Exploring mental health needs and services among affected population in a cyclone affected area in costal Bangladesh: a qualitative case study

Abstract

Background: Bangladesh, one of the most densely populated countries in the world has been ranked 9th on the Climate Risk Index for 2017: the 10 most affected countries & 7th on the Long-Term Climate Risk Index: the 10 countries most affected from 1998 to 2017. Every year it is afflicted with various climatic disasters including floods, hurricanes and cyclones. Apart from the obvious devastation of lives and property, there is a huge increase in clinical diseases when these disasters occur. Mental health of affected persons after these disasters is a topic that is often neglected by local and national level. Methods: A qualitative case study was conducted on perceived need on mental health support & availability of such services in a cyclone affected area in rural Bangladesh. Ten (10) key informant interviews (KIIs) with different stakeholders and ten (10) in-depth interviews (IDIs) with affected people were taken. Findings: We found that cyclones had numerous psychosocial impacts on the population including acute stress disorder, sleep disorder, post-traumatic stress disorders (PTSDs), generalized anxiety disorders, suicidal ideation and depression. The survivors had specific needs for receiving support. Children, elderly and women were perceived to be more vulnerable. The government and NGOs had no specific action plans and initiatives to address these issues and support the mental health of affected population. There was a visible gap in finding effective ways to provide affected people with the required mental health & psycho-social services (MHPSS). Conclusion: Resilient, responsive and self-sustaining health systems for this vulnerable population are required. Implementation of effective mental health programs and strong mental health policies remain a challenge in Bangladesh where there is a cultural fatalistic acceptance of mental health issues.

Analysis of environmental migrants and their mental health in strengthening health systems

“…For instance, child and adolescent health specialists have been adamant in their concern and demand for studies on the state of mental health among environmental migrants (Myles et al, 2018). Children have been particularly vulnerable to post-disaster trauma given that their cognitive development does not prepare them for the witnessing of mass quantities of dead bodies (Hasan et al, 2020). Unfortunately, these mental scars are usually only exacerbated by the psychological stressors of climate migration (Schwerdtle et al, 2018).…”

“…Unfortunately, these mental scars are usually only exacerbated by the psychological stressors of climate migration (Schwerdtle et al, 2018). Despite pleas from professionals to invest in mental health evaluations and resources for environmental migrant populations, leaders and officials are often preoccupied by fighting for the provision of basic needs to these vulnerable communities and neglect addressing psychological concerns (Hasan et al, 2020;Nahar et al, 2014). This is especially unfortunate since there is evidence that environmental migrants themselves view their mental health as a valuable part of their overall health.…”

“…According to the World Health Organization (WHO), up to half of all earthquake and tsunami survivors in South East Asia coastal lands suffer from post-disaster mental health issues that range from moderate to severe levels of distress (WHO, 2016). A population-based survey specific to south India reported that five years after the 2004 tsunami, around 78% of survivors continued to express symptoms of mental health morbidity (Hasan et al, 2020).…”

“…The main acute mental health disorders that result from witnessing sudden climate change disasters include post-traumatic stress disorder (PTSD), insomnia, depression, hopelessness and suicidal ideation, generalized anxiety disorder (GAD), and mood disorders (Acharibasam & Anuga, 2018;Hasan et al, 2020;Palinkas, 2019). Past studies have concluded that even the anticipation of forced migration due to environmental changes significantly increases a community's level of depression (Torres & Cassey, 2017).…”

“…Many of those who are vulnerable to climate migration reside in countries where mental health care access is limited; thus, existing mental health issues often go unaddressed before migration (DW Documentary, 2017; Hanna & Oliva, 2016;Hasan et al, 2020;Lakhani, 2019;McIver et al, 2016;Nahar et al, 2014;Torres & Casey, 2017;Tschakert et al, 2013;Vorobyov, 2020). For instance, while Bangladesh ranks first worldwide in natural disaster mortality, the country only has one mental health hospital for its entire population (Nahar et al, 2014).…”