Breaking The Silence: Mental Health Stigma in Bangladesh

By Faizan A. Rakin

Introduction 
The mental health situation in Bangladesh is marked by significant unmet needs and systemic barriers that worsen the crisis. Expanding the number of mental health professionals and facilities is crucial, but tackling the deep-rooted societal stigma is just as important. This stigma, driven by cultural, social, and economic factors, leads to widespread silence and misunderstanding about mental health conditions. Even with advancements in healthcare, the stigma continues to hold back progress, leaving many people to suffer alone. To improve the situation, it is essential to focus on advocacy, education, and policy changes to create a more supportive environment for those struggling with mental health issues.

Bangladesh has faced a significant decline in mental health, a trend that threatens to worsen if not urgently addressed. Approximately 18.7% of adults and 12.6% of children in the country are affected by one or more mental health conditions. Disturbingly, nearly 91% of these individuals do not receive adequate treatment, largely due to pervasive stigma, societal discrimination, and a profound sense of shame and guilt. The study by the Bangladesh Health and Injury Survey 2016, reported a suicide rate of 14.7 per 100,000 people and revealed that 4.7% of young people have contemplated suicide at least once in their lifetime. This pressing issue underscores the need for comprehensive mental health strategies and a cultural shift towards greater understanding and support for those in need.

Ongoing Issues

Mental health stigma in Bangladesh is a significant barrier to accessing care and addressing the mental health crisis. Despite Bangladesh's substantial GDP of approximately 324.2 billion USD and its predicted 6.9% growth rate in 2022, the country’s health system struggles with inadequate mental health services and a high disease burden. Mental illness is among the top ten causes of global disease burden, yet in lower-income countries like Bangladesh, it remains largely neglected. The prevalence of suicide attempts—estimated to be 10–20 times more common than actual suicides—highlights the urgent need for mental health intervention. However, mental health care is severely underdeveloped, with only around 500 psychiatrists for a vast population, and most facilities concentrated in urban areas. The National Institute of Mental Health (NIMH) in Dhaka offers just 200 beds, and a nearby psychiatric hospital has 500 beds, but mental health units still account for only 8% of all hospital beds. Mental health issues contribute to 32.4% of years lived with disability and 13% of disability-adjusted life-years (DALYs), underscoring their significant impact on the overall disease burden.

Stigma remains a formidable obstacle, deeply rooted in societal taboos and a lack of awareness. In Bangladesh, mental health conditions are often stigmatized, and individuals suffering from mental illness face severe discrimination. The shortage of qualified professionals, inadequate public mental health facilities, and a poorly managed referral system exacerbate these issues. Women, in particular, are more affected due to the male-dominated culture that overlooks the complexities of female mental health. The combination of these factors results in a considerable number of people remaining untreated and suffering in silence. 

Current Steps Toward Improvement

Bangladesh has begun taking crucial steps toward improving mental health care, reflecting a shift in policy and approach. In 2018, the Bangladesh Parliament approved a new Mental Health Act that legislation aims to extend government-sponsored mental health care benefits across all population groups, emphasizing inclusivity and community-based services. The 2019 Mental Health Policy further advances these efforts by promoting a psychosocial treatment model, decentralization of services, and integration of mental health into primary health care. Despite only 0.05% of the overall health budget being allocated to mental health services, with 60% of that dedicated to psychiatric hospitals, the government has recognized mental illness as a top ten health priority. A National Mental Health Strategic Plan for 2020-2030 has been drafted, although it is yet to be fully implemented. This plan includes innovative strategies such as digital platforms for e-health services, videoconferencing for supervision, and distance-learning modules for training providers, aiming to bridge the gaps in mental health care, especially in underserved areas.

Addressing The Future

Enhancing service quality and consolidating the overall mental health system is essential, including better health service management and robust monitoring and supervision. Addressing demand-side barriers through patient education and community empowerment will also play a crucial role. Research and advocacy are needed to overcome cross-cutting issues such as a lack of shared understanding of Universal Health Coverage (UHC). Suicide prevention strategies should be incorporating population-based approaches like mental health promotion, awareness campaigns, and restricting access to means of suicide, as well as targeted interventions for high-risk groups, including school-based programs and crisis hotlines. Improving community-based care and closing the gap between available treatments and services will enhance satisfaction and quality of life. Recruiting skilled professionals and increasing financial support for advocacy groups will ensure better care and policy development. Additionally, further research is required to refine effective treatment strategies for mental health struggles. 

Conclusion

The current system in Bangladesh faces severe challenges, from inadequate resources and facilities to deep-rooted stigma and cultural barriers. To make meaningful progress, it's essential to enhance mental health services, improve public understanding, and reform healthcare structures. By prioritizing mental health education, increasing funding, and fostering an environment of empathy and support, Bangladesh can move towards a more inclusive and effective mental health system. Only through these concerted efforts can the country hope to alleviate the burden of mental illness and ensure better well-being for all its citizens.

Works Cited

“Bangladesh WHO Special Initiative for Mental Health Situational Assessment.” World Health Organization (WHO), https://www.who.int/docs/default-source/mental-health/special-initiative/who-special-initiative-country-report---bangladesh---2020.pdf?sfvrsn=c2122a0e_2. 

“Disability-adjusted life years (DALYs).” World Health Organization (WHO), https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158.

Hasan, Md. Kamrul, et al. “Mental health challenges in Bangladesh and the way forwards.” NCBI, 4 August 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372593/.

Hasan, M. Tasdik, et al. “The current state of mental healthcare in Bangladesh: part 1 – an updated country profile.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554893/. 

National Institute of Mental Health (NIMH) - Transforming the understanding and treatment of mental illnesses, https://www.nimh.nih.gov/. 

Rose Barua, Bangladesh’s Mental Health Act 2018: A Critical Analysis, Medical Law Review, Volume 32, Issue 1, Winter 2024, Pages 101–110, 

https://doi.org/10.1093/medlaw/fwad041

“Universal Health Coverage.” World Health Organization (WHO), https://www.who.int/health-topics/universal-health-coverage#tab=tab_1.