Abstract
Bangladesh is a lower-middle-income country of the Indian Subcontinent with a huge population density. Historically, education and research in mental health have been neglected in this region as well as in the country. Psychiatry is grossly under-prioritized in the undergraduate curriculum in the country. Before, independence mental health professionals were being trained in England. The first mental health specialist course was opened in 1975 named Diploma in Psychological Medicine which was ceased later. In 1979 a fellowship course [Fellow of Bangladesh College of Physicians and Surgeons (FCPS)] was started under Bangladesh College of Physicians and Surgeons (BCPS). The organization also offers a short-duration membership course. The Master of Philosophy (MPhil) in psychiatry was started in 1995 and ceased eventually. The Doctor of Medicine (MD) in psychiatry was started in 1995 and revised in 2010 as “Residency Program”. The MD in child and adolescent psychiatry was started in 2016 and the FCPS in child and adolescent psychiatry was started in 2022. There are two specialized journals in psychiatry in Bangladesh. In this chapter, I have discussed the education and research system in psychiatry in Bangladesh
In what is now Bangladesh, there were no mental
health facilities until 1947, when India was divided.
(Psychiatric patients had to go to the Central European
Asylum in Ranchi, which was too far away for many
people.) In that situation the government (of what
was then East Pakistan) decided to establish a mental
hospital, and in 1957 one was opened in Pabna, a
district town 175 km from the capital, Dhaka. Initially
it was a 50-bed hospital, but it grew to become today
a 500-bed hospital. In 1974 Dhaka Medical College
introduced a mental health service. This service
was then extended to the Institute of Postgraduate
Medicine and Research (now Bangabhandu Sheikh
Mujib Medical University, BSMMU) and other medical
colleges, as well as to the Institute of Mental Health
and Research. This service included both outpatient and in-patient departments. At present, all 13
government medical colleges and hospitals and some
of the non-government medical college hospitals
provide psychiatric services, both out-patient and inpatient
Prevalence of psychiatric disorder
Psychiatric disorder is common in Bangladesh, as
in any other country, but the psychiatric service at
present is confined to Pabna Mental Hospital, the
Institute of Mental Health, the BSMMU and the
medical college hospitals (Islam et al, 1993). Although
the results of a recent national survey of psychiatric
morbidity are yet to published, the evidence from
smaller surveys suggests that psychiatric disorder is
prevalent in both the urban and rural communities.
In a survey of the rural population of Dasherkandi
(a village near Dhaka) it was found that 29 per 1000
people suffered from psychiatric disorder, and an
additional 36 per 1000 had both a psychiatric and a
physical disorder (Chowdhury et al, 1981).
In another study it was found that 29% of patients
seen in a medical general practice during the course
of 1 year were suffering from a purely psychological
or emotional disorder (Alam, 1978).
At the medical out-patient department of the Institute of Postgraduate Medical Research, it was found
that 31% of patients had a purely psychological condition and an additional 15% had a condition with both
organic and psychogenic features (Chowdhury et al,
1975).
In a study of 600 patients attending a psychiatric
clinic in Chittagong city, schizophrenia and affective
disorder were found in 30% and 25% of patients,
respectively. Neurosis and personality disorder in
combination were found in 30%. Organic disorder
and learning disabilities were found in 7% and 3%
respectively (Ahmed, 1978).
Medical education
Undergraduate education
Psychiatry is included in the undergraduate curriculum.
The course comprises 15 lectures (1 hour each)
and 15 days of clinical clerkship in the fourth-year
MBBS class, which is mandatory for all students. In the
MBBS, 12.5% of marks are allotted to mental health
in the written final examination.
Postgraduate education
Postgraduate courses in Bangladesh include fellowship and membership of the Bangladesh College of
Physicians and Surgeons (FCPS and MCPS), master
of philosophy (MPhil) and doctor of medicine (MD).
The FCPS course is run by an autonomous body
following the curriculum of the MRCPsych. It has part
I and part II examinations and also requires 2 years
of full-time clinical experience. There have been
34 fellows to date. The MD course is run by the
BSMMU. It has had one successful student complete
the course and another 11 are currently taking it.
The MD is a 5-year course, which includes 3 years
of training. The MPhil course is run by both the
BSMMU and Sylhet MAG Osmani Medical College.
It is a 3-year course, including 1 year of residential
training. So far 25 students have gained the MPhil and
18 students are presently on the course. At the end
of both the MD and the MPhil courses, students have
to submit a thesis, and FCPS students have to submit
a dissertation.
Training
The BSMMU, the Institute of Mental Health and
Research and the 13 government-run medical colleges provide postgraduate training in psychiatry.
Doctors interested in psychiatry work as ‘indoor’
medical officers, assistant registrars or honorary
medical officers. The institutes do not pay the nongovernment doctors, who work as honorary medical
officers. The training is full time and residential.
Child psychiatry
Child psychiatry has not been developed in Bangladesh, although there is a child psychiatry wing at the
BSMMU and another child psychiatry department at
the Institute of Mental Health and Research. The
country has only three psychiatrists trained (abroad) in
child psychiatry.
Psychotherapy
Psychotherapy (which is still in a rudimentary state)
is mostly done by psychiatrists. In the University of
Dhaka there is a clinical psychology department.
Students are trained in psychotherapy at the psychiatry
department of the BSMMU.
Mental health services in Bangladesh
As the number of psychiatrists is low relative to the
size of the population, psychiatric patients are taken
care of by psychiatrists, doctors trained in psychiatry,
doctors practising relevant specialties and general
practitioners. There is no formal referral system,
although patients are referred by other health
professionals to psychiatrists for proper management.
Many patients attend psychiatrists after ‘referral’
from people in their local community. Some patients
are now referred to psychiatrists by traditional healers,
faith healers and unqualified medical practitioners (socalled ‘village doctors’). There are approximately 800
beds sanctioned for psychiatric patients in government
hospitals. In non-government sectors, there are about
1000 psychiatric beds, most of which are occupied
by drug misusers, whereas in the government sector
people with a psychosis occupy almost all the beds.
There is one government drug addiction treatment
centre, with 75 beds, situated in Dhaka.
Doctors who have been trained in psychiatry
work mostly in primary care centres. They are supposed to take care of the psychiatric patients in their
areas, but there are no statistics regarding the patient
care undertaken by these doctors. Also, there are no
refresher courses for these trained doctors, so they
are not in touch with recent advances in psychiatry.
Associations
There are two psychiatric associations: the Bangladesh
Association of Psychiatrists (BAP), of which all psychiatrists practising in Bangladesh are members; and
the Forum of Psychiatry, which has emerged only
recently.
Overview
Education and services in psychiatry are gradually
increasing, but still psychiatrists and psychiatric services
tend to be available only in big cities. Most of the
psychotropic medications are available in Bangladesh.
On the other hand, psychotherapy is not widely available. Bangladesh lacks a mental health act. The BAP
has been struggling to have an act passed and to
expand psychiatric services in remote areas.
References
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