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The Royal College of Psychiatrists Improving the lives of people with mental illness

Half-way point

The volunteer link is nearing the half-way point, with a huge amount left to achieve over the next few weeks. I have been working on an interesting project looking at establishing an early intervention service in psychosis at the BSMMU. Essentially the task is to ascertain whether it is feasible to set up such a service without any further resources (feels like in the UK…), and to establish whether there is an evidence base for such a service in a low income country (I am yet to find such information…)

As I have spoken about previously, there are no mental health workers in the community here. Despite this, however, the team at the BSMMU believe that an early intervention service could be replicated, with biological interventions provided by a specialist clinic, psychological interventions, i.e. CBT and family therapy, provided by the psychology department, and social interventions provided by the extended family network that pretty much each patient seems to have – i.e. in-house occupational therapy and rehab training for families.
A quick trip out of Dhaka
 
There is clearly a potential demand – a range of individuals with psychosis present to the outpatients department– the challenge is, however, that often they present later on in the time-course of illness, and it is actually the traditional and spiritual healers who are providing early intervention services currently. 

I continue to work along-side the junior doctors at the BSMMU and every day am seeing large numbers of interesting patients, including many conversion cases, which are difficult to treat, as again individuals present at a later stage, via the alternative healers, and then usually via large numbers of private clinics, all of which perform a multitude of physical investigations first (often repeated several times) which seems to reinforce the belief system of many of the patients. (Including one who said he had spent £5000 on investigations, a huge amount of money here). Also, although there is no direct evidence base to support it, I am beginning to believe that there are larger numbers of individuals presenting to the services who could potentially be diagnosed with personality disorders but are not, maybe due to the necessary speed at which patients are seen in the department. A last observation is the continuing input from the drug companies – no different form the UK several years ago, but noticeable, nevertheless.

Mental health has been well-represented in the media over the past few weeks – Bangladesh lost to Pakistan in the Asia cricket cup, and the local media linked the result to seven suicides. The papers seem to have a weekly suicide report. This has previously been criticised for being sensationalist, rather than providing useful information on how to access help.

 Medical Conference - Dhaka style
Perhaps surprisingly, I am not encountering much suicidal ideation or behaviour here (compared to the UK) which is slightly at odds with the media reports – local attempts have been made to raise awareness, with suicide being the major topic of a day seminar by the Association of Therapeutic Counsellors here in Dhaka – a very good day topped by a cultural evening in which all of the doctors took part. 

Ending on a positive note, the staff tell me that times might be starting to change a little in terms of recognition of mental health - the daughter of the prime minister is a psychologist, and mental health has been discussed at several political meetings (which is new here). I understand that the department is due to move into larger premises in a year or two, also, with more space.

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About this blog

Dr Adrian Phillipson

 

 

 

 

 

 

Dr Adrian Phillipson is an ST5 in general adult psychiatry, based in South Yorkshire.  He is currently part way through a year out from his training rotation, utilising the time to pursue research and travel interests.  Adrian is the first psychiatrist to take part in a new Royal College of Psychiatrists Volunteer Scheme Link with the Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh.  He hopes that this blog will provide good insight into the link, and will encourage others thinking of taking part in the volunteer scheme.

Adrian’s attraction to transcultural psychiatry stemmed from a chance encounter with a local practitioner in Malawi in 2003, where he witnessed a traditional healing ceremony for psychosis.  He has further developed his interest through completing a masters degree in Transcultural Mental Health Care at Queen Mary, University of London, as well as through further overseas exposure.   In 2010 Adrian made an initial scoping visit to Bangladesh to look at mental health services and help establish a sustainable link.  A report from this project can be found here.