ADDRESSING MENTAL HEALTH
IN
LOW RESOURCE COUNTRIES
SAIMA WAZED HOSSAIN, S.S.P., NCSP
SCHOOL PSYCHOLOGIST
CHAIR OF NATIONAL ADVISORY COMMITTEE ON AUTISM
MEMBER OF WHO’S EXPERT ADVISORY PANEL ON MENTAL
HEALTH
STIGMA
SKILLED
PROFESSIONALS
INFRASTRUCTURE
GLOBAL MAPPING OF ACCESS TO
SERVICES (WHO-ATLAS-2005)
EVOLUTION OF MENTAL HEALTH
SERVICES IN BANGLADESH
Mental Health
Act
1912
Lunacy Act
Organization of
Training in
Mental Health
(OTMH) by
Bangabandhu
Sheikh Mujibur
Rahman
Act for
disability
rights
DPM
(Diploma)
Started at
IPGMR
FCPS
(Fellowship)
and Mphil
Program
NIMH
(National
Institute
of Mental
Health)
MD
(Masters)
Degree
First
Psychiatric
Hospital in
Pabna
1957
1972
1975
1979
1981
2005
2014
EXISTING REFERRAL SYSTEM FOR
MENTAL HEALTH
Only 1

Trained health
workers at PHC
(18000 Community Clinics,
USC, UHC)
 NIMH, Dhaka
 Mental Hospital (Pabna)
Trained PHC
Physicians
district has a
psychiatrist
Psychiatrist in district
Hospitals
Psychiatry Dept.
In Nearby Medical
Colleges
Prevalence of Mental Disorders in
Bangladesh

WHO supported National Survey
on Adults: 16.1% have a mental
health condition(2003-2005).
WHO supported National Survey
on Children: 18.4% have a mental
health condition (2009)
Data on Mental Health Work Force

 2007 WHO - AIMS Data:
• Human resources working in mental health: 0.49/100,000
 2014 (Bangladesh Association of Psychiatrist)
• Total number of Psychiatrist: 210
Population
• Clinical Psychologist: 10
156 million
• Psychiatrist Social Workers: 3
• General physicians trained in mental health: 7000
• Nurses trained in mental health: 7200
• General Physician trained in disaster management: 60
Mental Health Service Centers

 2007- WHO-AIMS Survey indicated:
 National Institute: 1 (200 beds – 50 for Drug addicts)
 Mental hospital : 1 (500 beds)
 Department in Medical University : 1 (40 beds)
 Departments in medical colleges : 64 (0-60 beds)
 Total beds for mental health: 828 (0.58/100000)
 Treatment center for Drug Addiction: 4 (Govt.); 32 (Private)
 Budget Allocation in mental health: 0.44% of Health
Budget
 2014 Unpublished
0.25% of total
Health Budget Allocated to Mental Health
data indicates
MULTISECTORIAL PLANNING (since 2011)
Ministries, NGOs, Universities and Training Institutes
Health & Family Welfare
Social welfare
Women & Children Affairs
Education
Information & Communication
Technology
Economic Relations
Information
Primary & Mass Education
Labor & Employment
Youth and Sports
Local & Rural Development
Cultural Affairs
Finance
INCREASING CAPACITY FOR
DISABILITY SERVICES

o First Stage: Sensitization and understanding about ALL
disabilities
Training teacher trainers, doctors, medical students and allied health
professionals, social workers, community health workers and other community
services providers
o Second Stage: Specialized training on distinguishing
different developmental disabilities
Including information on neurodevelopmental disorders within the curriculum
of medical students
o Third Stage: Training of experts
Training on developmental disabilities for pediatricians, psychologists,
counsellors, therapists and others, parents
Achievements in Disabilities Issues:
Bangladesh

 2010: Center for Neurodevelopment and Autism in Children
(CNAC)
 2011: Regional Conference on ASD and Development
Disabilities. Dhaka Declaration for Autism and
Developmental Disabilities & Southeast Asian Autism
Network (SAAN)
 2012: Situation Analysis of Autism and Developmental
Disabilities in Bangladesh (Autism, Intellectual Disabilities,
Cerebral Palsy, ADHD)
 2013: Survey on Autism and Neurodevelopmental Disorders by
community health workers (MOHFW): .08-2.46%
 2013: Disability census by MOSW (results pending)
Achievements in Mental Health
Services

 Significantly improved Awareness in Mass media
 In 4 model Upazilla ALL physicians and other health
professionals have been trained in mental health
 Manuals and training guides for PHC physicians, nurses and
health workers, disaster management, family guide book etc
 VOLUNTARY Weekly psychiatric services to almost every
district
 Training for health professionals, local leaders, professionals,
law enforcement agencies, law makers & parents
 Included in several operational plans (OP) of Directorate
General of Health Services (MOHFW)
ACHIEVEMENTS IN DISABILITY
POLICY

 Neurodevelopmental Disability Protection Trust Act 2013
 Disability Rights And Protection Act 2013
PRIORITY NEEDS
ENACTMENT OF MENTAL HEALTH ACT

health policy
 Adoption of mental
within existing services
structures (i.e. disaster management, education curriculum)
 Incorporation of mental health in national health policy
 Standardize training & regulate ALL Mental Health professionals
(only psychiatrist training is regulated and standardized)
 Increase budget on mental health
 Organize a multidisciplinary team at community centers
 Collaboration for sustainability
 Improve Accessibility to services
 Evidence based care: Talk therapy and medication combined
most effective (Lancet, 2014)
THANK YOU