In a conversation, Dr Ashique Selim, Head of SAJIDA Mental Health Programs and Rubina Jahan, Clinical Psychologist and Assistant General Manager SAJIDA Mental Health Program talk about SAJIDA Foundation’s endeavours to address mental health issues in the country.
According to the latest National Mental Health Survey by the Ministry of Health and Family Welfare Bangladesh, 92.3% of adults and 94.5% of children diagnosed with mental disorders do not get treatment for their condition. In your opinion, why do you think that’s the case?
Dr. Ashique Selim: There are three primary reasons for mental illness going undiagnosed in the country.
The aspect of mental illness is quite broad. We experience it in various ways. Even the feeling of stress or fear can take its turn towards mental illness. So to specify, a lot of mental illnesses are an extreme version of an average experience. One of the biggest reasons for mental illness going undiagnosed in the country is the failure to distinguish between normal and problematic behaviour.
Secondly, even if mental illness gets recognised, there is a massive stigma in our society that bottles up people to take mental health support. The way mental health is diagnosed and treated also plays an enormous role in this regard. Psychiatrists treat all kinds of mental illnesses in Bangladesh. In contrast, general practitioners are allowed to treat minor mental health problems in the U.K. Consequently, people in Bangladesh develop a tendency to bottle minor mental health issues in Bangladesh instead of going to the doctor over the fear of looking like a big deal.
Finally, the field of psychology is relatively young in Bangladesh. As a result, the available treatments often rely on medication. Therefore, insufficient psychological treatments leading people to seek medication signalised the sector to some extent.
Which mental health disorders are most common among young adults in Bangladesh?
Rubina Jahan: According to a recent mental health survey, 14% of children and young adults are suffering from mental health disorders or concerns. Among them, mental health issues such as anxiety and depression are widespread. Alarmingly, suicide and self-harm tendencies in young adults have grown significantly. In children, neuro-developmental disorders are also found to be prominent. Subsequently, screen addiction has also risen alarmingly among children and young adults.
How would you assess the impacts of the pandemic on the mental health of our society in general? Is there any specific segment that has been more vulnerable in this aspect? Any specific elements that have aggravated these issues?
Dr. Ashique Selim: Several types of research are globally being conducted on the impacts of the pandemic on mental health. When the pandemic is over, we will get a more accurate assessment.I feel there has been a profound effect on mental health. People with pre-existing mental health issues found their condition deteriorating. Besides, depression and substance misuse have been on the rise during the same period. So the number and range of mental health problems have been on the rise due to the pandemic.
Subsequently, the suicide rate has increased alarmingly throughout the period, and numbers suggest it has been higher than the death rate from COVID 19. Therefore, we can expect to see a very high correlation between the pandemic and the growing suicide rate when more comprehensive researches are gradually conducted.
In my view, children and adolescents have suffered the most during the pandemic. The impact is not limited to a specific segment of the population; rather, the consequences were felt across the spectrum. The closure of educational institutions had a massive impact on the children’s mental health condition. Although adults are expected to adapt to the disruptions psychologically, the situation has taken an enormous toll on children and adolescents. Concurrently, as people were stuck in their homes, children and adolescents were exposed to a concerning number of domestic violence incidents. So, in my opinion, these two sections of the population have been the most vulnerable to the adverse effects of the pandemic.
Home-office, prolonged lockdowns, schools suspension, and of course, the stress of the pandemic itself have aggravated the mental health problems. In some way, the pandemic is similar to the wartime situation where people were engulfed in constant fear of losing lives. The news and headlines of millions of people dying had certainly catalysed mental health issues on a global scale.
How will the two-month-long campaign on mental health by SAJIDA Foundation impact mental health awareness in the country?
Rubina Jahan: As September and October are Suicide Prevention and Mental Health month respectively, it was an excellent opportunity to start the campaign. Through our previous campaigns we focused on community people, connecting and educating them. But our current campaign focuses more on policy-level advocacy. Our target population is people from our community and people working with mental health, helping with policy-making at both national and international levels. Therefore, we are engaging more national and international stakeholders in all our webinars. The ultimate goal is to enable collaboration, partnerships, local and cross-cultural collaboration. SAJIDA Foundation is encouraging evidence-based clinical care and exploring more quality mental health service providers through this campaign.
As mental health services are not available for everyone and are quite expensive in Bangladesh, people from the lower segment often get deprived of its benefits. In light of that, we are working on making mental health services accessible and affordable for rural communities. We are trying to spread quality mental health support throughout the socio-economic spectrum. Through collaboration and partnership, we are trying to ensure better mental health for everyone through connecting and growing our partnerships.
How has SAJIDA Foundation been helping to address mental health and reach out to those seeking support during the pandemic?
Dr. Ashique Selim: As the pandemic began to take effect, SAJIDA Foundation started to reform the SAJIDA Mental Health Program. This initiative collaborated with BRAC, PSWC (part of the SAJIDA Foundation), and Kaan Pete Roi, which is a free counselling hotline that allows people to get a free 20-minute
AS PART OF OUR EFFORT IN TACKLING MENTAL HEALTH ISSUES, SAJIDA FOUNDATION HAS ALSO INITIATED SHOJON, A MENTAL HEALTH SERVICE PLATFORM
counselling session. With the Foundation’s support, KPR could expand their service hours from 6 hours to 12 hours daily. This was a much needed step and we have seen a huge increase in the monthly number of calls due to extended operation hours. We are now working with a nationwide service expansion plan with KPR. According to KPR’s call data, we have seen over the pandemic the number of young adults and students seeking help from the service from 45% to 60%. It shows the effect of the pandemic on young adults.
As part of our effort in tackling mental health issues, SAJIDA Foundation has also initiated SHOJON, a mental health service platform where people from any part of Bangladesh can call, and get counseling and psychiatric consultation using their phone for free or a nominal fee only if they can afford it.
Apart from that, we have worked closely with the British Asian Trust to analyse the impact of COVID on a specific population. Moreover, from this research, we intend to see how we might help people more effectively. We made a series of video and print materials to be distributed in particular areas.
What would you advise friends/family members of those reluctant to seek help for mental health support?
Rubina Jahan: We have to start being empathetic to those suffering from mental health issues and reduce the stigmas surrounding them. It is essential to understand that the person is fighting a mental illness and everyone needs to create an enabling environment where they can talk about it and look for professional support. It is easier for friends and family members to help than strangers. Friends and family members need to be understanding and allow the person to open up and express themselves. Even after seeking professional help, people may need time to process the diagnosis. The process can be enabled by giving some personal space, and showing empathy and support just as much as they want. And in cases where the person with mental illness is reluctant to seek help, we need to keep our patience. The process is not similar for everyone. Some might take an hour, or a day or even a few months to accept their condition and seek professional help. We need to avoid being judgmental and try our best to resonate with the person with empathy and logic.