chief Sonia Gandhi on the dais.
Hasina also inaugurated the sixth International Conference on Psychiatry and World Mental Health Day on October 16 in the capital.
The government has kept special allocation in the five-year Health, Population and Nutrition Sector Developmental Plan (HPNSDP) while the process to finalise a Mental Health Act is on the cards.
Extolling Bangladesh government's pro-active role in mental health, WHO's Dr Vijay Chandra said, "It reflects the government's total commitment to develop mental health service. Now we need to support it."
SUPPORT AT COMMUNITY LEVEL
WHO supervised pilot projects are underway in four countries of Southeast Asia -- Bangladesh, Thailand, Bhutan and Timor Leste -- to narrow down the gap in treatment of mental illness at community level.
"Once scaled up (at national level), our role will be nominal," Dr Chandra said. He also said WHO will give technical support and offer new things that evolve anywhere in the world.
The WHO pilot projects are working on diagnosing epilepsy, psychosis, depression and developmental disorders such as autism at the grassroots level.
"Our evaluation showed they (community healthcare providers) can do it," National Institute of Mental Health's Prof Golam Rabbani. "They will identify patients only by interviewing (from a) set of questions.
"Then they will refer them to the upazila level, where trained physicians would be available. The physicians can also interact with the specialists over phone.
"The whole system will work together. There will no additional funding into it."
Dr Chandra said the process would drive away misconception and malpractices over mental health disorders. "They will not go to the traditional healers; instead, they (patients) will come to the hospitals with modern methods of treatment.
"You will not see anyone chained or locked up in the hospital -- they walk around free, and receive treatment."
He also urged people to get rid of the prevailing misconceptions against patients with mental illness. "People still think they (some mental ill patients) are violent. Many people still pelt stones when they see them on the streets.
"But when they (mentally ill) retaliate, people think they are violent. Everyone will retaliate if they are pelted with stones -- it's a natural reaction."
Experts blame more nuclear families, growing demand and soaring costs and drug abuse for increase in cases of mental disorder. But most people suffer in silence, fearing social stigma.
The three-day meeting recommended all member-countries to have mental health policy, plans, programme and legislation that include mental health promotion, prevention, treatment and rehabilitation, welfare and human rights protection.
It urged the countries to make mental healthcare services an integral part of the mainstream health system.
It also urged the WHO to help countries with training and research.
"It (mental health) needs a dual approach -- we have to reach out to the people and at the same time should have tertiary support," WHO South-East Asia regional adviser on mental health and substance abuse Dr Vijay Chandra said on Saturday.
"Bangladesh has tertiary support in Bangabandhu Sheikh Mujib Medical University and National Institute of Mental Health. Now it needs to reach to the people.
"Community clinics can play a role in this regard," he told after a three-day regional meeting of 11 countries wound up in the capital on Saturday.
According to Bangladesh Association of Psychiatrists, there is vast gap between the number of patients and mental health services in the country.
Available data suggest at least three in 10 Bangladeshis suffer from some form of mental illness.
A pilot project in Dhaka's Sonargoan upazila showed the gap is 92 percent when it comes to experts required for treatment only of children's epilepsy -- a brain condition that leads sudden unconsciousness and sometimes to have fits.
"The picture is almost the same for rest of the country," National Institute of Mental Health director Prof M Golam Rabbani, said. "There are only 190 psychiatrists for over 150 million people, so healthcare providers at community settings can help narrow down this gap."
GOVT WORKING ON THE BASICS
The Awami League government has appointed healthcare providers at its prioritised community clinics, one for every 6,000 families. So far, 10,320 clinics are ready to offer services while the health ministry hopes that a further 3,000 clinics will become 'fully functional' by next July.
The government is also creating awareness about the 'long-neglected' mental health problems and developmental disorders.
The first-ever autism conference in this region was held in Dhaka this July, with Prime Minister Sheikh Hasina and India's Congress party chief Sonia Gandhi on the dais.
Hasina also inaugurated the sixth International Conference on Psychiatry and World Mental Health Day on October 16 in the capital.
The government has kept special allocation in the five-year Health, Population and Nutrition Sector Developmental Plan (HPNSDP) while the process to finalise a Mental Health Act is on the cards.
Extolling Bangladesh government's pro-active role in mental health, WHO's Dr Vijay Chandra said, "It reflects the government's total commitment to develop mental health service. Now we need to support it."
SUPPORT AT COMMUNITY LEVEL
WHO supervised pilot projects are underway in four countries of Southeast Asia -- Bangladesh, Thailand, Bhutan and Timor Leste -- to narrow down the gap in treatment of mental illness at community level.
"Once scaled up (at national level), our role will be nominal," Dr Chandra said. He also said WHO will give technical support and offer new things that evolve anywhere in the world.
The WHO pilot projects are working on diagnosing epilepsy, psychosis, depression and developmental disorders such as autism at the grassroots level.
"Our evaluation showed they (community healthcare providers) can do it," National Institute of Mental Health's Prof Golam Rabbani. "They will identify patients only by interviewing (from a) set of questions.
"Then they will refer them to the upazila level, where trained physicians would be available. The physicians can also interact with the specialists over phone.
"The whole system will work together. There will no additional funding into it."
Dr Chandra said the process would drive away misconception and malpractices over mental health disorders. "They will not go to the traditional healers; instead, they (patients) will come to the hospitals with modern methods of treatment.
"You will not see anyone chained or locked up in the hospital -- they walk around free, and receive treatment."
He also urged people to get rid of the prevailing misconceptions against patients with mental illness. "People still think they (some mental ill patients) are violent. Many people still pelt stones when they see them on the streets.
"But when they (mentally ill) retaliate, people think they are violent. Everyone will retaliate if they are pelted with stones -- it's a natural reaction."
Experts blame more nuclear families, growing demand and soaring costs and drug abuse for increase in cases of mental disorder. But most people suffer in silence, fearing social stigma.
The three-day meeting recommended all member-countries to have mental health policy, plans, programme and legislation that include mental health promotion, prevention, treatment and rehabilitation, welfare and human rights protection.
It urged the countries to make mental healthcare services an integral part of the mainstream health system.
It also urged the WHO to help countries with training and research.
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