THE loss of vision of a large number of people to police firing during the July-August uprising and the subsequent agony have laid bare the pressing need for prioritising mental health in the healthcare system. A National Institute of Mental Health survey conducted on 55 of the injured, mostly students aged under 22 now being cared for in National Institute of Ophthalmology and Hospital with eye injuries, found that the majority of them are suffering from mental illness. About 75 per cent of the victims are suffering from mild to severe depression, more than 50 per cent from mild to severe anxiety and around 60 per cent from mental stress. Many of the injured at a meeting with health sector officials talked about the agony that they were going through. Their situation has come up as a wake-up call for physicians, leaders, authorities and policymakers to think about the matter seriously and recognise mental health as a critical part of overall treatment and well-being.
Mental health is closely interconnected with physical health. A person cannot be healthy without mental well-being. Yet, mental health has for long been undervalued, treated as secondary to physical ailment in Bangladesh. So, patients here often find themselves unwelcome and alienated and are treated as cases of physical symptoms rather than individuals with complex emotional and mental needs. When patients suffer from life-altering conditions such as blindness or chronic diseases, their mental health becomes as fragile as their physical state. It also negatively impacts their parents, family and friends.
If their emotional struggles are complicated and they are ignored by physicians from whom they expect responsive behaviour, profound compassion and empathy, the recovery process delays and their quality of life diminishes. For example, patients who have lost their vision because of sudden incidents experience profound mental illness, beginning with denial and anger followed by depression, anxiety, mental stress and, even, suicidal ideation. It is obvious that the affected or patients and their family cannot tackle the illness alone without any professional mental health support offered in a planned manner. Any mental health support, therefore, needs to be planned in a way so that the family could always take the initial steps to address various stages of psychological changes that they encounter before they are supported through a professional mental health team.
Here, the focus traditionally remains solely on diagnosing and treating the physical condition of patients. Physicians, who often struggle to handle a lot of patients, can hardly inquire about their emotional states or personal backgrounds, leaving the mental and emotional struggles that accompany physical illnesses overlooked or unaddressed. When physicians overlook a patient鈥檚 mental distress or ignore their concern, for whatever the reason is, it sends out wrong signals to the patients and the families and the mental health status becomes complex. Neglecting mental health in treatment results in the erosion of patient鈥檚 trust in healthcare providers. Such lack of trust makes patients seek alternative solutions and consult multiple physicians for the same condition, sometimes receiving conflicting advice and unnecessary treatment.听 It costs them a lot of money, which pushes the families into a catastrophic disaster.
And those who are affluent fly abroad for treatment, spending money several times higher than the cost in Bangladesh, which is a drain on foreign exchange. The patients believe that foreign physicians offer a more empathetic, patient-centred approach, which Bangladesh鈥檚 healthcare providers gravely lack.
How can Bangladesh address these challenges? Several steps might be necessary. The country should adopt a more holistic approach to health care, integrating mental health into the treatment process.
Healthcare professionals, particularly physicians, should be trained in mental health care, including techniques to recognise patient鈥檚 psychological distress, and communicating with them empathetically. Our medical education curricula are yet to include courses on mental health. Process should be initiated to incorporate such courses in medical education.
Physicians and the team have a most critical role in this regard. They can adopt a more patient-centred approach that considers the individual鈥檚 background, emotional state, concern, expectations and the way of life. They should keep in mind that simple practices such as asking patients how they are feeling mentally and emotionally, what changes they experience and what psychological support they need could assess the patient鈥檚 clinical and psychological status and a counselling and treatment plan designed accordingly can make a significant difference in the changed status.
Hospitals and other health facilities should integrate mental health professionals such as psychologists into their care teams. It needs to be ensured that every trauma victim and their family should have greater access to mental health treatment and counselling services to address their emotional struggles to transform their denial stage into acceptance stage whichever is possible alongside their physical recovery with high-quality clinical care and services both at the facility and at home.
There is no disagreement that in a country like Bangladesh, health system capacity is limited. It is not ready with its system, trained human resources and financing to address such a catastrophic disaster due to eye injury. Now, the government should allocate sufficient resources to mental health care, ensuring that psychological support becomes a standard part of patient treatment and management protocols. There should be a scope to divert resources and allocate them in priority areas in order to address patient鈥檚 clinical and mental healthcare needs. The government should also formulate policies focusing on integrating mental health services into primary healthcare settings. The public health sector is progressing to its next five years operational planning and resource allocation process. Each operational plan should have the flexibility to address such emerging issues in an integrated manner.听听
In today鈥檚 world, mental health is no luxury. It is a fundamental component of overall health and well-being. The July-August uprising and its aftermath have brought the matter into focus anew. By integrating mental health support into clinical care and treatment or patient management, we can build a healthcare system that is more compassionate, holistic and patient-centred. If we can do that, no one will feel like mere numbers on a physician鈥檚 patient list. They will, rather, feel that they are treated as individuals with their unique needs, experiences and emotions properly addressed. This will be a paradigm shift in health care services delivery and will not only improve health outcomes but also help to restore patient鈥檚 trust and confidence in the healthcare system and save foreign exchange now spent on treatment abroad.
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Munir Ahmed is the country director of Orbis International, Bangladesh.
