1. ADDRESSING MENTAL HEALTH IN LOW RESOURCE COUNTRIES S AIMA W AZED H OSSAIN, S.S.P., NCSP S CHOOL P SYCHOLOGIST C HAIR OF N ATIONAL A DVISORY C OMMITTEE ON A UTISM M EMBER OF WHO’ S E XPERT A DVISORY P ANEL ON M ENTAL H EALTH

3. GLOBAL MAPPING OF ACCESS TO SERVICES ( WHO-ATLAS-2 005 )

4. EVOLUTION OF MENTAL HEALTH SERVICES IN BANGLADESH 1957 First Psychiatric Hospital in Pabna 1972 Organization of Training in Mental Health (OTMH) by Bangabandhu Sheikh Mujibur Rahman 1975 DPM (Diploma) Started at IPGMR 1979 FCPS (Fellowship) and Mphil Program 1981 NIMH (National Institute of Mental Health) 2014 Mental Health Act 2005 MD (Masters) Degree 1912 Lunacy Act Act for disability rights

5.  Trained PHC Physicians Psychiatrist in district Hospitals Psychiatry Dept. In Nearby Medical Colleges NIMH, Dhaka Mental Hospital (Pabna) Trained health workers at PHC (18000 Community Clinics, USC, UHC) EXISTING REFERRAL SYSTEM FOR MENTAL HEALTH Only 1 district has a psychiatrist

6.  Prevalence of Mental Disorders in Bangladesh WHO supported National Survey on Adults: 16.1% have a mental health condition(2003-2005). WHO supported National Survey on Children: 18.4% have a mental health condition (2009)

7.   2007 WHO - AIMS Data: Human resources working in mental health: 0.49/100,000  2014 (Bangladesh Association of Psychiatrist) Total number of Psychiatrist: 210 Clinical Psychologist: 10 Psychiatrist Social Workers: 3 General physicians trained in mental health: 7000 Nurses trained in mental health: 7200 General Physician trained in disaster management: 60 Data on Mental Health Work Force Population 156 million

8.  2007- WHO-AIMS Survey indicated:  2007- WHO-AIMS Survey indicated:  National Institute: 1 (200 beds – 50 for Drug addicts)  Mental hospital : 1 (500 beds)  Department in Medical University : 1 (40 beds)  Departments in medical colleges : 64 (0-60 beds)  Total beds for mental health: 828 (0.58/100000)  Treatment center for Drug Addiction: 4 (Govt.); 32 (Private)  Budget Allocation in mental health: 0.44% of Health Budget  2014 Unpublished data indicates 0.25% of total Health Budget Allocated to Mental Health Mental Health Service Centers Mental Health Service Centers

9. MULTISECTORIAL PLANNING (since 2011) Ministries, NGOs, Universities and Training Institutes

10.  o First Stage: Sensitization and understanding about ALL disabilities Training teacher trainers, doctors, medical students and allied health professionals, social workers, community health workers and other community services providers o Second Stage: Specialized training on distinguishing different developmental disabilities Including information on neurodevelopmental disorders within the curriculum of medical students o Third Stage: Training of experts Training on developmental disabilities for pediatricians, psychologists, counsellors, therapists and others, parents INCREASING CAPACITY FOR DISABILITY SERVICES

11.  Achievements in Disabilities Issues: Bangladesh  2010: Center for Neurodevelopment and Autism in Children (CNAC)  2011: Regional Conference on ASD and Development Disabilities. Dhaka Declaration for Autism and Developmental Disabilities & Southeast Asian Autism Network (SAAN)  2012: Situation Analysis of Autism and Developmental Disabilities in Bangladesh (Autism, Intellectual Disabilities, Cerebral Palsy, ADHD)  2013: Survey on Autism and Neurodevelopmental Disorders by community health workers (MOHFW):.08-2.46%  2013: Disability census by MOSW (results pending)

12.   Significantly improved Awareness in Mass media  In 4 model Upazilla ALL physicians and other health professionals have been trained in mental health  Manuals and training guides for PHC physicians, nurses and health workers, disaster management, family guide book etc  VOLUNTARY Weekly psychiatric services to almost every district  Training for health professionals, local leaders, professionals, law enforcement agencies, law makers & parents  Included in several operational plans (OP) of Directorate General of Health Services (MOHFW) Achievements in Mental Health Services

13.   Neurodevelopmental Disability Protection Trust Act 2013  Disability Rights And Protection Act 2013 ACHIEVEMENTS IN DISABILITY POLICY

14.  ENACTMENT OF MENTAL HEALTH ACT  Adoption of mental health policy within existing services structures (i.e. disaster management, education curriculum)  Incorporation of mental health in national health policy  Standardize training & regulate ALL Mental Health professionals (only psychiatrist training is regulated and standardized)  Increase budget on mental health  Organize a multidisciplinary team at community centers  Collaboration for sustainability  Improve Accessibility to services  Evidence based care: Talk therapy and medication combined most effective (Lancet, 2014) PRIORITY NEEDS

15. THANK YOU