Bangladesh is grappling with an alarming rise in mental health disorders, with a prevalence rate of 18.7% and a daunting treatment gap of 92.4%, as per the 2019 National Mental Health Statistics (National Mental Health Survey 2019). Globally, mental health conditions account for 13% of the disease burden and are projected to increase to nearly 15% by 2030 (United Nations,2022).
In response to this challenge, BRAC, in collaboration with Mental Health Unit of Non-Communicable Disease Control (NCDC) and the Directorate General of Health Services (DGHS), has been working since January 2022 to initiate mental health and psychosocial support and ensure access to mental health services at the grassroots level.
To assess the effectiveness of the intervention, two research studies have been carried out: 1) "Impact Study on Mental Health Pilot Project'' by BRAC Institute of Educational Development (BIED), University of Tokyo, Kanazawa University, and Infant, Child and Family Psychiatrist, Australia; and 2) "Process Evaluation of Mental Health Pilot Project" by Professor Dr. M. Kamruzzaman Mozumder, Department of Clinical Psychology, University of Dhaka.
On 22 October, 2023, two research findings on the mental health pilot project were presented. Experts, government officials, academicians, researchers, and representatives of reputed non- governmental and international organisations related to mental health were present at the event. The focus of the event was to share important findings from the researchers and gather valuable feedback from the guests for future planning. KAM Morshed, Senior Director BRAC, facilitated the discussion.
The research shows that BRAC mental health Para-professionals began with limited knowledge and confidence but improved their skills through training and supervision. They provided a safe and open space for clients to share their thoughts and emotions, resulting in clients feeling emotionally lighter and more at ease, with improved mental health. Clients also learned techniques to manage anger and regulate emotions during sessions. As a result of receiving Psycho-social Support (PSS) from Para-professionals, clients and community members observed positive behavioural changes and improved coping strategies, leading to enhanced emotional understanding and stronger relationships.
Farjana Sharmin, Programme Manager, Clinical Psychology, BRAC Health Programme, shared project details and the intervention process. She also discussed global mental health conditions, Bangladesh mental health status, and the government's initiatives in mental health programmes. The collaboration between the government and BRAC in implementing mental health and psychosocial support at the community level was highlighted.
Prof. Dr. Tabassum Amina from BRAC Institute of Education Development prtesented the findings of the Impact Evaluation of Mental Health Pilot Projec. The project, conducted collaboratively by BIED, University of Tokyo, Kanazawa University, and Infant, Child, and Family Psychiatrist from Australia, revealed the remarkable impact of community-based mental health interventions. The project significantly raised mental health awareness, reduced distress levels, severe psychological distress, depression, and Post-traumatic Stress Disorder (PTSD), while enhancing the quality of life in areas like physical health, psychological well-being, and social relationships.
Professor Dr. M. Kamruzzaman Mozumder, the second speaker, provided a comprehensive process evaluation that highlighted the effectiveness of the training module designed for Para-professionals. Notably, the study emphasises the significance of handholding, supervision, and self-care support in building the skills and confidence of these Para-professionals.
The chief guest Prof. Dr. Mohammad Robed Amin, Line Director, DGHS, emphasised the collaboration between the government and the NGOs. He said, “This project has been highly successful at every step with powerful client satisfaction. BRAC can be part of our existing mental health initiative through the WHO special initiative. In this context, it's important to ensure that mental health services are not limited to intellectual individuals in society but should be made accessible to the local population through Para-professional training. Mental health cannot only be addressed by the government, rather there is a need to collaborate with NGOs.”
The special guest, Hossain Ali Khondokar, Additional Secretary, Ministry of Health and Family Welfare, added, “Superstition can only be tackled through education. It is essential to remember that no health is sustainable without mental health. Thus, I believe now is the time to advocate for a partnership between the government and NGOs in detecting and providing services for mental health issues among the general population.”
Asif Saleh, Executive Director of BRAC said, “This is a significant achievement in the field of mental health, made possible by the government's support and freedom of operation. It's essential to emphasise the principle of ‘Do No Harm’ in mental health, as interventions can sometimes do more harm than good. Care and sensitivity are paramount. The Para-counselor model, a relatively recent concept, has the potential to become a pioneering export from Bangladesh to the global mental health arena.”
The Mental Health Pilot Project is working to contribute to the community-based mental health landscape, significantly enhancing awareness and emphasising the importance of Para-professional capacity development. Its holistic approach enriches individual lives and ensures mental health well-being.
The findings from these two research studies shed light on the positive impact of community-based mental health interventions in Bangladesh. Moving ahead, the intervention remains committed to strengthening mental health support, both locally and as a potential global model.