Mental health in health service delivery :
In the health system of Bangladesh, unfortunately, there is no specific authority or commission to operate or supervise the mental health service nationwide and no day treatment facilities for mental health care either. To talk about specialized hospitals, there is only one mental hospital available in the country for a total of 0.4 beds per 100,000 population. So, most of the patients seeking mental health care are managed in the usual health care service delivery system. Depression, schizophrenia and mood disorders are the most prevalent mental disorders there.
If we magnify the mental health facilities in the context, there are 50 outpatient mental health facilities in the whole country and only 2 of them are for children and adolescents, which facilitates only 26 care seekers per 100,000 population. Apart from those, the number of community-based psychiatric inpatient units and community residential facilities are 31 and 11 respectively, which doesn’t even serve more than one person in every 100,000 population. National Institute of Mental Health (NIMH) is the only coordinating body dedicated to public education and awareness campaigns on mental health and mental disorders. Though the number of beds in the lone mental hospital in Bangladesh has increased by 25% in the last five years, it is still scarce. Most of the admitted patients there suffer from schizophrenia and rest mostly from mood disorder . Sadly, although it is the only mental hospital of the country, there is no reservation for children and adolescents, whereas studies showed that 10-20% of children and adolescents experience signs of mental disorders globally and half of all mental illnesses begin by the age of 14, and three-quarters during the mid-20s.
Barriers to mental health care seeking in Bangladesh:
There are a variety of factors inhibiting people to seek mental health care in Bangladesh, which both are dependent on individual, as well as societal factors. Social stigma, lack of relevant knowledge, and awareness seemed to play a major role. Most of neurotic patients do not prefer to consult or get admitted into psychiatric units due to social stigma, mental ward phobia, and poor maintenance of the working environment. Scarcity of health care facilities is another vital point, which is jeopardizing the mental health condition. Because of the limited resources and health care facilities, many people get deprived; accessibility and availability are two big issues there.
Inequity is profound at a large scale in the healthcare of Bangladesh. For example: distribution of beds is a barrier, which prevents the access for rural users and users from other religious, ethnic and linguistic minorities. A study showed that the density of psychiatrists around the largest city is 5 times higher than whole country. In Bangladesh, health care services mostly depend upon out of pocket expenses, so does mental health care; only 0.1% patients get free services. No mental disorder is covered in social insurance schemes either.
Mental health expenditures from government health department are less than 0.5%!!!. Moreover, around 67% of all the expenditures spent on mental health are devoted to mental hospitals and rarely for further research and mental health promotion. Considering human resources, in every 100,000 population, the accompanying number of human resources involved is only 0.49.
Whatever mental health services are there in South-East Asian regions, it is rounded of 0.00s comparing to the other parts of the world according to WHO-2005 global mapping of access to mental health services.