World mental helth and Bangladesh perspective
Firoz AHM 1

World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease on infirmity”. So health care as a humanitarian activity, as a component of human rights protection and as an essential element of poverty alleviation must include mental health in its activity. There are about 400 million people in the world suffering from neuro-psychiatric disorders and about 1 crore 50 lacs people in Bangladesh (about 10% of the population) are now suffering from mental illnesses. This vast number of people is in immediate needs of mental health treatment. But the facilities for mental health services is very much limited both at the government and private levels.There are about 700 beds in the government hospitals for mental patients and the number of psychiatrists in the country is about 85.This is almost impossible to provide mental health services to this large number of people of the country. The modern concept of mental health treatment is not treating patients in long stay hospital like mental hospital, Pabna, but treating patients in short stay hospital like National Institute of Mental Health, Dhaka and other general hospitals of the country including all medical colleges. Community psychiatry is another milestone in the development of psychiatry around the globe. National Institute of Mental Health, Dhaka has been training general physicians, health workers, imams of mosques and community leaders for more than last two decades to provide mental health services at the community level of the country. Till now the institue has trained about 5000 health workers, 4000 general physicians, 50 civil surgeons and 200 imams of mosque on mental health.They are now providing mental health services to communty people at the rural area.This training programme is an on going process with an aim of covering almost all health workers, physicians and imams working at thana level. In this way Bangladesh has been trying its best to develop mental health in the country keeping harmony with other parts the world. Chaining and locking of mental patients are back dated concepts violating human rights of the people in general and producing no benefit in respect of modern medical management. In the recent time, Bangladesh has seen introduction of lot of psychotropic drugs in the market and these drugs are making tremendous contribution in the treatment of mental patients including treatment of violent patients. Pharmaceutical companies of the country are playing their parts in this respect. Mental illnesses are highly stigmatized around the globe and Bangladesh is the worst example of world scenario in this regard. Creating awareness regarding magnitude of mental illness and availability of the modern medical treatment is an urgent need of the time. National Institute of Mental Health, Sher-e-Bangla Nagar, Dhaka in collaboration with Bangladesh Association of Psychiatrists and National Forum for Psychiatrists are making tremendous efforts in this regard . World Health Organization (WHO), as one of its 10 priorities, and Government of Bangladesh are also playing their parts in the development of mental health. With the collective efforts of professionals, media, NGO's, pharmaceutical companies, United Nations Organizations and government of the country mental health in Bangladesh will reach its desired goal in the coming time and this is the people's expectation.  

Admissions to Mental Hospital rise by 30% over 10 years
London Zosia Kmietowicz Mental health services in the United Kingdom are in crisis, with more people than ever being detained in hospital under compulsory orders, says a report. Admissions to hospital under the Mental Health Act have risen by nearly 30% in the past decade in England, figures from the Department of Health show. According to a report from three national mental health charities, Rethink, Sane, and the Zito Trust, this figure is a sorrowful reflection of the current state of hospital care for people with psychiatric illness. The report, Behind Closed Doors, says that despite 650 national strategies, guidelines, and frameworks issued by the government over the past five years, little progress has been made in the care of people with serious mental illnesses. Postcode prescribing continues to flourish throughout the
United Kingdom, says the report, with many patients still failing to receive modern drugs despite rulings from the National Institute for Clinical Excellence in 2002 and 2003 that atypical antipsychotic drugs should be used as firstline drugs in the treatment of schizophrenia. Of the 20 000 or so people sectioned under the Mental Health Act each year, one in five are readmitted within three months of leaving hospital, confirming the so called ‘revolving door” of acute mental health care. Feedback from patients also suggests that their experiences were so negative that they would do anything to avoid being readmitted. In particular, they complained about the lack of basic necessities, privacy, dignity, and comfort and of being bored. They also said they were given inadequate information about their condition and excluded from the planning of their care. Paul Corry, head of policy and campaigns at the charity Rethink, blames the lack of effective community mental health services for the rise in section rates. As a result, vulnerable people are left untreated and unsupported.   bmj.corn

1. Prof. Dr. A.H. Mohammad Firoz, MBBS, FCPS, MRCP, FRCP' Director,
    NationaI Institute of Mental Health & Hospital, Sher-e-Bangla Nagar, Dhaka.