Domain 1: Policy and Legislative F

1.1 Financing of mental health services

1.1.1 HEALTH EXPENDITURE TOWARDS MENTAL HEALTH 1.1.2MENTAL HEALTH EXPENDITURE TOWARDS MENTAL HOSPI
1.1.1.1All Other Health 1.1.1.2Mental Health 1.1.2.1 Expenditures For 1.1.2.2All Other Mental Health
Expenditure Expenditure Mental Hospitals Expenditures
100% 0.44% 33% 67%
olicy and Legislative Framework
1.2 Human rights policies

ITURE TOWARDS MENTAL HOSPITALS No human rights review body exists in the country to oversee regular inspections in
mental health facilities. In terms of training no (0%) staff of mental hospital,
1.1.2.2All Other Mental Health inpatient psychiatric
Expenditures unit and community residential facility has provision for training on human rights
67%
 2.1 Mental health outpatient facilities 2.2 Day treatment facilities
There are 50 outpatient mental health facilities available in the country, There is no day treatment mental health
of which 4% are for children and adolescents only. These facilities treat facilities available in the country.
about 26 users per 100,000 general population. Of all users treated in
mental health outpatient facilities, 44% are female and 7% are children or
adolescents. The users treated in outpatient facilities are primarily
diagnosed with schizophrenia (30%), mood disorders (20%) and neurotic
disorders (20%).

The average number of contacts per user is four. No outpatient facility

(0%) provides follow-up care in the community, while 2% have mental
health mobile teams. In terms of available treatment, a few (1-20%) of
patients in outpatients facilities last year received one or more
psychosocial interventions. Fifty eight percent of mental health
outpatient facilities have at last one psychotropic medicine of each
therapeutic class (anti-psychotic, antidepressant, mood stabilizer,
anxiolytic, and antiepileptic medicines) available in the facility or a near-
by pharmacy all year round.
tment facilities 2.4 Community residential facilities
2.3 Community-based psychiatric inpatient units
tment mental health There are 31 community-based psychiatric inpatient There are 11 community residential
the country. units available in the country for a total of 0.58 bed facilities available in the country for a
per 100,000 population. Two percent of these beds total of 0.92 beds/places per 100,000
in communitybased population. These facilities treat 0.85
inpatient units are reserved for children and patients per 100,000
adolescents only. Forty two percent of patients are population. Fifty-five percent of these
female and 12% are children/adolescents. The rate beds in community residential facilities
of admissions in these are reserved
facilities is 4 per 100,000 population. The diagnoses for children and adolescents. Eighty-one
of admissions to community-based psychiatric percent of patients are female and 73%
inpatient were primarily from the following two are children.
diagnostic groups: On average patients spend 350 days in
schizophrenia (42%) and mood disorders (37%). On community residential facilities.
average patients spend 29 days in community-based
psychiatric inpatient units per discharge. A few
patients (1-20%) in
community-based psychiatric inpatient units
received one or more psychosocial interventions in
the past year. While 100% of community-based
psychiatric inpatient units had at least one
psychotropic medicine of each therapeutic class
(anti-psychotic, antidepressant, mood stabilizer,
anxiolytic, and antiepileptic medicines) available in
the facility
 D
2.5 Mental hospitals 2.6 Forensic and other residential facilities
There is 1 mental hospital available in the country In addition to beds in mental health facilities, there
for a total of 0.4 beds per 100,000 population and are also 15 beds for persons with mental disorders
this facility (100%) is organizationally integrated in forensic inpatient units and 3900 beds in other
with mental health outpatient facilities. There is no residential facilities such as homes for persons with
bed (0%) in mental hospital reserved for children mental retardation, detoxification inpatient
and adolescents only. The number of beds has facilities, homes
increased by 25% in the last five years. The for the destitute, etc. In forensic inpatient units
patients admitted to the mental hospital belong 100% of patients spend less than one year,
primarily to the following two diagnostic groups: 0% of patients spend 1-4 years, 0% of patients
schizophrenia (70%) and mood disorders (30%). On spend 5-10 years, and 0% of patients spend
average patients spend 137 days in mental hospital. more than 10 years.
Sixty-three percent of patients spend less than one
year, 21% of patients spend 1-4 years, 11% of
patients spend 5-10 years, and 5% of patients spend
more than 10 years in mental hospital. A few
patients (1-20%) in mental hospital
received one or more psychosocial interventions in
the past year. The mental hospital (100%) had at
least one psychotropic medicine of each therapeutic
class (anti-psychotic, antidepressant, mood
stabilizer, anxiolytic, and antiepileptic medicines)
available inthe facility
 Domain 2. Mental Health Services

2.7.1 BEDS IN MENTAL HEALTH FACILITIES 2.7.2 PATIENTS TREATED IN 2.7.3PERCENTAGES OF FEMALE USERS
AND OTHER RESIDENTIAL FACILITIES MENTAL HEALTH FACILITIES TREATED IN MENTAL HEALTH FACILITIES

2.7.1. 1 Mental Health 2.7.2.1 Out patient

8% 2.7.3.1 Mental Hospitals
Hospitals Fac. 26.087
2.7.2.2 Inpatiet Unit
2.7.1.2 Community based 12% 2.7.3.2 Residential Facilities
Psychiatric Inpatient Unit 4.18
2.7.2.3 Residential Fac
2.7.1.3 Forensic Unit 0% 2.7.3.3 Inpatient Units
0.85
2.7.1.4 Cmmunity Residential
Facilities 20% 2.7.2.4 Mental 2.7.3.4 Outpatient Facilities
Hospitals 0.68

2.7.1.5 Other Residential 60% 2.7.2.5 Forensic Unit

Facilities 0.008
 2.7 Human rights and equity
OF FEMALE USERS 2.7.4 PERCENTAGE OF CHILDREN AND ADOLESCENTS TREATED
L HEALTH FACILITIES IN MENTAL HEALTH FACILITIES AMONG ALL USERS 2.7.5 PATIENTS TREATED IN MENTAL HE

19% 2.7.4.1 Mental Hospitals 0%

81% 2.7.4.2 Residential Facilities
42% 2.7.4.3 Inpatient Units
44% 2.7.4.4 Outpatient Facilities
2.7.5.1 Mood Disorders
2.7.5.2 Others
73%
2.7.5.3 Personality Disordes
2.7.5.4 Neurotic Disorders
12%
2.7.5.5 Schizophrenia
2.7.5.5 Subtance Abuse
7%
ghts and equity
2.7.6 LENGTH OF STAY IN INPATIENT FACILITIES (days
ATIENTS TREATED IN MENTAL HEALTH FACILITIES BY DIAGNOSIS per year)
Outpatient Facilities Inpatient Units Mental Hospitals
Inpatient Units 29
20% 37% 30%
9% 4% 0%
Residential Facilities 350
5% 1% 0%
20% 10% 0%
Mental Hospitals 137
30% 42% 70%
16% 7% 0%
ENT FACILITIES (days 2.7.7 AVAILABILITY OF PSYCHOTROPIC 2.7.8 INPATIENT CARE VERSUS
DRUGS IN MENTAL HEALTH FACILITIES OUTPATIENT CARE

29 Outpatient Facilities 59% Outpatient Care 146989

350 Inpatient Units 100% Inpatient Units 717955

137 Mental Hospitals 100%

 Domain 3. Mental Health in Primary He
3.2 Mental health in primary health care
3.1 Training in mental health care for primary care
staff
Four percent of the training for medical doctors is Both physician based primary health care (PHC) and non-physician based
devoted to mental health, in comparison to 2% for in the country. In terms of physician-based primary health care clinics, all
nurses and 0% for non-doctor/non-nurse primary almost all clinics (81-100%) have assessment and treatment protocols for
health care workers. In terms health conditions available, in comparison to only a few clinics (1-20%) in
of refresher training, very few (almost 0%) primary primary health care. A few (1-20%) of physician-based primary health car
health care doctors have received at make on average at least one referral per month to a mental health profe
least two days of refresher training in mental health, of non-physician based primary health care clinics (1-20%) make a referra
0% of nurses and 1% of non-doctor/ level of care. In terms of professional interaction between primary health
non-nurse primary health care workers have other care providers, some (21-50%) of primary care doctors have interac
received such training. mental health professional at least once in the last year. Only a few (1-20%
physician-based PHC facilities, a few (1-20%) of non-physician-based PHC
a few (1-20%) of mental health facilities have had interaction with a comp
alternative/traditional practitioner.

3.1.1 OF PRIMARY CARE PROFESSIONALS WITH AT

LEAST 2 DAYS OF REFRESHER TRAINING IN MENTAL
HEALTH IN THE LAST YEAR

PHC Doctors 0.00% 3.2.1 Comparison of physician-based primary health care with non-physic
health care
PHC Nurses 0.00%
PHC Others 1.00% Tx Protcols Referrals Interaction with Trad Prac
Physician PHC
100% 10% 15%
Non Physician PHC
1% 5% 5%
al Health in Primary Health Care
th in primary health care
HC) and non-physician based PHC clinics are present
rimary health care clinics, all or
t and treatment protocols for key mental
o only a few clinics (1-20%) in non-physicianbased
ian-based primary health care doctors
onth to a mental health professional. Some
clinics (1-20%) make a referral to a higher
tion between primary health care staff and
ary care doctors have interacted with a
he last year. Only a few (1-20%) of
of non-physician-based PHC clinics and
e had interaction with a complimentary/
y health care with non-physician based primary
Interaction with Trad Prac
15%
5%
3.3 Prescription in primary health care
Primary health care nurses and non-doctor/ non-nurse
primary health care workers are not allowed to prescribe
psychotropic medications in any circumstance. In contrast
primary
health care doctors are allowed to prescribe psychotropic
medications without restrictions.
As for availability of psychotropic medicines, all or almost all of
physician-based primary
health care clinics have at least one psychotropic medicine of
each therapeutic category
(anti-psychotic, antidepressant, mood stabilizer, anxiolytic, and
antiepileptic) in comparison
to no clinics (0%) in non-physician-based primary health care.
 4.1 Number of human resources in mental health care

The total number of human resources working in mental health facilities or private practice per 100,000
population is 0.49. The breakdown according to profession is as follows: 0.072857143 psychiatrist, 0.182142857
other medical doctors (not specialized in psychiatry), 0.196428571 nurses, 0.007142857 psychologists,
0.002142857 social workers, 0.002142857 occupational therapists, 0.028571429 other health or mental health
workers (including auxiliary staff, non-doctor/non-physician primary health care workers, health assistants,
medical assistants, professional and paraprofessional psychosocial counsellors). Other medical doctors, not
specialized in psychiatry did not include primary health care doctors trained on mental health. Other health or
mental health workers also
did not include health workers trained on mental health.

4.1.1 HUMAN RESOURCES IN MENTAL HEALTH (rate per 100.000 population)

Psychiatrists Other Nurses Psycholog Social Workers Occupational Other Mental Helath
Doctors ists Therapists Workers

0.072857143 0.182142857 0.196428571 0.007143 0.002142857 0.002142857 0.028571429

4.1.2 STAFF WORKING IN MENTAL HEALTH FACILITIES (percentage in the graph, number in the table)
Psychiatrists Other Nurses Psychologists/s Other Mental
Doctors taff Helath
Workers
14 15 140 3 10
Mental Hospitals

33 140 220 3 20
Inpatient Units

10 70 21 4 0
Outpatient Facilities

4.1.3 AVERAGE NUMBER OF STAFF PER BED

Psychiatrists Nurses Psychologists staff

Community -Based
Psychiatric Inpatient Unit 0.04 0.27 0

Mental Hospitals 0.01 0.28 0.01

 Domain 4: Human Resources
4.2 Training professionals in mental health
4,3 C
The number of professionals graduated last year in academic and educational institutions per 100,000 There is no consumer
is as follows: 0.0036 psychiatrists, 1.43 medical doctors (not specialized in psychiatry), 0.71 nurses (not 40 family members. Th
specialized in psychiatry), 0.18 psychologists with at least 1 year training in mental health care, 0 nurses for the family associati
with at least 1 year training in mental health care, 0 social workers with at least 1 year training in The family association
mental health care and 0 occupational therapists with at least 1 year training in mental health care. implementation of
Between 1 and 20% of psychiatrists emigrate to other countries within five years of the completion of mental health policies
their training. no interaction
between mental healt
addition to consumer
and family association
individual assistance
activities such as coun
4.2.1 PROFESSIONALS GRADUATED IN MENTAL HEALTH

Psychiatrists Other Nurses Psychologists Social Nurses 1 Yr Occupational

Doctors 1 Yr Workers Yr Therapists
0.0003571429 1.428571429 0.7142857 0.178571429 0 0 0
 4,3 Consumer and family associations
There is no consumer association. There is 1 family association which has
40 family members. The government does not provide economic support
for the family association.
The family association has not been involved in the formulation or
implementation of
mental health policies, plans, or legislation in the past two years. There is
no interaction
between mental health facilities and consumer or family association. In
addition to consumer
and family associations, there are 10 NGOs in the country involved in
individual assistance
activities such as counselling, housing, or support groups.

5.1 Public education and awareness campaigns on
mental health
There is a coordinating body (National Institute of
Mental Health, Dhaka) to oversee public education
and awareness campaigns on mental health and
mental disorders. Ministry
of Health & Family Welfare, NGOs, professional
associations, private trusts and
foundations and international agencies have
promoted public education and awareness
campaigns in the last five years. These campaigns
have targeted the following groups:
general population, children, adolescents, women
and trauma survivors.
Domain 5: Public Education and Links with O
5.2 Legislative and financial provisions for persons with mental
disorders
There are no legislative and financial provisions to protect and
provide support for users in respect of employment of
disabled, protection from discrimination (dismissal, lower
wages) solely on account of mental disorder, priority in state
housing and in subsidized
housing schemes for people with severe mental disorders,
protection from discrimination
in allocation of housing for people with severe mental
disorders.
ducation and Links with Other Sectors
5.3 Links with other sectors
r persons with mental

visions to protect and There are formal collaborations between the government department responsible for: mental
mployment of health and the departments/agencies responsible for primary health care / community health,
(dismissal, lower substance abuse, welfare and criminal justice. In terms of support for child and adolescent
der, priority in state health, no primary and secondary school has either a part-time or full-time mental health
professional and no primary and secondary school has school-based activities to promote
mental disorders, mental health and prevent mental disorders. Regarding mental health activities in the
criminal justice system, the percentage of prisoners with psychosis and mental retardation
evere mental are unknown. A few prisons (between 1-20%) have at least one prisoner per month in
treatment contact with a mental health professional. As for training, a few (between 1-
20%) police officers and a few (between 1-20%) judges and lawyers have participated in
educational activities on mental health in the last five years. In terms of financial support
for users, no mental health facility has access to programs outside the mental health facility
that provide outside employment for users with severe mental disorders. Finally, 5% of
people who receive social welfare benefits do so for a mental disability.
A formally defined list of individual data items that ought to be collected by some mental health 6.2 Strengths and Weakness
facilities exists. This list includes number of beds, admissions, length of stay and
patient diagnoses in mental hospital. The government health department received data
from 100% mental hospital, 45% community based psychiatric inpatient units, and 28% Providing mental health serv
mental health outpatient facilities. However, no report was published with comments on existing government health
the data. In terms of research, 5% (according to pubmed) of all health publications in the the government.
country were on mental health. The research focused on the following topics:
epidemiological studies in community samples, non-epidemiological clinical assessments There is one 500 bedded me
of mental disorders, pharmacological and electroconvulsive interventions. long time leading to service
with bigger investment. The
increasing but the existing se
in comparison to outpatient
are no mechanisms for supe
6.1 Percentage of mental health facilities collecting and the country. Mental health s
compiling data by type of information of social class, religion, langu
TYPE OF MENTAL HOSPITALS INPATIENT UNITS OUTPATIENT Facilities more accessible to poor, trib
INFORMATION health budget is spent for m
COMPILED serving a small number of lo
N° of beds 100% UN NA health care physicians and p
programmes for more than t
N° inpatient required number. Essential p
admissions/users Hospital and the National In
treated in outpatient hospital psychiatry units. Th
facilities 100% UN UN
no consumers’ association e
association and mental heal
of health ministry. Linkage w
N° of days spent/user are informal which needs to
contactsin outpatient with primary care staffs duri
100% UN UN meeting with public, field su
facilities.
have been taken to maintain
N° of involuntary around capital city to develo
admissions 0% UN NA health policy and plan has b
Health Act is yet to be appro
N° of users restrained information system is yet to
0% UN NA felt for development of evid

Diagnoses 100% UN UN
6.1.1 PERCENTAGES OF MENTAL HEALTH FACILITIES TRANSMITTING DATA TO HEALTH
DEPARTMENT

Outpatient Facilities
Inpatient Units Mental Hospitals
28% 48% 100%

Progress is being made in ov

accelerated keeping pace wi
health wing in the health mi
unsatisfactory co-ordination
are among the prime barrier
of new leadership, increasin
number of qualified and trai
mental health
 Domain 6: Monitoring and Research
6.2 Strengths and Weaknesses of the Mental Health System in Bangladesh 6.3 Next Steps in Strengthening

Providing mental health services through trained primary health care physicians and health workers using Community based mental heal
existing government health network that is extended up to grass root level is the ongoing programme of existing training of primary hea
the government. Strengthening of existing outpa
hospitals and creation of such f
There is one 500 bedded mental hospital in the country, where most of the patients remain admitted for hospitals existing at the division
long time leading to service provision for small number of people steps for development of comm
with bigger investment. The spectrum of community mental health facilities are of qualified and trained manpo
increasing but the existing service is quite inadequate. The inpatient service is inadequate campaign on mental health inv
in comparison to outpatient care though the outpatient care is also insufficient. There
are no mechanisms for supervision and protection of human rights of mental patients in
the country. Mental health services are accessible to all people of the country irrespective
of social class, religion, language and ethnicity. Special efforts are needed to make it
more accessible to poor, tribal minority and the vulnerable. Less than 0.5% of government
health budget is spent for mental health and about 67% of that is spent for mental hospital
serving a small number of long stay patients. Training on mental health for primary
health care physicians and primary care health workers are ongoing government
programmes for more than two decades but the number of trained staff is still less than
required number. Essential psychotropic medicines are satisfactorily available in Mental
Hospital and the National Institute of Mental Health, but not widely available in general
hospital psychiatry units. There is only one small family association in the country and
no consumers’ association exist. No good interaction exists between the family
association and mental health service facilities. Mental health service is a formal activity
of health ministry. Linkage with education, criminal, justice and other relevant sectors
are informal which needs to be officially linked. Mental health care providers interact
with primary care staffs during their training on mental health, out-reach programme, awareness
meeting with public, field survey and such other related activities. Initiatives
have been taken to maintain continuous communication with four model upazillas (subdistricts)
around capital city to develop community mental health services. A mental
health policy and plan has been approved by government in 2006. A draft of the Mental
Health Act is yet to be approved and enacted by government. The mental health
information system is yet to start functioning formally, but its importance is intensely
felt for development of evidence-based psychiatry in the country.

Progress is being made in overcoming the weakness of mental health service system but it should be
accelerated keeping pace with the need of the time. Absence of separate mental
health wing in the health ministry, inadequate awareness among people of relevant sectors,
unsatisfactory co-ordination system, limitation of manpower, logistic and financial support
are among the prime barriers to progress. The factors facilitating progress are an emergence
of new leadership, increasing attention by relevant sectors including WHO, increasing
number of qualified and trained manpower and recent development of policy and plan on
mental health
6.3 Next Steps in Strengthening the Mental Health System

Community based mental health facilities needs to be strengthened through broadening the
existing training of primary health care physicians and primary health workers.
Strengthening of existing outpatient and inpatient psychiatric facilities in the general
hospitals and creation of such facilities in private medical college hospitals and big general
hospitals existing at the divisional and greater district level may be considered important
steps for development of community mental health services. Initiatives for development
of qualified and trained manpower are also urgently needed. Awareness and promotional
campaign on mental health involving relevant sectors are also needed.