> Posted by Joshua Goldstein, Principal Director for Economic Citizenship & Disability Inclusion, CFI

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Shamsin Ahmed of BRAC in her powerful piece, “The ‘Normal’ Ones”, makes an impassioned plea for greater tolerance and more treatment options and opportunities for those who suffer from some kind of psychosocial disability (mental illness). People with psychosocial disabilities make up at least 16 percent of the population in Bangladesh, and yet less than 1 percent of the national health budget is allocated to mental health care. For those of us who work on financial inclusion, I would argue that there needs to be much greater attention directed towards poor mental health as an obstacle to achieving economic citizenship.

Originally published on bdnews24, an online Bangladeshi newspaper, here is “The ‘Normal’ Ones”.

When I was eight years old I watched an Indian movie where the mother of the hero had gone mad, possibly from trauma of being tortured or having witnessed the death of the hero’s father by the villain. And in one scene this mad mother was running around the village in her white saree, disheveled, bushy hair, and villagers were running after her with sticks and stones, calling her “pagol”. I asked my father, “Why are the people stoning her? If she is the crazy one, shouldn’t she be the one stoning them?” My father was disturbed as well as deeply moved by my question as I was told years later.

People always say those who have mental illnesses are not “normal”. It’s funny how no one thinks it’s necessary to define “normal”. I grew up knowing anyone with some sort of disability, be it psychological or physical, was “not normal”. No one said they are unable to live like everyone else. No one said they are unable to lead “normal” lives not because of their disability but because of the “dis-enabling” environment that those without mental illness, who have a say in the making of our society, create for people with mental illnesses. No one admits that those of us who have a “sound mind” have continuously shunned, isolated, and stigmatized people with mental illnesses.

Mental health is more than the absence of mental illness: it is vital to individuals, families, and societies. In Bangladesh, a country of 160 million, almost one-sixth of the population, about 20 million people suffer from one form of mental illness or another. Prevalence of mental illness is as high as 16.5 percent in Bangladesh according to an ADB report conducted in 2006. This number is likely to be higher given the stigma and resulting silence regarding mental illness. Families are ashamed to talk about their family members with mental disorders. Caretakers usually keep their family members at home in an effort to protect them from being insulted and treated as “pagol”, not to mention the stigmatization they face themselves for having an “odd one at home”. With no access to education or work, people with mental illness become more vulnerable, they lose social skills and hence the ability to adapt to the mainstream way of life. In most rural areas, people either cannot afford treatment for mental illness or don’t feel a need for it. Very little information in the public domain talks about the normality of seeking therapy and specialist care for mild mental problems like depression which can build up to become something serious.

“Mental illnesses” these days are being termed as “psychosocial disabilities” because “illness”, as opposed to “disability”, does not take into account the pervasive stereotypes and attitudes and other barriers that result in inequalities that affect people with mental illnesses. Such a social model of disability demands a political response, since the problem is created by an unaccommodating physical environment brought about by attitudes and other features of the social environment.

Psychosocial disability can exacerbate mental health conditions, and cause social isolation and economic marginalization that can spiral into crisis, homelessness, poverty, and risk of harm through exploitation. This causes extreme hardship for mental health consumers and caretakers, placing an unfair burden on some of the most vulnerable members of our society. Community ignorance, stigma, and discrimination toward mental health conditions compound the impact of psychosocial disabilities and contribute to poor self-esteem, social isolation, and individual and systemic discrimination for both people with psychosocial disability and their caretakers.

All over the world developed and developing countries have established comprehensive mental health services because good mental health cannot be ensured by only providing access to specialist psychological care. A comprehensive mental health care system should provide people with mental illnesses with accommodations and acceptance in society, along with ensuring access to education and work.

After the tsunami left hundreds and thousands dead across Sri Lanka, the country adopted a mental health system which included training community people to provide basic therapy and psychological help along with strategies involving all agencies and sectors including inputs from family and community members. After the Rana Plaza that killed over a thousand people and left hundreds disabled physically and psychologically, Bangladesh also should have come up with something similar.

We have no national mental health policy and less than 0.5 percent of our national health budget is allocated for mental healthcare. Amazingly, Bangladesh still holds on to the Indian Lunacy Act of 1912 although India itself has repealed that act. The act defines a person with mental illness as a “lunatic”, “which means an ‘idiot’ or ‘person of unsound mind.'” As far as the information goes, a new draft of a mental health act has been developed but yet to be enacted.

When dealing with those suffering from mental disorders, people neglect to look into the quality of their lives and the social stigma and tribulations that the society adds to their already difficult life. The real scrutiny however, should be of us, the “normal” ones; who make up a society where people who have mental illness or disability are further victimized. We must question and rectify the morals of a society that allows and endorses the dehumanization of others, because that is where the “disorder” lies.

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