Mental Health in Bangladesh: From Bench to Community

Foreword by Hidayetul Islam
Foreword by Anwara Begum
Preface
Contents
About the Editor
List of Figures
List of Tables
1 Prominent Figures in Psychiatry in Bangladesh
	1.1 Introduction
		1.1.1 Professor Dr. A K M Nazimuddowla Chowdhury
		1.1.2 Professor Dr. Hidayetul Islam
		1.1.3 Professor Dr. Anwara Begum
		1.1.4 Dr. Shamim Matin Chowdhury
		1.1.5 Professor Dr. Syed Kamaluddin Ahmed
		1.1.6 Professor Dr. Abul Hasnat Mohammad Firoz
		1.1.7 Professor MSI Mullick
		1.1.8 Others
	1.2 Conclusion
	References
2 Epidemiology and Burden of Mental Disorders in Bangladesh
	2.1 Introduction
	2.2 Prevalence of Mental Disorders Among Adults
		2.2.1 Findings from Empirical Studies
		2.2.2 The First National Mental Health Survey on in Bangladesh (2003–2005)
		2.2.3 Prevalence of Mental Disorders Among Children and Adolescents
		2.2.4 Mental Disorders, Mental Retardation, Epilepsy and Substance Abuse in Children: Survey Report 2009
		2.2.5 Mental Health Status of Adolescents in Post-Covid Era
		2.2.6 National Mental Health Survey 2019
	2.3 Burden of Mental Illness in Bangladesh
	2.4 Coping Initiatives
		2.4.1 The Mental Health Act (MHA) of 2018
		2.4.2 The National Mental Health Strategic Plan 2020
		2.4.3 Bangladesh National Mental Health Policy (NMHP) 2022
		2.4.4 The Persons with Disabilities Rights and Protection Act 2013
	2.5 Ways Forward
	2.6 Conclusions
	References
3 Mental Health Services in Bangladesh
	3.1 Introduction
	3.2 Historical Developments of Psychiatric Services in Bangladesh
		3.2.1 Development of Public Service Points
		3.2.2 Development of Private Services Points
		3.2.3 Advocacy Groups
		3.2.4 Development of Legal Frames
	3.3 Mental Health Services Systems in Bangladesh
		3.3.1 Components of Mental Health Services in Bangladesh
		3.3.2 Level of Government Mental Health Services in Bangladesh
		3.3.3 Formal and Informal Services
		3.3.4 Referral System
		3.3.5 Telepsychiatry
		3.3.6 Current Psychiatric Services in Bangladesh
		3.3.7 Essential Drugs in Psychiatry in Bangladesh
	3.4 Human Resource in Mental Health Care in Bangladesh
	3.5 Help-Seeking Behavior in to Mental Health Care in Bangladesh
	3.6 Potential Challenges and Ways Out
	3.7 Conclusions
	References
4 Biological Management of Psychiatric Disorders in Bangladesh
	4.1 Introduction
	4.2 Mental Health Services and Access to Mental Health Care in Bangladesh
	4.3 Available Pharmacotherapies
		4.3.1 Psychotropics in Bangladesh Pharma Market
		4.3.2 Electroconvulsive Therapy (ECT) in Bangladesh
		4.3.3 Other Insights: Neuromodulation
	4.4 Supply of Psychotropics in Bangladesh
	4.5 Current Challenges and Ways Forward
		4.5.1 Current Challenges
		4.5.2 Ways Forward
	4.6 Conclusion
	References
5 Psychosocial Management of Mental Disorders in Bangladesh
	5.1 State of Mental Health Professionals in Bangladesh
	5.2 Historical Development of Psychological Therapies in Bangladesh
	5.3 Approaches to Psychological Therapies in Bangladesh
		5.3.1 Medistic Psychotherapy
		5.3.2 Psychodynamic Therapy
		5.3.3 Client-Centered Therapy
		5.3.4 Behavior Therapy
		5.3.5 Cognitive Behavior Therapy (CBT)
		5.3.6 Eye Movement Desensitization and Reprocessing (EMDR) Therapy
		5.3.7 Transactional Analysis (TA)
		5.3.8 Psychodrama
		5.3.9 Narrative Therapy
		5.3.10 Dialectical Behavior Therapy (DBT)
		5.3.11 Systemic and Family Therapy
		5.3.12 Interpersonal Therapy (IPT)
		5.3.13 Problem Management Plus (PM+)
	5.4 Specialized Areas of Work
		5.4.1 Addiction Counseling
		5.4.2 Neurodevelopmental Disabilities
		5.4.3 Sex Therapy
		5.4.4 Violence, Torture and Trauma
		5.4.5 Neuropsychology
		5.4.6 Refugee Mental Health
		5.4.7 Community Mental Health
		5.4.8 Psychological Therapy in Digital Platform
	5.5 Challenges and Opportunities in Psychosocial Management
		5.5.1 Beliefs About Supernatural Possession and Divine Punishment
		5.5.2 Dominance of Medical Model
		5.5.3 Stigma Around Mental Illness
		5.5.4 Poor Mental Health Literacy
		5.5.5 Slow Impact of Psychological Therapies
		5.5.6 Cost of Psychological Treatment
		5.5.7 Lack of Regulation and Licensing
		5.5.8 Lack of Skills Among Service Providers
		5.5.9 Limited Availability of Supervisor
		5.5.10 Limited Awareness and Scope of Continuing Professional Development
		5.5.11 Lack of Integration and Coordination
		5.5.12 Increasing Availability of Multiple Models of Intervention
		5.5.13 Willing Contribution from Experts from Abroad
		5.5.14 Legislative Framework on Mental Health
		5.5.15 Professional Identity as a Psychologist
	5.6 Recent Transitions Around Psychosocial Management in Bangladesh
		5.6.1 Rohingya Crisis
		5.6.2 COVID-19 Pandemic
		5.6.3 World Health Organization’s Special Initiative for Mental Health, Bangladesh
	5.7 Conclusion
	References
6 Child and Adolescent Psychiatry in Bangladesh
	6.1 Introduction
	6.2 Epidemiology and Cultural Perspective of Child Psychiatric Disorder in Bangladesh
		6.2.1 Epidemiology
		6.2.2 Cultural Perspective in the Presentation of Disorders
	6.3 History of Service Development of Child and Adolescent Psychiatry in Bangladesh
	6.4 Current Status of Child and Adolescent Psychiatry in Bangladesh
		6.4.1 Child and Adolescent Psychiatric Service
		6.4.2 Training and Courses on Child and Adolescent Psychiatry
		6.4.3 Human Resources
		6.4.4 Research in Child and Adolescent Psychiatry
		6.4.5 Child Mental Health Legislation and Policy
	6.5 Current Challenges and Ways Forward
		6.5.1 Lack of Resources
		6.5.2 Lack of Adequate Standard Training
		6.5.3 Lack of Research
		6.5.4 Distant Services
		6.5.5 Stigma Related to Mental Health
	6.6 Conclusion
	References
7 Substance Use and Mental Health Conditions: Co-existence of Dual Problems in Bangladesh
	7.1 Introduction
	7.2 Epidemiology of Substance Abuse in Bangladesh
	7.3 Relationship of Substance Use and Mental Health Conditions in Bangladesh
		7.3.1 Mental Health Conditions or Psychological Issues as Risk Factors for Substance Use
		7.3.2 Psychiatric Comorbidities in Persons with Substance Use
	7.4 Treatment-Seeking Behavior of the Substance Users with Mental Health Conditions
	7.5 Available Services for Managing Patients with Dual Diagnosis
		7.5.1 Government Services
		7.5.2 Private Services
		7.5.3 Procedure of Hospitalization
		7.5.4 Assessment and Management of Patients with Dual Problems in Bangladesh
		7.5.5 Opioid Substitution Therapy in Bangladesh
		7.5.6 Diagnostic Norms and Jargons Used in Substance Abuse Field
	7.6 Laws Related to Substance Abuse and Mental Health Conditions
		7.6.1 Narcotics Control Act (2018)
		7.6.2 Mental Health Act (2018)
	7.7 Non-government Organizations Working in the Field of Substance Use and Mental Health
		7.7.1 Bangladesh Rehabilitation and Assistance Center for Addicts (BARACA)
		7.7.2 Ashokti Punorbashon Nibash or Addiction Rehabilitation Residence (APON)
		7.7.3 Dhaka Ahsania Mission (DAM)
		7.7.4 Other Organizations
	7.8 Current Status of Research on Substance Use with Psychiatric Disorders
	7.9 Challenges of Management of Substance Abuse with Mental Health Conditions in Bangladesh
		7.9.1 Poor Awareness Along with High Stigma
		7.9.2 Inadequate and Separate Services for Mental Health and Substance Abuse
		7.9.3 Lack of Skilled Manpower
		7.9.4 Negligible Budget
		7.9.5 Complicated System of Care
		7.9.6 Poor Research and Data Quality
		7.9.7 Lack of Clarity and Discrepancy in Existing Laws
	7.10 Future Direction for Services Development in Bangladesh
		7.10.1 Integration of Services for Substance Abuse and Mental Health Conditions
		7.10.2 Developing Skilled Manpower
		7.10.3 Intersectoral Collaboration
		7.10.4 Information and Communication Technology (ICT)-Based Management
		7.10.5 Quality Data and Research
		7.10.6 Raising Awareness
		7.10.7 Reform of the Existing Laws and Regulations
	7.11 Conclusion
	References
8 Community Psychiatry in Bangladesh: Development and Current Status
	8.1 Introduction
	8.2 History of Community Psychiatry in Bangladesh
	8.3 Legal Frameworks and Policy for Community Psychiatry in Bangladesh
	8.4 Generic Mental Health Services in Bangladesh
	8.5 Community Psychiatric Services
		8.5.1 Day-Centers
		8.5.2 Telepsychiatry
	8.6 Research on Community Psychiatry in Bangladesh
	8.7 Gaps in Community Psychiatric Services and Ways Forward
	8.8 Conclusion
	References
9 Psychosexual Disorders in Bangladesh: From Bench to Community
	9.1 Introduction
	9.2 Prevalence and Burden of Psycho-sexual Disorders
	9.3 Comorbidities of Psychosexual Disorders in Bangladesh
	9.4 Factors Associated with Sexual Dysfunctions in Bangladesh
	9.5 Gender and Sexual Diversity-Related Issues in Bangladesh
		9.5.1 Gender Identity-Related Issues
		9.5.2 Sexual Orientation-Related Issues
		9.5.3 Hijra—The Intersex Community in Bangladesh
	9.6 Other Sexuality Issues
		9.6.1 Dhat Syndrome—A Culture Bound Syndrome
		9.6.2 Paraphilia
		9.6.3 Pornography Consumption
		9.6.4 Masturbation
		9.6.5 Hypersexuality
		9.6.6 Sex-Related Myths and Misconceptions
	9.7 Available Services in Bangladesh for Psychosexual Disorders
		9.7.1 General Services
		9.7.2 Specialized Services
	9.8 Help-Seeking Behavior for Psychosexual Disorders in Bangladesh
	9.9 Legal Aspects of Sexuality-Related Issues in Bangladesh
	9.10 Organizations Working in the Field of Psychosexual Disorders in Bangladesh
	9.11 Current Trend of Researches Regarding Psychosexual Disorders in Bangladesh
	9.12 Current Challenges
		9.12.1 Stigma and Cultural Taboos
		9.12.2 Lack of Awareness and Education
		9.12.3 Limited Access to Healthcare Services
		9.12.4 Lack of Trained Professionals
		9.12.5 Lack of Budget and Infrastructure
		9.12.6 Gender Inequality
		9.12.7 Lack of Research and Data
	9.13 Ways Forward
	9.14 Conclusion
	References
10 Forensic Psychiatry in Bangladesh
	10.1 Introduction
	10.2 Why Forensic Psychiatry is Necessary in Bangladesh?
		10.2.1 Case Study 1
		10.2.2 Case Study 2
	10.3 Historical Context
	10.4 Roles and Responsibilities of Forensic Psychiatrists
		10.4.1 Competency Evaluations
		10.4.2 Criminal Responsibility Assessments
		10.4.3 Risk Assessments
		10.4.4 Expert Witness Testimony
		10.4.5 Prison Psychiatry
		10.4.6 Collaboration with Legal Professionals
		10.4.7 Research and Advocacy
	10.5 Psychiatric Defences in Criminal Courts
		10.5.1 Insanity Defence
		10.5.2 Diminished Capacity
		10.5.3 Intoxication as a Mental State
		10.5.4 Automatism
		10.5.5 Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI)
		10.5.6 Mental Incapacity at Sentencing
	10.6 Current Status of Forensic Psychiatry Services in Bangladesh
		10.6.1 Mental Health Act in Bangladesh
		10.6.2 Forensic Beds
		10.6.3 Undergraduate Curriculum
		10.6.4 Prison Mental Health in Bangladesh
		10.6.5 Forensic Psychiatric Assessment Pathway in Bangladesh
		10.6.6 Forensic Psychiatric Services Spectrum
	10.7 Current Challenges of Forensic Psychiatry in Bangladesh
	10.8 Ways Forward
	10.9 Conclusion
	References
11 Suicidal Behavior and Suicide Prevention in Bangladesh
	11.1 Introduction
	11.2 Epidemiology of Suicidal Behavior in Bangladesh
		11.2.1 Rate of Suicide
		11.2.2 Rate of Suicidal Idea, Plan, and Non-fatal Attempt
		11.2.3 Gender Distribution
		11.2.4 Life-Stage
		11.2.5 Risk Factors
		11.2.6 Methods of Suicide
		11.2.7 Seasonal Variation of Suicidal Behavior
	11.3 Legal Status of Suicidal Behavior in Bangladesh
	11.4 Suicide Literacy and Stigma in Bangladesh
	11.5 Media Reporting of Suicide in Bangladesh
	11.6 Suicide Research in Bangladesh
	11.7 Suicide Prevention in Bangladesh
	11.8 Ways Forward
	11.9 Conclusions
	References
12 Psychiatric Education and Research System in Bangladesh
	12.1 Introduction
	12.2 Psychiatric Education in Bangladesh
		12.2.1 Psychiatry in Undergraduate Curriculum
		12.2.2 Specialist Courses in Psychiatry in Bangladesh
		12.2.3 Mental Health and Psychiatric Nursing
	12.3 Research Systems in Psychiatry in Bangladesh
		12.3.1 Specialized Journals in Psychiatry in Bangladesh
	12.4 Conclusions
	References
13 Research on Common Mental Disorders in Bangladesh
	13.1 Introduction
	13.2 Epidemiology of Common Mental Disorders in Bangladesh
		13.2.1 Studies Involving the General Population
		13.2.2 Studies of Specific Populations or Groups
		13.2.3 Studies Specifically Related to the COVID-19 Pandemic
		13.2.4 Risk Factors for Common Mental Disorders in Bangladesh
	13.3 Assessment of CMDs: Psychometric Instruments
	13.4 Phenomenology and Psychopathology
	13.5 Biomarkers of Common Mental Disorders
		13.5.1 Depression
		13.5.2 Anxiety Disorders
	13.6 Interventional Studies for CMDs in Bangladesh
	13.7 Quality and Quantity of Research on CMDs in Bangladesh
	13.8 Summary and Recommendations
		13.8.1 Future Directions for Research
		13.8.2 From Research to Clinical Practice
		13.8.3 From Research to Public Health and Policy
	13.9 Conclusion
	References
14 Public Mental Health in Bangladesh
	14.1 Introduction
	14.2 Public Health Burden of Mental Illness in Bangladesh
	14.3 Public Mental Health Programs in Bangladesh
	14.4 Current Challenges of Public Mental Health in Bangladesh
	14.5 Ways Forward
	14.6 Conclusion
	References
15 Climate Change and Mental Health in Bangladesh: Vulnerability, Inequality, and the Crucial Need for Intervention on the Frontlines of the Climate Crisis
	15.1 Climate Change and Mental Health—An Introduction
	15.2 Vulnerability of Bangladesh to Climate Change
	15.3 Climate-Related Risk Factors and Mental Health in Bangladesh
		15.3.1 Elevated Temperature and Humidity
		15.3.2 Floods
		15.3.3 Cyclones
		15.3.4 Drought
		15.3.5 Migration
		15.3.6 Gender
	15.4 The Way Forward: The Need for Interventions, Policy, and Research
	15.5 Conclusion
	References
16 Technology-Based Interventions for Mental Health Support in Bangladesh
	16.1 Introduction
		16.1.1 Overview of Mental Health Challenges in Bangladesh
		16.1.2 Prevalence of Mental Health Disorders & Barriers to Accessing Mental Health Services
	16.2 Technology Landscape in Bangladesh
		16.2.1 Overview of Technological Advancements in Bangladesh
		16.2.2 Internet Connectivity & Accessibility and Penetration Rates (Internet and Mobile)
		16.2.3 Utilization of Smartphones and Digital Devices
	16.3 E-Mental Health Initiatives in Bangladesh
	16.4 Tele-Psychiatry and Tele-Counseling Services
	16.5 Mobile Technology and Mental Health in Bangladesh
		16.5.1 Role of Mobile Technology in Global Mental Health Initiatives
		16.5.2 Review of Mobile Apps for Mental Health Support in Other Contexts
		16.5.3 Potential Benefits and Challenges of Using Mobile Apps in Bangladesh
	16.6 Virtual Reality (VR) and Augmented Reality (AR) Applications
		16.6.1 VR and AR in Mental Health Interventions
		16.6.2 Overview of VR and AR in Bangladesh
		16.6.3 Challenges and Prospects of VR and AR in Bangladesh
	16.7 Online Support Groups and Peer-To-Peer Platforms
	16.8 Combating Stigma and Raising Mental Health Awareness
		16.8.1 The Role of Technology in Reducing Mental Health Stigma in Bangladesh
		16.8.2 Online Campaigns and Social Media for Awareness-Raising
		16.8.3 Overview of Collaborations Between Tech Companies and Mental Health Institutions
	16.9 Coping with Challenges
		16.9.1 Addressing Barriers to Technology-Based Mental Health Interventions
		16.9.2 Overcoming Digital Literacy and Language Challenges
		16.9.3 Integrating Technology with Traditional Mental Health Services
		16.9.4 Ensuring Data Privacy and Security
		16.9.5 Strengthening Evidence-Based Practices
		16.9.6 Capacity Building and Training
		16.9.7 Collaboration and Public–private Partnerships
		16.9.8 Sustainable Funding and Resource Allocation
	16.10 Conclusion
	References
17 Mental Health of Vulnerable Populations in Bangladesh
	17.1 Introduction
	17.2 Vulnerable Communities in Bangladesh
		17.2.1 Stranded Pakistanis in Bangladesh
		17.2.2 Forcibly Displaced Myanmar Nationals
		17.2.3 Sexually Diverse Communities
		17.2.4 Climate Change Victims
	17.3 Mental Health Concerns Among the Vulnerable Communities
	17.4 Key Players in Mental Health Service Delivery for the Vulnerable Communities
		17.4.1 Government Organization
		17.4.2 Non-government Organization
		17.4.3 United Nations Entities
	17.5 Challenges and Recommendations for Psychosocial Service to Vulnerable Communities
		17.5.1 Linguistic and Cultural Differences
		17.5.2 Limited Understanding of the Vulnerable Communities
		17.5.3 The Top-Down Approach of Policymaking
		17.5.4 Resource Limitation
		17.5.5 Perception of the Wider Community
		17.5.6 Geological and Regional Priorities
	17.6 Conclusion
	References
18 Geriatric Psychiatry in Bangladesh
	18.1 Introduction
	18.2 Epidemiology and Burden of Mental Disorders Among Elderly People in Bangladesh
		18.2.1 Findings from Empirical Studies
		18.2.2 The First National Mental Health Survey on in Bangladesh (2003–2005)
		18.2.3 National Mental Health Survey 2019
	18.3 Available Services in Geriatric Psychiatry in Bangladesh
		18.3.1 Government Services
		18.3.2 Non-Government Organization (NGO) Services
	18.4 Conclusion
	References
19 NGOs Working on Mental Health in Bangladesh
	19.1 Historical Context: NGOs Work in Mental Health Sector in Bangladesh
		19.1.1 The Early Years: 1970 to 1980s
		19.1.2 1980 to 1990s
		19.1.3 The Transition 2000s to Present
	19.2 Role of NGOs in Mental Health
		19.2.1 Raising Awareness and Reducing Stigma
		19.2.2 Advocating for Policy Changes
		19.2.3 Expanding Access to Mental Health Services
	19.3 Approaches of NGOs
		19.3.1 Fund-Based Approach
		19.3.2 Revenue-Generating Approach
		19.3.3 Mental Health as a Value-Added Service
	19.4 NGOs Working with Vulnerable Communities
		19.4.1 Forcibly Displaced Myanmar National (Rohingya)
		19.4.2 Survivors of Climate Change
		19.4.3 Indigenous Community
		19.4.4 LGBTQ Community
	19.5 Mental Health Innovations—Case Studies
		19.5.1 Kaan Pete Roi (KPR) Emotional Support and Suicide Prevention Helpline
		19.5.2 Humanitarian Play Lab (HPL) of BRAC
		19.5.3 SHOJON Tele Mental Health Service of SAJIDA Foundation
	19.6 Challenges of NGOs in Bangladesh
		19.6.1 Funding, Sustainability, and Long-Term Impact
		19.6.2 Dearth of Ethical Practice
		19.6.3 Regulatory Oversight
		19.6.4 Limited Resources and Personnel
		19.6.5 Burnout Among Staff
	19.7 Future Scope and Opportunities
		19.7.1 Integration of Theory and Research
		19.7.2 Evidence-Based Practice and Quality of Care
		19.7.3 Community-Based Mental Health Intervention
		19.7.4 Utilization of Digital Innovations in Mental Health
	19.8 Conclusion
	References