Photo Credit: Alexandre Bonneau-Afroto/ALIMA

Integrating Mental Health Services into Bangladesh’s Health System

In low-income countries like Bangladesh, people with severe mental health disorders (such as schizophrenia, bipolar disorder, or major depression) die 10 to 20 years earlier on average than the general population. These premature deaths come from a mix of factors: untreated mental illness can lead to suicide, and it also worsens outcomes for physical diseases (for example, someone with untreated depression may not manage their diabetes well, leading to complications). In Bangladesh, mental health conditions are common, but awareness is so low that nearly 70% of patients referred to specialists didn’t even realize they had a serious mental disorder. There’s also significant stigma, and mental health has been largely overlooked in public health initiatives. This means that at the community level, there are almost no services—no counseling at local clinics, no routine screening, and very limited psychiatric care (mostly confined to a few hospitals in big cities).
The gap is clear: physical health has a system (community clinics, health workers, immunization drives, etc.), but mental health does not. Patients who need help often bounce around or only come into contact with the health system after their condition has severely worsened. Without integration, people continue to suffer or even die young due to treatable mental health issues, and families bear heavy burdens.

“Experimentation at Scale”: This project is a large-scale pilot to figure out the best way to embed mental health services into Bangladesh’s public healthcare system. Instead of starting small, it deliberately works across two entire districts (covering 345,000 households) to test integration in a real-world setting.
Training Health Workers: The plan involves training a range of healthcare providers – from community health workers up to doctors – in basic mental health care. This includes how to screen for common conditions (using simple questionnaires for depression, anxiety, etc.), how to refer more severe cases up the chain (for example, from a village health worker to a psychologist or psychiatrist at the sub-district hospital), and even how to provide structured counseling for mild-to-moderate cases at the community level. By using existing staff and infrastructure, they avoid creating a separate vertical program. Instead, mental health becomes part of what the health system routinely offers.
Multiple Models in Parallel: A key aspect is that the project will try a couple of different models in different areas to see what works best. All these models will be monitored to assess outcomes, cost, and ease of implementation.

Policy Integration: From the get-go, the project has government buy-in at all levels. By the end of two years, the government will have solid evidence on how they can integrate mental health into primary care nationwide. Since BRAC and other NGOs are also partners, they too can incorporate the successful model into their country-wide programs.
Nationwide Rollout Plan: If the results show that even one of the models is successful, Bangladesh’s Ministry of Health can take that model and start rolling it out in other districts. With BRAC (the world’s largest NGO) involved, they can also implement through their massive network (BRAC workers reach nearly every village). The existence of a large NGO partner and a willing government means successful practices won’t stay in a pilot—they have channels to go nationwide. Furthermore, success in Bangladesh can influence other countries in South Asia or similar settings. As one of the first “at-scale” trials of mental health integration in a low-income country, it will produce evidence and a playbook that the WHO and global mental health community can use to advocate for and design programs in other nations, potentially improving millions of lives by bridging the mental health care gap globally.

Task-Shifting to Lower Costs: One of the strategies being examined is task-shifting, which means assigning tasks to the least specialized person who can do them well. For example, routine counseling or follow-up could be done by trained community health workers or peer counselors instead of expensive psychiatrists. This dramatically lowers the cost per patient. By relying on these trained lay counselors and existing clinic staff, the program avoids the high salary costs of adding many new specialists. This approach could make mental health support affordable even for a large population.
Group Counseling Efficiency: Another tactic to reduce cost and increase reach is using group counseling sessions. In group therapy, one counselor can guide multiple patients at once (for example, 5–10 people with depression meeting together weekly). This not only is efficient but can also provide peer support benefits. The project is testing such models, which, if effective, mean more people helped with the same resources.
Measuring Cost-Effectiveness: Importantly, the program is designed to measure outcomes and costs very carefully. It’s essentially researching “what is the most cost-effective way to do this at scale?”. By the end, we will know the cost per patient improved, and how those costs compare to other health interventions.

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