“It has emerged from focus group discussions that general physicians are not trained and skilled enough to diagnose and manage schizophrenia. Also, patients delay in seeking help and there is no clear referral system at work in Bangladesh. Till date, no single uniform management guideline for schizophrenia has been published in Bangladesh; so, Bangladesh Association of Psychiatrists (BAP) felt the need to develop a national clinical management guideline for the psychiatrists and for other physicians that can be widely incorporated at all levels of health care services from the community to tertiary.
[...] Focus group discussion (FGD) findings
[...] It was very disappointing and unexpected that none of the participants representing the general practitioner group got any training focusing on mental illness. They mentioned that social stigma is common in rural people and patients are abused and negatively motivated by quacks and traditional healers at the beginning of the illness and when course of the disease worsens, they visit the physician. The general practitioners also stated that they often refer patients who they find unmanageable and untreatable, and in critical conditions like suicidal behaviors.”
“In 2018 Bangladesh Parliament approved a new Mental Health Act. A new Mental Health Policy, approved by the Ministry of Health in 2019, reflects a shift from a medical to a psychosocial treatment model with emphasis on decentralization and community-based services and support for persons living with mental illness. ”
"It was not possible to calculate treatment coverage in Bangladesh for specific mental health conditions, as estimates of numbers of patients treated for specific mental health conditions were not available. However, the nationally representative Bangladesh Mental Health Survey of 2018-2019 estimated that 92.3% of persons with diagnosable mental disorders were not receiving mental health treatment.”
“Government facilities for treating persons with mental disabilities were inadequate.”
“Helal Uddin Ahmed, associate professor of child adolescent and family psychiatry at NIMH, one of two specialized mental hospitals in Bangladesh, said the country has a very limited number of mental health specialists. ‘There are a total of 270 psychiatrists while there are not more than 500 psychologists in the country at present to serve the vast number of mental health patients. And, another major concern is; those health services are mostly urban based,’ he said. He said the country must address these shortcoming [sic] because long-term mental health ailments can reduce life expectancy by 10 years on average. The government should make mental health care a part of its primary health care system in districts and sub-districts, Sharmin suggested. Echoing Sharmin’s views, Ahmed said: ‘We need to extend the mental health care facility to general hospitals rather than establishing specialized hospitals as people feel discomfort to go to specialized mental hospitals fearing to be stigmatized. All government hospitals should run mental health departments so that people could avail treatment in general hospitals,’ said Ahmed.”
“A Service Availability and Readiness Assessment (SARA) of Health Facilities in Providing Mental Health Related Services survey (unpublished) was conducted by the Centre for Injury Prevention, Health Development and Research, Bangladesh and DGHS in 2018 to acquire more insight on mental health service availability. Data were collected from all tiers of health systems, including tertiary hospitals (79 medical college hospitals and two specialized hospitals), 54 district hospitals, 129 Upazila heath complexes (UHCs) and 76 private hospitals or clinics. [...]
This survey confirmed the chronic shortage of mental health workforce at all levels. There is a severe lack of mental health professionals in both district hospitals and UHCs – only about 15% district hospitals and 2% UHCs had a psychiatrist, and none of these facilities had a clinical psychologist. Almost 69% of the tertiary hospitals had psychiatrists, but only 15% of them had clinical psychologists, followed by 8% psychiatric and mental health nurses, 10% psychotherapists and 5.6% certified mental health professionals. 62.5% of private hospitals had psychiatrists, while 6.3% had clinical psychologists. Although 11% of district hospitals and 12.5% UHCs had mental health nurses, only 3.1% of private facilities had deployed such cadre. Although a modest 18.2% of district hospitals and 9.4% of private hospitals had psychotherapists, none of the UHCs had these types of service providers. Availability of mental health workforce was very negligible in district hospitals, UHCs and private hospitals. Research indicates that tertiary hospitals had the highest inpatient bed allocation (40.3%) followed by 15.6% in private facilities. However, there was no bed allocation either in the district hospitals or UHCs (58). Scarcity of psychotic drugs in district hospitals and UHCs pose great challenges in offering quality mental health services. In the UHCs, there is no supply of the two most commonly used drugs to treat clinical depression – amitriptyline and fluoxetine. Similarly, in district hospitals, only 2% and 1% had supply of amitriptyline and fluoxetine, respectively. However, the availability of psychotic drugs was modest in tertiary hospitals – ranging from 21% to 56%. Private facilities had the least amount of supplies, varying from as low as 5% to as high as 15%. It is important to note that very few facilities providing mental health services followed national guidelines, reflecting varying quality and standards of service delivery. Only 36% of tertiary level facilities followed national guidelines on mental health, which was just over 14% for both district hospitals and UHCs.”