According to World Health Organisation, mental health is defined as "a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community." Around 450 million people suffer from mental or neurological disorders and mental health is one of the leading causes of ill-health and disability worldwide.   

Mental health contributes to 13 percent to the global burden of disease. Depressive disorders, in particular, rank fourth with regard to the global disease burden. Research shows that low and middle income countries are likely to experience a higher burden of mental health disorders, and despite the fact, the latter is one of the least recognised health issues in countries like Bangladesh. Around 10 percent of Bangladesh's population suffer from mental illness. A poor healthcare system, lack of awareness programmes and scarcity of prevalence data make it even more challenging to highlight the issue of mental health in the country.

According to Icddr,b the overall prevalence of mental disorders in Bangladesh is between 6.5 to 31 percent among adults, with psychiatric and psychogenic (a psychological condition being the origin) disorders such as depression and anxiety most widely reported. Mental disorders were found to be prevalent in densely populated urban communities compared to rural ones, and among the poor. Although women are more vulnerable than men to experiencing mental disorders, medical treatment is less accessible to women due to their lower social status.

According to a study conducted by Icddr,b the prevalence of mental disorders among children is anywhere between 13.4 and 22.9 percent. Behavioural disorders (for example: oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder) were most common among children, but psychiatric disorders (such as depression, schizophrenia, bipolar disorder) were also reported among poor children, like those living in urban slums. The study reports that psychiatric disorders among children are associated with malnutrition, lack of education of fathers and a family history of mental illness.

Chronic diseases and mental disorders are said to be "mutually reinforcing", meaning mental disorders increase the risk of chronic diseases and vice versa. Mental disorders can strongly affect the immune system, thereby increasing the intensity of symptoms related to chronic diseases. (It is not unusual for diabetes and cancer patients to be diagnosed with depression). And this can severely complicate prognosis and diagnosis. 

There is a strong social stigma attached to mental disorders around the world but it can be argued that the stigma is worse in the case of developing countries like Bangladesh due to multiple reasons. One crucial factor is the major lack of mass awareness about mental health in general, which not only plays a part in ostracising the mentally ill but also hampers the process of medical treatment. This includes widespread superstitious beliefs that suggest mental illnesses stem from "evil forces" because of which many resort to "traditional healing". Many even completely deny the existence of mental disorders and view the latter as untreatable. People with mental disorders are sometimes viewed as unintelligent, difficult and/or incapable; this can lead to them being abused, rejected and discriminated against. These factors play a vital role in preventing the mentally ill from seeking medical help which is why researchers believe that statistics of the prevalence of mental illness in Bangladesh are likely underestimated.

The other important factor is poor service delivery for mental disorders. The facilities available for mental health services are extremely limited, both at the local and government level. There are allegedly around 700 beds designated for mental health patients at government hospitals and less than 100 psychiatrists in the country. There is a serious shortage of qualified mental health practitioners, and referrals to mental health specialists by practitioners are basically non-existent. The lack of adequate health workers both at the primary and secondary levels of healthcare adds to the constraints. There is currently no structured, organised mechanism at either level to treat mental illnesses. Coupled with a lack of general knowledge about the issue and rising costs of healthcare, access to medical resources is becoming increasingly difficult. In short, the existing system of mental healthcare delivery is simply not functioning as well as it should.

Given the magnitude of the problem, research on mental health in Bangladesh is unsatisfactory. Although after the introduction of psychotropic drugs, Bangladesh has had some significant achievements, a lot more needs to be done to reduce the inequity in the distribution of skilled human resources for mental health and address the shortage of psychiatrists and psychologists nationwide. Governments and donors must work in tandem to boost financial resources with the aim of increasing mental health services. Research needs to improve, particularly in neglected poor urban and rural areas wherein lie the more vulnerable groups. But most importantly, there needs to be special focus on public education and mass awareness campaigns to destigmatise mental illness and bust myths associated to mental health in order to not only rehabilitate the mentally ill, but also to challenge the prevailing attitudes that the general people hold towards them.

The writer is a journalist at The Daily Star.