Mental health...

‘Girl, Interrupted’ is a film based on author Sussana Kaysen, reflection upon her stay in a mental hospital during the late 60s. It gives a lasting and specific dimension to our definition of sane and insane, mental illness and recovery.
The film and discussion about people with mental illness was organized by film maker Fauzia Khan at Goethe-Institut Bangladesh.
The World Health Organization - World Federation of Mental Health chose to focus on the relationship between mental health and chronic physical illness as the theme of this year’s World Mental Health Day.
Over a decade ago, 1998 WHO’s estimate of mental patients in Bangladesh with a population of about 130 million had nearly 1.2 million and 12.0 million severe and mild respectively, mentally ill patients.  About then the National Mental Health Institute was established in Dhaka that started functioning in 2000. All the Government Medical College Hospitals and all the Combined Military Hospitals/CMHs, have psychiatric wards.  Narayanganj General Hospital and few private clinics also have wards for mental patients. In 1999 a 50 beds Mental Health Hospital with outdoor facilities was established in Sylhet under private management. The number of beds may have increased to 100 with added facilities in future. It has started treating out door patients with nominal charges. Total psychiatric beds per 10 000 population is 0.065, in mental hospitals, general hospitals and in other settings are 0.03, 0.009, and 0.024 respectively.  
Mental health facilities in the country cover lifetime pension for the mentally handicapped children after the death of either parent who was receiving pension. Mental health is a part of the primary health care system. Actual treatment of severe mental disorders is available at the primary level.
Efforts are being made to provide cheaper drugs at primary level. Regular training of primary care professionals is carried out in the field of mental health. Over a period of two years about 1200 personnel were provided training on mental health to primary health care physicians and health workers by the Ministry of Health and Family Welfare.
Training covered activities in data collection, develop biological, psychological, social orientation and diagnostic skills. Training in mental health is an ongoing government programme for more than two decades but the number of trained staff is still less than required number.
Mental health service is a formal activity of the Health Ministry. Linkage with education, criminal, justice and other relevant sectors are informal which needs to be made official so as to be effective. Mental health care providers interact with primary care staff during their training on mental health, out-reach programme.
The Institute of Mental Health Research, Dhaka provides public education and family counseling with the supervision of specialists. There are community care facilities for patients with mental disorders. Periodic mental health extension services are also provided at primary health care level. Though specific rehabilitation programmes are not available in an organized form, efforts are made to implement day care facilities, sheltered workshops and rehabilitation programmes for chronic schizophrenics. Essential psychotropic medicines are available in the Mental Hospital and the National Institute of Mental Health, but often are not available in the General Hospitals psychiatry units.
Pabna Mental Hospital is the first and only mental hospital in Bangladesh. It was established in 1957 by the Civil Surgeon of Pabna District in a local landlord's house. Two years later it was shifted to Hemayetpur, 8 km from the district town, on an area of 111.25 acres of land. Initially there were only 60 beds which number was increased by 120 more beds and in 1966 another 200 beds were added. Out of the total beds, 280 are non-paying and 120 are paying beds.
There are 18 wards, 13 for male, of which 11 non-paying and 2 paying wards. Female wards are 5 in number with 4 non-paying and 1 paying. Much effort is directed to increasing the number of beds.
The Director is the administrative head of the hospital. It has 365 sanctioned posts, including 24 psychiatrists, doctors, clinical psychologists, biochemists, psychiatric social workers and others. Supporting staff include nurses, pharmacist, radiographer, technicians, occupational therapists, administrative assistants.
The hospital provides service to patients coming from all over the country. There are separate departments for indoor and outdoor patients. The outdoor department takes the decision whether to admit a patient in the hospital or not. Generally patients below the age of 18 and above the age of 60 are not admitted in the hospital. Patients with drug addiction problems are admitted only in paying beds.
Patients who are not admitted in the hospital are given advice and medicine free of charge. They are advised to visit outdoor department every 15 days till they are fully recovered. Although drug therapy is the main vehicle of treatment, group therapy and occupational therapy are also provided to the patients. There is arrangements for indoor and outdoor sports and cultural activities.
In the case of indoor patients the physicians on duty follow them up everyday. For routine examination of the patients, facilities such as X-ray, pathology laboratory, ECG, electroencephalogram/ EEG, are available. Most of the patients admitted in the hospital are schizophrenic. During 1996-98 the total number of patients treated in outdoor departments was about 90,000 and in indoor departments about 2,800.
There is only one small family association in the country and no consumers’ association exists. There is no interaction between the family association and mental health service facilities. There is no rehabilitation centre in Bangladesh for the mental patients. Pabna Mental Hospital has a government registered Welfare Society. This Society provides funds for sending patients home after their recovery and supplies essential life saving drugs. Besides, the Society provides jobs to the capable patients during their stay in the hospital. The Directorate of Society Welfare of the Government of Bangladesh gives an annual grant to the Society. It also runs a number of projects such as, dairy and agricultural farms. Income generated from them is used for the welfare of the patients. The Society also receives donations from NGOs and private individuals and firms.
Mental Health Legislation is covered under the Lunacy Act 1912.Mental Health Policy is incorporated in the Policy of Surveillance & Prevention of Non-communicable Diseases/NCD. The policy was last revised in 2006. The essential medicines listed are: antipsychotics, anxiolytics, antidepressants, mood stabilizers and antiepileptic drugs. No human rights review body exists in the country to oversee
regular inspection in mental health facilities.
Human rights and equity: Some 80 percent of all admissions to community-based inpatient psychiatric units and 100 percent of all admissions to the mental hospital are involuntary.
The majority of the admitted patients are psychotic who are usually admitted, without the consent of the patient but with consent of the attendant(s). Most of the neurotic patients do not like to get admitted into psychiatry units because of social stigma and mental ward phobia. Nearly 2-5 percent of patients were restrained or secluded at the community-based psychiatric inpatient units and also in mental hospital.  
Inequity of access to mental health services for other minority users, for example, linguistic, an ethnic, religious minority is also an issue of concern. The most common mental disorders found in the hospitals are: schizophrenia 70 percent, mood disorder 20 percnt and personality disorder and substance abuse. Majority of the mental patients receive treatment at residential facilities.
In conclusion WHO notes that ‘there can be no health without mental health.’ Mental health accounts for 13 percent of total burden of disease globally, and 31 percent of all years lived with disability. The forecast is that by year 2030 depression alone is likely to be single highest contributor to burden of disease in the world.
(Reprint)

 

Mental health...

Girl, Interrupted is a film based on author Sussana Kaysen, reflection upon her stay in a mental hospital during the late 60s. It gives a lasting and specific dimension to our definition of sane and insane, mental illness and recovery. The film and discussion about people with mental illness was organized by film maker Fauzia Khan at Goethe-Institut Bangladesh. The World Health Organization - World Federation of Mental Health chose to focus on the relationship between mental health and chronic physical illness as the theme of this years World Mental Health Day. Over a decade ago, 1998 WHOs estimate of mental patients in Bangladesh with a population of about 130 million had nearly 1.2 million and 12.0 million severe and mild respectively, mentally ill patients. About then the National Mental Health Institute was established in Dhaka that started functioning in 2000. All the Government Medical College Hospitals and all the Combined Military Hospitals/CMHs, have psychiatric wards. Narayanganj General Hospital and few private clinics also have wards for mental patients. In 1999 a 50 beds Mental Health Hospital with outdoor facilities was established in Sylhet under private management. The number of beds may have increased to 100 with added facilities in future. It has started treating out door patients with nominal charges. Total psychiatric beds per 10 000 population is 0.065, in mental hospitals, general hospitals and in other settings are 0.03, 0.009, and 0.024 respectively. Mental health facilities in the country cover lifetime pension for the mentally handicapped children after the death of either parent who was receiving pension. Mental health is a part of the primary health care system. Actual treatment of severe mental disorders is available at the primary level. Efforts are being made to provide cheaper drugs at primary level. Regular training of primary care professionals is carried out in the field of mental health. Over a period of two years about 1200 personnel were provided training on mental health to primary health care physicians and health workers by the Ministry of Health and Family Welfare. Training covered activities in data collection, develop biological, psychological, social orientation and diagnostic skills. Training in mental health is an ongoing government programme for more than two decades but the number of trained staff is still less than required number. Mental health service is a formal activity of the Health Ministry. Linkage with education, criminal, justice and other relevant sectors are informal which needs to be made official so as to be effective. Mental health care providers interact with primary care staff during their training on mental health, out-reach programme. The Institute of Mental Health Research, Dhaka provides public education and family counseling with the supervision of specialists. There are community care facilities for patients with mental disorders. Periodic mental health extension services are also provided at primary health care level. Though specific rehabilitation programmes are not available in an organized form, efforts are made to implement day care facilities, sheltered workshops and rehabilitation programmes for chronic schizophrenics. Essential psychotropic medicines are available in the Mental Hospital and the National Institute of Mental Health, but often are not available in the General Hospitals psychiatry units. Pabna Mental Hospital is the first and only mental hospital in Bangladesh. It was established in 1957 by the Civil Surgeon of Pabna District in a local landlords house. Two years later it was shifted to Hemayetpur, 8 km from the district town, on an area of 111.25 acres of land. Initially there were only 60 beds which number was increased by 120 more beds and in 1966 another 200 beds were added. Out of the total beds, 280 are non-paying and 120 are paying beds. There are 18 wards, 13 for male, of which 11 non-paying and 2 paying wards. Female wards are 5 in number with 4 non-paying and 1 paying. Much effort is directed to increasing the number of beds. The Director is the administrative head of the hospital. It has 365 sanctioned posts, including 24 psychiatrists, doctors, clinical psychologists, biochemists, psychiatric social workers and others. Supporting staff include nurses, pharmacist, radiographer, technicians, occupational therapists, administrative assistants. The hospital provides service to patients coming from all over the country. There are separate departments for indoor and outdoor patients. The outdoor department takes the decision whether to admit a patient in the hospital or not. Generally patients below the age of 18 and above the age of 60 are not admitted in the hospital. Patients with drug addiction problems are admitted only in paying beds. Patients who are not admitted in the hospital are given advice and medicine free of charge. They are advised to visit outdoor department every 15 days till they are fully recovered. Although drug therapy is the main vehicle of treatment, group therapy and occupational therapy are also provided to the patients. There is arrangements for indoor and outdoor sports and cultural activities. In the case of indoor patients the physicians on duty follow them up everyday. For routine examination of the patients, facilities such as X-ray, pathology laboratory, ECG, electroencephalogram/ EEG, are available. Most of the patients admitted in the hospital are schizophrenic. During 1996-98 the total number of patients treated in outdoor departments was about 90,000 and in indoor departments about 2,800. There is only one small family association in the country and no consumers association exists. There is no interaction between the family association and mental health service facilities. There is no rehabilitation centre in Bangladesh for the mental patients. Pabna Mental Hospital has a government registered Welfare Society. This Society provides funds for sending patients home after their recovery and supplies essential life saving drugs. Besides, the Society provides jobs to the capable patients during their stay in the hospital. The Directorate of Society Welfare of the Government of Bangladesh gives an annual grant to the Society. It also runs a number of projects such as, dairy and agricultural farms. Income generated from them is used for the welfare of the patients. The Society also receives donations from NGOs and private individuals and firms. Mental Health Legislation is covered under the Lunacy Act 1912.Mental Health Policy is incorporated in the Policy of Surveillance Prevention of Non-communicable Diseases/NCD. The policy was last revised in 2006. The essential medicines listed are: antipsychotics, anxiolytics, antidepressants, mood stabilizers and antiepileptic drugs. No human rights review body exists in the country to oversee regular inspection in mental health facilities. Human rights and equity: Some 80 percent of all admissions to community-based inpatient psychiatric units and 100 percent of all admissions to the mental hospital are involuntary. The majority of the admitted patients are psychotic who are usually admitted, without the consent of the patient but with consent of the attendant(s). Most of the neurotic patients do not like to get admitted into psychiatry units because of social stigma and mental ward phobia. Nearly 2-5 percent of patients were restrained or secluded at the community-based psychiatric inpatient units and also in mental hospital. Inequity of access to mental health services for other minority users, for example, linguistic, an ethnic, religious minority is also an issue of concern. The most common mental disorders found in the hospitals are: schizophrenia 70 percent, mood disorder 20 percnt and personality disorder and substance abuse. Majority of the mental patients receive treatment at residential facilities. In conclusion WHO notes that there can be no health without mental health. Mental health accounts for 13 percent of total burden of disease globally, and 31 percent of all years lived with disability. The forecast is that by year 2030 depression alone is likely to be single highest contributor to burden of disease in the world. (Reprint)