Mental health support for them

The post-poll violence against the minority population of Bangladesh added an extra dark spot in otherwise glorious history of Bangladesh which is widely appraised for its image of religious harmony. Tears from those terrified faces made millions of sensible human being around the world cry.

This is plausibly believed to be a part of "Ethnic Cleansing" historically orchestrated by the anti-liberation forces in Bangladesh. Under the policy of Ethnic Cleansing, Pakistani perpetrators, along with their Bangladeshi quislings, killed, raped, and tormented hundreds of thousands of Bengalis, with special emphasis on Minority population during Bangladesh's War of Independence in 1971. The local anti-liberation forces, i.e., the pro-Pakistani forces still follow the inglorious strategy to materialise their political agenda.

Despite initial failure to take an immediate action against the criminals, the Government of Bangladesh (GoB) has arrested quite a few of those alleged, and has decided to form a special tribunal to try those convicted. While much of it is political, and has to be dealt politically, the aftermath of such a horrific event requires immediate attention from all the sectors of the society, including the GoB.

One of the most crucial impacts of such incidents would be on the mental health status of the survivors. Initially resulting in post-traumatic stress, this may lead to a more clinically significant disorder officially known as Post-traumatic Stress Disorder (PTSD), if not managed properly.

The victims may start experiencing the clinical signs and symptoms of PTSD within as early as three months to years following the traumatic incident. The symptoms exhibited by the survivors may be classified into following categories: (i) re-experiencing the event, (ii) avoidance and emotional numbing, and (iii) hyperarousal states.

The terror of re-experiencing the event is the main symptom of PTSD, and this requires special attention from the respective agencies and authorities. The survivors must be counselled by professionally trained and experienced psychotherapists on an ongoing basis. This should also accompany reassurance by the legislative authorities that such an event would never happen again. The latter should never be restricted to an official statement; appreciable efforts should be in place to make sure it is sufficiently convincing to the survivors. Activists of Ganajagaran Mancha recently took a wonderful initiative. They visited the areas and people affected, and expressed their solidarity with the victims. People from other sectors should also take similar efforts in reassuring the victims that the people of Bangladesh have been, are, and will be, with them, forever.

The survivors may tend to avoid the situations that they consider might remind them of the painful incident. They may also withdraw themselves from their closest ones, and may lose interests in their activities they were involved in. The hyperarousal symptoms may include alteration of sleeping patterns and increased alertness. Professional counselling is mandated to address these symptoms.

It is to be noted that this is NOT an exhaustive list of potential symptoms, and those who experience these symptoms, in any combination, may not necessarily have been suffering from PTSD, or any other mental health disorders. One should see a qualified psychiatrist before s/he comes to such a conclusion.

There are several important points to be specifically emphasised in this context. Firstly, the counselling should ONLY be offered and implemented by a professional team of qualified and experienced psychiatrists/psychotherapists (or any other relevant experts), and should NEVER be allowed to be conducted by amateur counsellors. This is very important as I know a group of people who organised and offered mental health counselling services, sporadically though, during the Rana Plaza incident without possessing any academic credentials and/or professional expertise. While the sense of social responsibility and the essence of philanthropy should be highly lauded, such a non-professional service should not be encouraged as one such would only worsen the case.

Secondly, mental health issues are highly stigmatized around the globe; Bangladesh is no exception if not worse. Even those who are experiencing some degree of mental ailments often refuse to see a psychiatrist due to social stigma associated with it. It would surely be challenging to have all the survivors included in the counselling initiative. Hence, caution must be exercised in designing the mental health services for these survivors. A practical proposal is to formulate a comprehensive recovery and rehabilitation programme that includes medical, social, financial, legislative, and other relevant components properly integrated. Such an initiative would have at least two advantages: (a) this would ensure a participatory and interdisciplinary approach in addressing the issues, and (ii) the survivors would not specifically identify this as a focal point of dealing with mental health problems.

The survivors have to be reassured that this is not meant to treat mental health problems, but to prevent people from developing these. Mental health stigma is a reality; it is not to be blamed or ignored, but to be taken care of.

Thirdly, the notion of responsible journalism. While our journalists risk their lives to collect information from hard-to-reach areas, there is, unfortunately, an unhealthy competition of probing the victims, often unnecessarily. This is no less traumatic than the actual trauma!

While the most updated information about the incident and the victims are to be broadcast by the newsmen, sufficient care is to be taken to make sure the victims are not victimised yet again across the process of probing. The journos assigned to collect sensitive information from the victims, especially in cases like this, should undergo extensive training that has issues of mental health integrated in it.

To conclude, we urge our policy makers to formulate a cross-disciplinary comprehensive recovery and rehabilitation plan having relevant experts on board. The process should start as soon as possible, if it did not already. Moreover, we also ask amateur counsellors to refrain from their non-professional endeavours, and our journalist friends to be cautious in dealing with the traumatised victims. We understand your sensibility, compassion, and solidarity to those affected. However, these are not enough. We have to be professionally trained and technically sound to offer such sophisticated services. The situation of those affected is sufficiently bad already; let us not make it even worse!

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Nazrul Islam is research assistant at St. Paul's Hospital, Canada, and Honorary Lecturer, Faculty of Medicine, University of British Columbia.