World Mental Health Day - No Health Without Mental Health

Mental health and psychosocial support is a priority in the humanitarian crisis in Cox’s Bazar given the high need for such services - currently and prior to the emergency response - not only in the district but also nationwide. According to findings of the National Mental Health Survey (2018-19) almost 17% of the adult population had some form of mental health condition, and the Mental Health Atlas 2017 revealed a very low number of human resources for mental health: 0,13 psychiatrists per 100 000 people.

In this context, the Rohingya refugees - who were exposed to traumatizing events and whose future remains uncertain - present an added challenge to health care professionals in order to close the treatment gap and improve the health seeking behavior.

On World Mental Health Day, WHO showcases how the organization is addressing mental health needs in Bangladesh to assist the populations affected by the Rohingya refugee crisis and contribute to changing the historic neglect of mental health conditions.

“Sometimes I lose my memory and can’t recite the Koran”, Jahin*, 55 years old

“I was diagnosed with schizophrenia 12 years ago. We lived in Lemchi Badlapara, right at the Myanmar border with Bangladesh, and every year my husband would take me to Fuad Al Khatib - a private clinic in Cox’s Bazar - for treatment. We were once well-off but now we have nothing, it breaks my heart to see my husband and children suffering”, says Jahin*.

“Three years ago everything fell apart. We fled to Bangladesh and my condition worsened. Without medication, I developed anorexia (an eating disorder), sometimes I have visual hallucinations of people trying to strangle me or dead bodies around me. Other times I lose my memory and can’t recite the Koran. But I do get better when I have medication”, she adds.

“Now that I know that I can get medication for free I will always come to Hope Field Hospital”, says 55-year-old Jahin*. - WHO Bangladesh/ Tatiana Almeida

Common mental health conditions increase significantly among emergency affected populations and it is expected that the COVID-19 pandemic will have a massive impact on people’s mental well-being. These populations, including patients with existing mental health conditions, will need the support of empathetic and proactive mental health workers to slowly start rebuilding their lives.

“In all Bangladesh we have only 250 psychiatrists and in our district the situation is particularly challenging”, explains Dr Md. Kafil Uddin, Psychiatrist at 250 Bed District Sadar Hospital who visits Hope Field Hospital twice a month to ensure mental health care to Rohingya refugees.

“Patients with schizophrenia, bipolar disorder, psychosis and development disorders are among the conditions that require medication. It is very important to support mental health services, this is a big opportunity to help Rohingya restore their lives”, continues Dr Md. Kafil Uddin.

Dr. Kafil Uddin, psychiatrist, talking with a patient at Hope Field Hospital, Camp 4, in Ukhiya. - WHO Bangladesh/ Tatiana Almeida

A friendly space for women, the Hope Field Hospital in Camp 4, in Ukhiya, provides healthcare to the host community and Rohingya refugees. The mental health unit, at this facility, is composed of 1 doctor, 5 nurses, 2 midwives and 2 counsellors. All participated in the WHO Mental Health GAP training in 2019 where they learned the power of empathy and how to recognize and treat the symptoms of mental health conditions in order to provide first-line support to these populations.

However, over the past months, these health care workers faced many challenges: first, the fear of getting infected and bringing COVID-19 to their patients and family; then the lockdown that impacted essential health services in the Rohingya camps reducing mental health care to the hospital’s hotline which required access to telephone.

“For three months, we were unable to see our patients regularly. These people with mental health conditions experienced even greater social isolation, and that explains the many calls we received through our hotline. Since August mental health services are back to normal except for the masks that we are all wearing. In the first month we had 82 patients”, says Dr Rumana Rafiq, Mental Health Coordinator at Hope Field Hospital.

Dr Rumana Rafiq is one of the 300 health care workers in Cox’s Bazar who participated in the WHO Mental Health Gap Action Program (mhGAP) Training since 2019. WHO Bangladesh/ Tatiana Almeida

“We also have 45 community health workers who refer patients to our unit. We trained them in mental health awareness and psychological first aid care. They have good communication skills, ability to respond with empathy and confidentiality, and are very important to us because they work directly with the Rohingya”, adds Dr Rumana Rafiq.

Mental health training is one of the key ways to help health care workers understand how to address mental health needs in emergency and complex settings where specialized medical care is scarce or non-existent. By providing training to health care workers, WHO aims to enable more and more frontline workers to feel confident to talk about mental health and know how to provide primary support and refer patients when psychosocial support is needed.

Over the last two years, WHO has achieved a key milestone by implementing mhGAP training to at least one health facility in each Primary Health Care Center in Cox’s Bazar district. To date, 291 professionals working in the camps and government facilities – including doctors, nurses, councilors and selected members of the Mental Health & Psychosocial Support Network working group - have so far benefited from this training.

In 2020, the training started with a Training of Trainers (ToT) at national level that reached 145 humanitarian workers and government staff. Supportive supervision has so far been conducted at 22 Primary Health care facilities reaching 68 staff. In 2020, nearly 20 000 mental health and psychosocial support were provided to Rohingya refugees and host communities in Cox’s Bazar.

Dr Rumana Rafiq, Mental Health Coordinator, and Dr Beauty Sharma, Mental Health Councilor, talking with a child and his mother at Hope Field Hospital. WHO Bangladesh/ Tatiana Almeida

According to the WHO Mental Health Gap Action Programme (mhGAP), training on prevention and management of common mental health issues for non-specialists will increase the capacity for care. At Hope Field Hospital, the medical staff also talk about raising awareness and breaking the taboo because, as they say, there is no health without mental health.

*Not her real name