Why we need a grassroot mental health revolution

October 14, 2014 by , , and

Shima Rani, one of BRAC’s trauma management training participants, conducting a group session in her cyclone-prone village in coastal Bangladesh.

Shima Rani, one of BRAC’s trauma management training participants, conducting a group session in her cyclone-prone village in coastal Bangladesh. Photo copyright: BRAC/M N I Chowdhury

Whether it is the globally mourned celebrity deaths like that of Robin Williams’, or the shocking Rana Plaza tragedy occurring close to heart, recent news at both home and abroad have sparked global conversations on the importance of prioritising mental health at multiple forefronts. BRAC, a global leader in tackling poverty through social development, has been quick to jump in on the bandwagon.

Bangladesh’s turbulent relationship with mental health began from the very start of its violent birth. The repercussions of the genocide and bloodshed of its 1971 Liberation War, can be traced in our culture today. The trauma that was experienced just a few generations ago have  both aggravated and been triggered by other social issues such as rising crime, domestic violence, increasing anger mismanagement, stress and depression, which have resulted from changing societal pressures. Mental  disorder here is a silent trouble, often trivialised or treated as taboo, further perpetuated by classifying anybody as a ‘pagol’ or a lunatic, who is not legally protected from discrimation.   Bangladesh also has the highest natural disaster mortality rate in the world, with over half a million people lost to various natural disaster events since 1970. Traditionally disaster response focused on the tangible needs of survivors, such as shelter, food and emergency medical aid, while overlooking the more intrinsic need to provide trauma support. In addition to that,the Ministry of Health in Bangladesh spends only 0.44 per cent of the total health budget to support mental health,  which proves that it  is not yet a priority in the overall health care delivery framework. Moreover, it is estimated that the country has only one psychiatrist for every two million of its people.

Taking the above matters into consideration and realising mental health issues do not discriminate, BRAC has been engaging in various mental health interventions in the last few years. However, it was the Rana Plaza tragedy that was the wake up call. The organisation realised that currently, while there were already major gaps in mental health support provision, whatever services existed was a luxury item, mainly accessible by the rich. As such, it started catering its various programmes in a way where mental health support can begin to reach those who are truly vulnerable and have minimum access to it- at the country’s grassroots levels.

In 2013, BRAC’s community empowerment programme started the Monobondhu pilot project under the Stop Violence Initiative. In this project a group of selected members of pollishomaj and popular theatre groups are trained to be community-based, psychosocial counsellors. Trained by a professional clinical psychologist, they provide psychosocial counselling to survivors of violence and their families and make sure the survivors can smoothly reintegrate into society. Currently the project is running in four districts in the country. Also, in collaboration with Radio Pollikontho, a clinical psychologist of the community empowerment programme  is providing psychosocial support over phone in Moulvibazar district. The show goes on air thrice a week and the callers share their psychological problems over phone to receive counselling and support.

To understand those in trauma, the disaster, environment and climate change programme has introduced a project  where rural women from some of Bangladesh’s most exposed areas to climate change, mostlyflood and cyclone prone areas,  receive training on trauma management. Till date, 640 women have participated in these trainings. These women share their learning with the other women in their group. Over the next two years, it is expected that a total of 20,000 women will be made aware of trauma management and be able to provide trauma management support to their own community members, which will increase their resilience to climate change and their coping abilities.

It is worth mentioning that after the Rana Plaza collapse, the Institute of Educational Development, in coordination with the disaster, environment and climate change programme, provided primary counselling support to around 473 families during the emergency response. Since then, Institute for Educational Development has also been providing counselling support to the Rana Plaza survivors. BRAC provided some survivors with prosthetic limbs, and they are also supporting them through group and individual counselling.

BRAC is trying to mainstream psychosocial counselling into its activities, setting the cornerstone of a future when mental health will be mainstreamed in the whole country’s public healthcare system- making Bangladesh a model for other countries to follow.

 

Sakila Yesmin (Institute for Educational Development, BRAC University), Lusana Anika Masrur (BRAC disaster, environment and climate change programme), Salina Shahnaz Shilpi (BRAC community empowerment programme) and Anjali Sarker (BRAC social innovation lab).