Meeting of the Working Group on the National Mental Health Strategic Plan, January 2020

By Saima Wazed and Nazish Arman
DHAKA, Bangladesh, Oct 28 2021 (IPS)

Mental health and treating mental health conditions involves not only treating an individual’s ability to manage their thoughts, emotions, behaviors, and interactions with others, but also ensuring that the social, cultural, economic, political, and environmental conditions are in place through effective national policies, social protections, adequate living standards, working conditions, community social support, and a tiered system of care through a robust network of health services. In Bangladesh, the Mental Health Act 2018 and the National Mental Health Policy 2021 were developed with the above in mind.

The Act and the Policy have also directed the development of the National Mental Health Strategic Plan for the country. The Strategic Plan document has been developed at the request of the Ministry of Health and Family Welfare’s Department of Non-Communicable Diseases. This document has been prepared with funding from the Department for International Development, and technical support from the World Health Organization’s Regional Office for South-East Asia and the Shuchona Foundation. It is envisaged that the strategic plan will allow the incorporation of required priorities of the Government within the broader framework of the policy including appropriate resource allocation with an effective monitoring and evaluation mechanism.

The National Mental Health Strategy 2020-2030 embarks to establish a comprehensive, inter-sectorial, integrated, and responsive system to ensure access to and utilization of quality mental health and psychosocial wellbeing services and information. The mission of the strategic plan is to establish a sustainable, rights based, holistic, inclusive, multi-sectoral framework. This will ensure provision of information and quality services for promoting mental health and psychosocial wellbeing, prevention, treatment, as well as rehabilitation of mental health conditions throughout the life course of the people of Bangladesh.

The strategy development process included a series of reviews of program evaluation reports, literature search, evidence, strategy, and policy documents by consultants, focus group discussions with relevant professional societies, ministries and division, semi-structured interviews with experts, technical group meetings, field visits and stakeholder consultative workshops for consensus building on critical issues and finalization. The core values and principles in the strategic plan are guided by the National Mental Health Policy 2021 (currently pending final approval), the Mental Health Act 2018 and several global plans and charters including the WHO Comprehensive Mental Health Action Plan 2013-2020, UN Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, the Rights of Persons with Disabilities which have been ratified by the Government of Bangladesh.

Snapshot of Stakeholder consultation with members of the Bangladesh Association of Psychiatrists, October 2020. Some stakeholder consultations were held virtually due to the pandemic.

Four general objectives have been envisioned in this strategic plan which are derived from the ‘WHO Comprehensive Mental Health Action Plan 2013 – 2020’:

1) To strengthen effective leadership and governance for mental health.
2) To provide comprehensive, integrated, and responsive mental health and social care services in community-based settings.
3) To implement strategies for promotion and prevention in mental health.
4) To strengthen information systems, evidence, and research for mental health.

The Strategic Plan has been organized in a manner such that, there is a breakdown of specific objectives indicated against each of the General Objectives of WHO’s Mental Health Action Plan 2013-2020, along with global and Bangladesh’s country specific indicators and targets. The mental health strategic plan also outlines Core Responsibility, Collaborative Partners, Advised Activities, Resources, Output Indicators and Funding Allocation for each of the specific objectives.

The Strategic Plan also highlights the different factors across the lifespan that are associated with mental health and provides an overview on how they are linked. There is consistent evidence worldwide that there is a link between mental health and physical health and in fact, one can easily say that they coexist since many of the risk factors of poor physical health are also risk factors for poor mental health. The key factors highlighted in the Strategic Plan include noncommunicable diseases, poverty, nutrition, violence, childhood and adolescence, humanitarian crisis, substance abuse and suicide, amongst others.

In conclusion, it is clear that an effective strategy for mental health, requires a multi-sectoral approach with specific considerations for the needs of vulnerable groups of the population. In order for such a plan to be implementable, sustainable and relevant, it is imperative that stakeholders, especially those with lived experience, provide important insight from their point of view. The goal of the current plan, once approved, is to ensure that not only those living with mental health conditions receive timely and effective treatment, but that the treatment approaches are not further stigmatizing, harmful and threaten their basic human needs and rights. It is hoped that the strategy which has been developed can be easily implemented and will result in a plan of action that will enable greater understanding of mental health in the community and enable greater psychosocial well-being for the people of Bangladesh.

Saima Wazed, a licensed School Psychologist, is currently Clinical Instructor for the Department of School Psychology at Barry University. Additionally, she is Advisor to the Director General of WHO on Autism and Mental Health, Member of WHO’s Expert Advisory Panel on Mental Health, Chairperson of the National Advisory Committee on Autism and NDDs in Bangladesh, Thematic Ambassador for “Vulnerability” of the Climate Vulnerable Forum, and Chairperson of Shuchona Foundation.
Nazish Arman is Lead Content Developer of Shuchona Foundation.

Shuchona Foundation was the member of the Working Group on the National Mental Health Strategic Plan; and Saima Wazed was its Chief Advisor.

Excerpt:

Meeting of the Working Group on the National Mental Health Strategic Plan, April 2019

By Saima Wazed and Nazish Arman
DHAKA, Oct 27 2021 (IPS)

Mental health is a state of well-being when both your body and your mind are in balance, and you are able to deal with the difficulties and challenges that come your way and easily find joy, peace, and happiness once the challenge is overcome. For many people though, the challenges often remain for too long – the pain of losing someone you dearly loved, being diagnosed with a chronic disease like cancer or a heart condition, losing your family/home/job or feeling like you failed to meet expectations. All those things and more can trigger so much intense stress and maladjustment, that if it goes unchecked and untreated, it may lead to a chronic disease, a mental health disorder. WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The majority of people are able to cope and get back to life as normal, but for the many who cannot, they begin to experience intense detachment from reality (experiencing delusions, pervasive sadness, uncontrollable fears, intense anger and/or fantasies and hallucinations). For those individuals, there is limited help and treatment in every country in the world. Those who suffer from mental health disorders and the brave professionals who learn to treat them are chronically stigmatized, under-appreciated and under-paid.

Mental health conditions, substance use disorders, suicide, and neurological disorders like dementia affect more than a billion people annually, account for an estimated third of the global burden of disability and result in 14% of global deaths. (Vigo et al., 2016). There has been increasing global recognition of the importance of mental health and the significant global burden of mental health conditions in both developing and developed countries. More than 80% of people experiencing them are living without any form of quality, affordable health care. Due to negligence and ignorance, we have high levels of mortality through suicide and increased comorbid medical conditions. According to a study published in 2016, it is estimated that 14.3% of deaths worldwide, or approximately 8 million deaths per year are attributable to mental health disorders.

The 7th Five Year Plan (FYP) and Vision 2021 of the Government of Bangladesh recognized the urgency of addressing mental health and developed a comprehensive system of care that can be implemented within our well tiered health infrastructure. This plan emphasized that proper health is essential not only for physical well-being but also for economic livelihood. To realize the vision of the 7th FYP, the Ministry of Health and Family Welfare is implementing its 4th Health, Population and Nutrition Sector Programme (4th HPNSP) from January 2017 to June 2022. The 4th HPNSP’s objectives include strengthening governance, institutional efficiency, expanding access and improving quality within the universal health care system. To achieve the SDGs target, the Ministry of Health and Family Welfare has committed to ensuring that mental health is a priority in the 4th HPNSP.

Saima Wazed, Chief Advisor to the Working Group on the National Mental Health Strategic Plan, at its meeting in April 2019

It is important to note that Bangladesh is among the first few countries in the WHO South-East Asia Region to place mental health as one of its top 10 priority health conditions. Mental health programming in Bangladesh has undergone several phases of evolution. Bangladesh passed a new Mental Health Act in 2018; is working on finalizing a Mental Health Policy; and has developed a National Strategic Plan after conducting a thorough situation analysis involving both professionals and those with lived experiences. The focus of the Mental Health Act is to protect the dignity of citizens with mental health conditions, provide them with healthcare, ensure their right to property and rehabilitate them. The law has 31 sections and will oversee the direction, development, expansion, regulation, and coordination of mental health related issues and duties entrusted to the Government. The National Mental Health Policy 2021 which is currently under final approval, provides an overarching direction by establishing a broad framework for action and coordination, through common vision and values for programing and mental health service delivery. Although still under review, this policy document acknowledges the significance and importance of relevant and useful local knowledge and practices, and adheres to global and regional thinking, taking into perspective the Bangladesh context.

Across the globe in most nations, mental health treatment is underfunded and lack a well-designed system of care within the health system primarily due to a limited understanding of how to treat adequately, severe social stigma, and complication of the conditions. The situation is similar in Bangladesh, where mental health has been a low priority in both health services delivery and planning for many years now. To address these issues, developing a comprehensive and multi-sectoral National Mental Health Strategic Plan was the only way forward to ensure access to quality mental health care services across the nation.

Saima Wazed, a licensed School Psychologist, is currently Clinical Instructor for the Department of School Psychology at Barry University. Additionally, she is Advisor to the Director General of WHO on Autism and Mental Health, Member of WHO’s Expert Advisory Panel on Mental Health, Chairperson of the National Advisory Committee on Autism and NDDs in Bangladesh, Thematic Ambassador for “Vulnerability” of the Climate Vulnerable Forum, and Chairperson of Shuchona Foundation.

Nazish Arman is Lead Content Developer of Shuchona Foundation.

Shuchona Foundation is a non-profit organization focusing on advocacy, research, and capacity-building, specialising in neurodevelopmental disabilities, and mental health. It aims to construct an effective bridge between national and international researchers, policy makers, service providers, persons with NDDs and their families, to promote inclusion nationally, regionally, and globally. The Foundation is a member of the UN ESCAP Working Group on disability as of May 2018, and holds special consultative status with UN ECOSOC since 2019.

Shuchona Foundation was the member of the Working Group on the National Mental Health Strategic Plan; and Saima Wazed was its Chief Advisor.

Follow @IPSNewsUNBureau
  

Excerpt: