Abstract

In the fourth in this series of ‘comparative healthcare’ medical practitioners explore the approach to mental illness in Bangladesh and the UK respectively. Differences and similarities in treatment regimens are illustrated with reference to patients with varying degrees of mental illness. Mental illness poses the greatest challenge in health care as national investment in services often reflects cultural attitudes and norms.  While the authors describe very similar approaches to the diagnosis and management of severe psychotic illness there are striking differences in the availability of support services for people with substance abuse and those with relapsing conditions. The involvement and co-operation of the family is particularly important in Bangladesh where comprehensive access to mental health services is very limited.  Private alcohol and drug detoxification centres are available although many are expensive and such treatment may effectively be denied to all but the wealthiest people. In the UK all people with serious and enduring mental illness are entered onto a register and therefore flagged for follow up at least once a year. General Practitioners, working within the nationally funded health service have been remunerated since 2003 for maintaining the register. In contrast in the absence of a case-management based psychiatric follow-up framework in Bangladesh, a general practitioner and treating psychiatrist would need to formulate a management plan involving recognition of clinical warning signs by the family. Indeed the co-operation and support of the patient’s family is of paramount importance in maintaining outpatient appointments when supporting people with mental health problems in Bangladesh. Finally we emphasise that the views expressed are those of the authors and do not necessarily reflect health policy or practice in their respective countries. Nonetheless we believe they offer a valuable perspective on mental health issues and commend the article to our readers.