Interview by Abul Hasan
Mental illnesses are generally thought to be caused by a variety of genetic and environmental factors that are based on inherited traits, environmental exposures before birth and brain chemistry, said Professor Dr. M A Hamid, Director, National Institute of Mental Health (NIMH), in an exclusive interview with The Guardian.
In this context, the Director mentioned that mental illness refers to a wide range of mental health conditions- disorders that affect human mood, thinking or behavior, adding that for better understanding purpose, mental illnesses are categorized into two sections- one is neurosis and the other is psychosis.
He observed that in an age of information and technology, where the people have the limitless opportunity to have all information at their disposal; it is very regrettable that there are misconceptions about mental illness among people.
He suggested everyone to be awakened and conscious about mental illness and also urged the people affected with mental illness overpowering all negative perspective, superstition, imbecility to come forward to be treated properly.
In reply to a particular question about NIMH, the Director informed that NIMH outdoor was started in 2001 and indoor and other facilities started in 2002 and side by side outdoor and indoor facilities, NIMH provides Psychotherapy, Free medication, Post graduate training, Academic Course for MD (Psychiatry), Training for MCPS (Psychiatry) and FCPS (Psychiatry) and Training for community health care providers.
He also informed us about various limitation and shortages of manpower, budget and proper infrastructural facilities of NIMH. In spite of the fact, NIMH is committed to be the centre of excellence for the mental health services, trainings, and research. Keeping this in aim, a number of programmes have been undertaken for future action to fulfil the demand of the mental patients.
In an exclusive interview, NIMH Director, who is also a high-profile mental physician of the country, replied to several questions asked by this Correspondent of The Guardian. His replies focus on the entire activities, problems, potentials, contributions, achievements and future plans of NIMH, including the overall aspects of mental diseases and their treatments. His deliberations are quite outstanding, informative and educative as well. The excerpts of his valuable interview are presented here for The Guardian readers at home and abroad:
The Guardian: Please give us an idea about mental disease.
Director: Mental illness refers to a wide range of mental health conditions- disorders that affect your mood, thinking or behavior. For better understanding purpose, mental illnesses are categorized into two sections. One is neurosis. And the other is psychosis.
In neurosis-type diseases, expression or dimension of emotions exceed natural limit. For example- having a bad mood, anxiety and fear, these are natural human expression of emotion. Sorrow or failure can make anyone tensed, it is also natural to be anxious about any bad news or danger sign, similarly it is not quiet abnormal to be little afraid of dog, height or darkness. But when these emotions crossing the barrier of normal limit and time, endangers a person’s life and significantly damages his personal, familial, social, educational or professional life; only then these are identified as diseases.
Again sometimes mental stress is expressed through changes in physical state- on these events though the changes are physical no evidence of physical illness are found in tests. A neurosis patient generally doesn’t lose sense of reality and also his personality doesn’t suffer from any significant damage. Depressive disorder, anxiety disorder, phobic disorder, obsessive-compulsive disorder etc are examples of neurosis.
On the other side psychosis patients lose balance in their behavior and personality. They have no connection with reality. Many of them have illogical, reasonless and misjudged but firm belief. For example, a psychosis patient believes – everyone is his enemy, everyone is conspiring to harm him, or he himself is a very powerful person, he is the owner of a lot of money or power – although none of these are real.
Many see or hear paranormal things. Generally they themselves can’t realize that they are sick. People surrounding them can easily identify these changes in them. Schizophrenia, mania or bipolar disorder – these are examples of psychosis. Except of these, including drug addiction, mentally handicap, personality impairment there are many more types of mental diseases. Furthermore physical diseases may lead to symptoms of mental diseases.
The Guardian: And discuss the reasons and kinds of mental disease?
Director: Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:
Inherited traits: Mental illness is more common in people whose blood relatives also have a mental illness. Certain genes may increase your risk of developing a mental illness, and your life situation may trigger it.
Environmental exposures before birth: Exposure to environmental stressors, inflammatory conditions, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.
Brain chemistry: Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When the neural networks involving these chemicals are impaired, the function of nerve receptors and nerve systems change, leading to depression.
The Guardian: Would you also discuss the treatment of mental disease?
Director: Treatment means all the different ways in which someone with a mental illness can get help to minimize the effects of the illness and promote recovery. It can involve psychological therapy, medication, and various supports in the community, as well as people with the mental illness helping them.
Psychological therapy: A doctor, psychologist or other health professional talks with the person about their symptoms and concerns, and discusses new ways of thinking about and managing them – for further information see Psychological treatments in the Guide to Medication and other Treatment.
Medication: Some people are helped by taking medication for a while; others may need it ongoing basis. The doctor should explain the benefits and possible side-effects of medication before it is prescribed. Medical research shows that many mental illnesses are associated with changes in our brain chemistry. Medications help the brain to restore its usual chemical balance, so that the symptoms are reduced or even eliminated. For further information, it can be seen in Medication in the Guide to Medication and other treatments.
Community support programs: Support programs are especially important for people with recurrent symptoms or who have a psychiatric disability. This support may include information; accommodation; help with finding suitable work, training and education; psychosocial rehabilitation and mutual support groups. Understanding and acceptance by the community is also very important – for further information see ‘Support in the community’ in the Guide to Medication and other Treatments.
The Guardian: In this context, would you say when the National Institute of Mental Health (NIMH) was established in Bangladesh?
Director: NIMH outdoor was started in 2001. Indoor and other facilities started in 2002.
The Guardian: Please discuss the activities and facilities of NIMH.
Director: NIMH performs the activities as follows:
– Outdoor treatment
– Indoor treatment
– Free medication
– Post graduate training
– Training for community health workers
The Guardian: Would you also discuss the number of physicians, nurses and other staff currently working at NIMH?
Director: The number of physicians, nurses and other staff currently working at NIMH is 182. (1st class- 46, 2nd class – 41, 3rd class – 31, 4th class – 64).
The Guardian: In this context, would you mention the names and number of public and private hospitals working for the treatment of mental disease other than NIMH across the country?
Director: There is a government hospital named Pabna Mental Hospital (500 bedded). Besides, each govt. medical college has a department of psychiatry. But, exact number of non-government hospitals is not known.
The Guardian: Side by side treatment, what academic courses and training on mental health are conducted by NIMH?
Director: NIMH conducts the following courses and training programmes:
– Academic Course: MD (Psychiatry),
– Training for MCPS (Psychiatry) and FCPS (Psychiatry),
– Training for community health care providers.
The Guardian: What programme is also undertaken by NIMH to aware the people of the mental health and disease?
Director: NIMH observes the important mental health related days (world mental health day, suicide prevention day, Autism awareness day, etc) and also arranges seminars, workshops regarding mental health issues.
The Guardian: Would you say what research activities are conducted at NIMH on mental health and disease?
Director: National survey on mental health disorders was done in 2003-2005 with the cooperation of WHO. Besides, regular research activities and publications are done by NIMH.
The Guardian: Do you have any publications or manuals that can help people to know about mental health and disease in detail?
Director: Yes, NIMH has a number of publications and manuals that can help people to know about mental health and disease in detail. These are:
– Training manuals for community health care providers
– Scientific journal of NIMH
– Child guidance book for the caregiver of child patients
The Guardian: Would you also tell us something about National Mental Health Policy and its effectiveness?
Director: National mental health policy has been made, but yet to be passed through the parliament.
The Guardian: Please discuss the problems, potentials, achievements and future plans of NIMH.
Director: NIMH suffers a number of problems, including shortage of manpower, less budget and lack of proper infrastructure. In spite of the fact, as potential NIMH is committed to be the centre of excellence for the mental health services, trainings, and research in Bangladesh. Keeping this in aim, the following plans are undertaken for future action.
Start special service activities for children affected with autism and neurodevelopment disorder, such as scanning, medical service, special schooling and basic life school training
Start regular different outdoor division for children, women and older people
Start different outdoor division for drug addicts
Start training activity in community level for people providing mental health services
Start a day hospital for mentally ill persons
Increase the number of beds for the admitted patients including extending the upward portion of the present establishment of the organization
Provide service for admitted patients by arranging rent free bed, on rent bed and cabin in different floors
Create different wards for admitted children, women and aged people
Make at least 30 cabins for the convenience of patients
Construct a different unit for drug addicts comprising with 50 beds
Create a separate research cell for research activities
Increase research activities in the superintendence of the organization and publish scientific research papers or journals regularly
start special mental health care service for tortured women
Start new sections related with mental illnesses such as neurology division
Build a mental health care structure in grassroots level via community psychiatry
Make existing inadequate urgent medical facility more effective
Start medical consultancy service for patients from far places via internet similar to telemedicine
Start ‘One Stop Crisis Centre’ in the organization for preventing suicides
Turn the organization into a ‘Centre of Excellence’ in mental health care service.
The Guardian: In the end, would you give your valuable message for all concerned with mental health and especially for the people of Bangladesh?
Director: Even in this age of information and technology, where you have the limitless opportunity to have all information at your disposal; it is very regrettable that there are misconceptions about mental illness among people.
Everyone’s consciousness about mental illness is awakened and people affected with mental illness overpowering all negative perspective, superstition, imbecility come forward to be treated properly. This is the dream.
Profile of Prof Dr MA Hamid
Professor Dr Md Abdul Hamid is the present and 7th Director of National Institute of Mental Health (NIMH) since June 2015. He is also the Vice President of Bangladesh Association Psychiatry (BAP). He was born in Ullapara, Sirajganj, Bangladesh. He obtained FCPS in Psychiatry from Bangladesh College of Physicians and Surgeons (BCPS) in 1992. He completed MBBS from Dhaka Medical College in 1983. He also deserved brilliant fellowship in and abroad of Bangladesh. Prof Hamid is a reputed Psychiatrist in home and abroad. He is academically sound teacher and also caring in his profession. He has remarkable number of books and research articles published in reputed national and international journals. He has outstanding activities in different sectors. Prof Hamid has served on many national and international committees concerned with health, education, broadcasting and culture. Travelling and listening to music, reading books are his hobby and interest. A widely traveled man, Prof Hamid participated in many national and international seminars and workshops dealing with mental health issues.