Treatment gap and treatment seeking behavior in mental health care of Bangladesh Findings from Bangladesh National Mental Health Survey 2019

1. Treatment gap and treatment seeking
behavior in mental health care of
Bangladesh
Dr. Md. Faruq Alam
Professor, Psychiatry
Popular Medical College, Dhaka
Principal Investigator: Bangladesh National Mental Health Survey 2019

2. Treatment gap
in mental health
Gap between the number of individuals in need of
mental health care and those who actually receive
treatment.

3. Determinants of
health service
utilization
Predisposing factors: Female gender, higher
education level, being unmarried.
Need factors: Perceived need, disability, self-
evaluated health status, panic symptoms.
Enabling factors: Employment, access.

4. Methods
Data are taken from the published report of Bangladesh National
Mental Health Survey 2019.
Principal investigator – Dr. Md. Faruq Alam
Co-investigators
Dr Helal Uddin Ahmed
Dr MohammadTariqul Alam
Dr Mekhala Sarkar
Technical support:World Health Organization (WHO) and
Bangladesh Bureau of Statistics (BBS).

5. Methods
The survey used multiphasic, stratified, random cluster
sampling to select Primary Sampling Units (total 248
urban and 248 rural areas).
Systematic random sampling was used to select
individuals from households.

6. Methods
Nine questionnaires were used in the survey.
WHO Encounter Form: Pathway of Care was used to
assess treatment seeking behavior.
Study population: ≥ 7 years.
Adult respondent – 7270.
Child respondent – 2163.

7. Results
Sample
characteristics
Characteristic Adult Children
Sample ≥18 7-17
Number 7270 2163
Mean age (year) 38.2 12
Male 47.6% 51.7%
Urban 51.5% 46.2%
Education (mean year) 6 -

8. Prevalence of
mental
disorders
Adults
18.7%
Children
12.6%

9. Treatment gap
in adults
89.6%
87.2%
93.7% 93.1% 93.5%
70
75
80
85
90
95
18-29 30-39 40-49 50-59 60 and above
Treatment
gap
%
Age group (year)

10. Treatment gap
in adults
92%
90.4% 90.9% 91% 91%
70
75
80
85
90
95
Male Female Urban Rural Total
Treatment
gap
(%)
Variable

11. Treatment gap
in children (7-17
yrs)
98.4%
89.7%
94% 94.4% 94.3%
70
75
80
85
90
95
100
Boy Girl Urban Rural Total
Treatment
gap
%
Variable

12. Treatment gap
in mental health
Adults
91%
Children
94.3%

13. Delay in seeking
treatment
Adults
3.2 years
Children
14 days

14. Time to reach
nearest mental
health facility
Adults
1.6 hours
Children
8.1 hours

15. Disease-wise
treatment gap
contribution
5%
4.9%
11.6%
39.8%
26.1%
12.6%
Schizophrenia spectrum disorders
Sleep-wake disorders
Others
Depressive disorders
Anxiety disorders
Somatic symptoms and related
disorders

16. Place of taking
treatment for
mental illness in
adults
0.8%
2.4%
3%
20%
18.9%
24.9%
22%
0 5 10 15 20 25 30
Others
Homeopathy/Unani/Ayurved
Specialized mental hospital
Government hospital
Private hospital
Chamber of Psychiatrists
Chamber of other physicians

17. Place of taking
treatment for
mental illness in
children
12.9%
5.2%
9.9%
3.9%
16.5%
21%
30.6%
0 5 10 15 20 25 30 35
Others
Government hospital
Private hospital
Specialized mental hospital
Chamber of Psychiatrists
Chamber of other physicians
Homeopathy/Unani/Ayurved

18. Discussion
Treatment gap is high in Bangladesh. But similar
picture is seen in neighboring countries.
Treatment gap was found higher for common mental
disorders than it was for severe mental disorders.

19. Discussion
High treatment gap – possible explanations
Low perceived need of treatment due to limited awareness
Stigma and sociocultural beliefs
Inadequate and unequal distribution of resources
High out of pocket costs
Poor quality of mental health services
Lack of training of primary health care service providers

20. Recommendations
Delivering mental health services through primary health care
system.
Creating physical space, employing trained or qualified
manpower, supplying psychotropic drugs and in data registry at all
levels of health services.
Increasing mental health literacy and incorporation of it into
school curriculum.

21. Acknowledgement
Dr.Ahsan Aziz Sarkar,Consultant Psychiatrist, NIMH, Dhaka.
Members of Technical Advisory Committee & Working Group,
NMHS Bangladesh 2019.
Research Psychiatrists & Data Collectors, NMHS Bangladesh 2019.
Mr Mukul, Mr Anwar & Office Staffs, NIMH, Dhaka.
Participants of NMHS Bangladesh,2019 & People of Bangladesh.

22. References
1. Demyttenaere K, Bruffaerts R, Posada-Villa J, et al. Prevalence, severity and unmet need for
treatment of mental disorders in the World: World Health Organization Mental Health
Surveys. JAMA 2004; 291: 2581-2590.
2. National Institute of Mental Health. National Mental Health Survey 2019. Dhaka: NIMH
Press, 2019.
3. Patel V, Xiao S, Chen H, et al. The magnitude of and health system responses to the mental
health treatment gap in adults in India and China. Lancet. 2016; 388 (10063):3074-3084.
4. Pathways Interview Schedule (Encounter Form). (Internet). Accessed on 30th Sep 2014.
Available from: http://apps.who.int/iris/bitstream/10665/61855/1/MNH-NAT 87.1.pdf.
5. Roberts T, Miguel EG, Krupchanka D. et al. Factors associated with health service utilisation
for common mental disorders: a systematic review. BMC Psychiatry, 2018; 18: 262.