Comparative Healthcare: Mental health.

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