Increasing the provision of mental health care for vulnerable, disaster-affected people in Bangladesh

BMC Public Health

John Kinsman²  Laksono Trisnantoro¹  Istiti Kandarina¹  Beidi Wu²  Yulia Blomstedt²  Nazmun Nahar³ 

[1] Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, 91087 Umeå, Sweden;Protecting Human Rights (PHR) Program, Plan International Bangladesh, Dhaka 1212, Bangladesh

关键词: Social determinants of health;    Poverty;    Gender;    Vulnerability;    Mental health;    Disaster;    Flood;    Cyclone;    Bangladesh;   

Others  :  866284
DOI  :  10.1186/1471-2458-14-708

 received in 2014-03-04, accepted in 2014-07-03,  发布年份 2014

【 摘 要 】

Background

Bangladesh has the highest natural disaster mortality rate in the world, with over half a million people lost to disaster events since 1970. Most of these people have died during floods or cyclones, both of which are likely to become more frequent due to global climate change. To date, the government’s post-disaster response strategy has focused, increasingly effectively, on the physical needs of survivors, through the provision of shelter, food and medical care. However, the serious and widespread mental health consequences of natural disasters in Bangladesh have not yet received the attention that they deserve. This Debate article proposes a practical model that will facilitate the provision of comprehensive and effective post-disaster mental health services for vulnerable Bangladeshis on a sustainable basis.

Discussion

A series of socially determined factors render the women and the poor of Bangladesh particularly vulnerable to dying in natural disasters; and, for those who survive, to suffering from some sort of disaster-related mental health illness. For women, this is largely due to the enforced gender separation, or purdah, that they endure; while for the poor, it is the fact that they are, by definition, only able to afford to live in the most climatically dangerous, and under-served parts of the country. Although the disasters themselves are brought by nature, therefore, social determinants increase the vulnerability of particular groups to mental illness as a result of them. While deeply entrenched, these determinants are at least partially amenable to change through policy and action.

Summary

In response to the 2004 Indian Ocean tsunami, the World Health Organisation developed a framework for providing mental health and psychosocial support after major disasters, which, we argue, could be adapted to Bangladeshi post-cyclone and post-flood contexts. The framework is community-based, it includes both medical and non-clinical components, and it could be adapted so that women and the poor are actively sought out and provided for. After training, these services could be run by Bangladesh’s pre-existing 50,000-strong Cyclone Preparedness Programme workforce, alongside the country’s extensive network of community-based health workers.

【 授权许可】

   
2014 Nahar et al.; licensee BioMed Central Ltd.

【 图 表 】

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