Md. Sazedul Islam

World Mental Health Day will be observed across the world, including in Bangladesh, on October 10. Celebrated every year on October 10, the day’s overall objective is to raise awareness of mental health issues around the world and to mobilize efforts in support of mental health. The day provides an opportunity to reduce the stigma surrounding mental illnesses, and promote resources and support for individuals facing mental health challenges. World Mental Health Day was first observed in 1992 at the initiative of the World Federation for Mental Health (WFMH), a global mental health organization with members and contacts in more than 150 countries.

In Bangladesh, leprosy issue is one of the main factors responsible for creating mental health problems. Leprosy is a chronic infectious disease that affects the peripheral nerves and skin, leading to physical deformities and disabilities. Individuals affected by leprosy not only experience physical deformities, but also a range of emotional and psychological problems that can adversely affect their mental health, such as feelings of shame, low self-esteem, and social exclusion, which can significantly reduce their quality of life.

The condition can be worse in places like Bangladesh, where provision for mental health support after a diagnosis can be harder to come by locally. With no one to talk to about their condition or fears, this can lead to people feeling isolated, taking less interest in self-care, exacerbating the physical symptoms and even developing suicidal thoughts.

There are problems such as living with chronic pain, with little or no access to health care; losing independence when leprosy causes disability; deepening poverty and vulnerability; facing stigma, discrimination, and exclusion; feeling worthless or ashamed because of community attitudes. These are just some of the ways leprosy can affect people’s mental health.

A 2020 World Health Organisation (WHO) paper reported that many people affected by leprosy have experienced anxiety, depression, and psychological distress. Some people have even reported suicidal ideation because of leprosy. According to experts, leprosy has physical and psychological consequences that can lead to activity limitations, economic and physical dependence, social exclusion and stigma. All these factors are correlated and can worsen the mental wellbeing of the leprosy-affected persons.

The most commonly diagnosed mental problems are depression and anxiety disorders. An increased prevalence of mental distress is found in people affected by leprosy. This is because of disease impairments as well as societal influences, such as stigma and discrimination. Symptoms of depression are often diagnosed in people affected by leprosy who: are isolated from the community; are living alone; have difficulty with self-care and daily activities; have visible impairments.

According to National Library of Medicine, leprosy has long term consequences related to impairment and stigma. This includes a major impact on mental health. Multiple psychiatric morbidities have been identified among leprosy-affected persons, including depression, anxiety disorders and suicide (attempts).

Depressive symptoms and low self-esteem were identified among children of leprosy-affected persons. Depressive disorders and anxiety disorders were found to be very common among persons affected by leprosy. Feelings such as fear, shame and low self-esteem are also experienced by leprosy affected, and their children.

Impairments caused by leprosy lead to emotional reactions and negative behaviours. In the social course, persons with leprosy encounter social barriers that lead to disability, emotional reactions and negative behaviours. Both the biomedical and the social trajectory can contribute to unemployment, economic and physical dependence and difficulty with social integration. This can lead to dehabilitation and consequently to destitution.

It is found that the consequences of diseases like leprosy include stigma, social exclusion, reduced access to healthcare services, lack of educational and employment opportunities, restriction of rights, increased disability and early mortality. Each of these consequences may result in poor mental wellbeing by increasing feelings and behaviours such as sadness, hopelessness and social withdrawal.
Stigma and discrimination were frequently mentioned factors associated with psychiatric morbidity. Discrimination can result in unemployment, social and marital restrictions, low self-esteem, stress and self-stigmatisation. Stigma can harm the quality of life and social participation of persons affected, and increase mental distress, depression and fear.

Several case studies revealed that stigma was often mentioned as a reason to attempt suicide. Stigma refers to condemnation, exclusion and guilt, that is, the person who suffers the stigma comes to be seen as dirty, impure, deformed and untouchable, and this affects his/her personal life in professional, sexual, affective and social aspects. Besides being related to the deformities caused by the disease, stigma is also fueled by the ignorance of the population about the mode of transmission.

That social stigma compromises the mental health of people affected by leprosy by acting as a psychosocial stressor, producing alterations in the psyche as they experience social rejection, the sequelae of the disease, prejudice, problems in the work environment and in social and family relationships, and is strongly associated with visible deformities due to leprosy.

According to a study among over thousand leprosy-affected persons in Indonesia, 36% experience anticipated stigma. They state that physical deformities are the main cause of stigma and disability. Because of the stigma attached to physical deformities, patients experience fear, avoidance, discrimination and prejudice. This can result in diminished mental health, for instance by causing depression and low self-esteem. On the other hand, when deformities cause functional impairments, leprosy-affected persons can become unemployed. Without employment, a decrease in social participation occurs, resulting again in diminished mental health.

Additionally, poor mental health itself can have a negative impact on health outcomes, and may lead to low treatment seeking behaviour and treatment adherence, unemployment and work absence, social exclusion and stigma.

Mental health of the leprosy victims must be carefully considered in order to avoid the onset of sufferings and/or mental disorder. In order to solve the mental health issue due to leprosy, it is first recommended for taking actions to eradicate the disease. Massive anti-leprosy programmes should be taken up in the country and the initiative from the government with adequate financial allocation in the national budget for leprosy is a must.

It is urgently needed to take up anti-leprosy activities such as conducting active case search and skin camp, bringing newly identified leprosy patients under quick treatment, rehabilitation for leprosy-related disabled people, raising social and mass awareness on leprosy, arranging training on leprosy for physicians, health workers and field workers at central, zila and upazila levels, and arranging treatment facilities of leprosy complications at all the hospitals in the country.

The leprosy issue should get priority by the policymakers. If it is neglected, leprosy may cause untold sufferings for our people, hampering our efforts to achieve national development.

The author is a freelance journalist