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World Mental Health Day observed

Mental disorders a serious but overlooked problem

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Md. Sazedul Islam  :
 World Mental Health Day is observed on October 10 every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health.
A recent review, led by ICDDR,B, found that mental disorders in Bangladesh are a serious but overlooked problem. Mental health disorders- depression, anxiety, addiction, schizophrenia and neurosis - have a serious impact on the health situation in Bangladesh. Better data, awareness and more mental health practitioners are needed to address the unmet needs for mental health care.    
The review found that the overall prevalence of mental disorders in Bangladesh is between 6.5 to 31% among adults, with psychiatric and psychogenic disorders such as depression, anxiety and neurosis most commonly reported. The prevalence of mental disorders was much higher in overcrowded urban communities than rural ones, and among the poor.
Leprosy is a major health problem in our country where those affected by leprosy experience anxiety and depression. Due to stigma prevailing over leprosy, when a man is affected he gets upset, thinking that it may be the result of his previous sin. He has doubt that whether the disease will be cured. He feels himself cursed and depends on mercy shown by others. Hence, it can be said that leprosy also affects mind.         
Majority of the studies emphasized the frequent occurrence of depression and anxiety disorders in leprosy patients. Leprosy patients have loss of self-confidence, diminished capacity to cooperate, diminished capacity for employment, and loss of self-respect.
Leprosy is a chronic bacterial infection of the skin and superficial nerves (in the skin) caused by Mycobacterium leprae. It may also involve the nose, eyes, throat and testicles, said doctors.
"About 3500 new leprosy cases are detected annually in recent years in Bangladesh. Of them, 10 percent later turn disabled due to their failure of taking timely and proper treatment", according to The Leprosy Mission International-Bangladesh (TLMI-B).        
Leprosy is considered as not merely a medical condition, but as a condition encompassing psychological, socioeconomic and spiritual dimensions that dehabilitate an individual progressively, unless properly cared for. Leprosy is curable with early diagnosis and treatment, which are available for free in the country. If untreated, leprosy leads to progressive physical, psychological and social disabilities, said TLMI-B.
Mental health issues within leprosy patients have significantly increased over the last decade and stigma is a key factor to this. Social stigma is associated mainly due to prevalent myths like its hereditary and contagious nature, and divine curse along with physical deformities caused. The victims not only face physical impairments but also suffer psychosocial repercussions due to the community's attitude.
Beyond the effects of the disease itself, leprosy victims still experience discrimination and many limitations imposed by society; they are often excluded and their human rights are violated. Not only does this stigma and discrimination affect their mental health, but it also limits the possibilities they have for overcoming the problem.        
Because of the stigma, patients sometimes delay seeking proper care until they develop physical deformities. The quality of their life declines rapidly. This can result in unemployment, comorbidities like depression, a worsening of their condition including permanent disability, which can intensify the stigma.
The psychosocial issues that are commonly related to stigma are people's dignity, social status, employment opportunities, job security, family relationships, and friendships. People have left their families and even spouses and children, fearing the repercussions of the fact that they had the disease.
Being rejected by local community and family members,  leprosy patients face a high risk of developing psychiatric disorders.
Another important finding is that the long duration of the illness and physical handicaps raise the risk of psychiatric disorders. Depression is the most common psychiatric disorder among these patients.
Psychiatric illness can greatly aggravate the management of leprosy. Patients may become less compliant to self-administered and long-lasting treatment. Multi-drug therapy (MDT) is the cure for the disease, however, therapy requires regular medication for 6 months to 1 year, during which patient compliance is key.
Furthermore, psychiatric illness can aggravate many conditions directly. Depression and chronic stress have been associated with immune depression and a shift in the type of cellular immune responses to pathogens. This may impede proper response to M. Leprae, the bacterium responsible for leprosy.
Stigma attached to these patients has more impact on educated women belonging to a higher socio-economic group and in joint families. Because of the fear of infecting family members, women sufferers keep themselves aloof and are constantly worried about divorce.  The lack of support, advice and the increased stigma associated with the condition in female patients can precipitate mental health conditions. Furthermore, women have been shown to be more vulnerable to mental health issues. Because of the greater proportion of delayed diagnoses in women, increased incidence of deformities may aggravate their social status and hence their mental health.  
People with mental disorders need counselling, but there is scarcity of it in our country. There should be arrangement of adequate counselling service for the victims at hospitals across the country.    
As leprosy is causing sufferings for us in different ways, it is better to eradicate the disease.
According to the rights activists, the following steps, if implemented, can help make a leprosy-free country. These are: motivating people about the importance of early case detection and treatment, giving importance to the leprosy issue with adequate financial allocation by the government, recruiting adequate manpower and imparting necessary training to them on leprosy for detecting leprosy cases across the country, and developing adequate skill of those providing leprosy health services.
The steps also include carrying out extensive awareness raising activities through Information, Education, Communication (IEC) for removing stigma and discrimination surrounding leprosy, ensuring adequate supply of MDT and improved leprosy health care including its complications management all over the country, providing leprosy health services through integrated system, and adopting the approach of public-private partnership in combating the disease.
The measures mentioned below should also be implemented for alleviating the sufferings faced by the leprosy victims and establishing their rights.
It is needed to build an inclusive society and remove all kinds of barriers, which block people with disabilities from access to the mainstream of society.  Programmes should be particularly focused on building the capacity of all stakeholders to enable them to move towards an inclusive approach. Active involvement of the affected persons in the intervention is essential. Communities should be involved in action for improvement of leprosy services.
It is needed to ensure equality of opportunities and rights of all the people, including the leprosy victims, so that they can live with dignity.
It is important that leprosy victims are aware of their rights and how to speak up for themselves so that they can gain access to services, resources and local support to improve their quality of life and ensure that they are able to participate as equal members in society. It is needed to promote coalition-building among leprosy patients and encourage the integration of these coalitions and/or their members with other community-based organizations.
We ought to support the development of self-help groups to help the leprosy victims learn about self-management/self-care activities to prevent and manage their impairments, and provide advice to people experiencing sensory loss about protecting their hands, feet and eyes, facilitating access to assistive devices where required.
(The writer, a journalist, can be reached at sissabuj@yahoo.com)

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