At his first PhD workshop with Deaf community members in Bangladesh in 2023, Dr M Tasdik Hasan Dip asked the participants through an interpreter to describe how the interviewees felt.
One person turned to the interpreter. "What is he talking about? What is emotion?"
Surprised, Dr Dip asked about depression and anxiety, and the room went quiet. The people there had lived with loneliness, exclusion and psychological distress, yet they were never given the signs to name it.
"Feelings," one participant replied, "are expressed through four signs—happy, sad, surprised and pain."
Four signs for an entire inner life. For a fully grown human being with all its complex emotions and feelings, this is nowhere near enough.
That encounter changed the direction of Dip's PhD. The resulting study, 'Giving voice to the Deaf community: co-designing a Bangla Mental Health Sign Language Bank in Bangladesh', published in The Lancet Psychiatry, produced South Asia's first digitally delivered mental-health sign-language resource.
It is a Bangla bank of 64 signs for concepts including anxiety, depression, trauma, counselling and recovery. Whether that language reaches a clinic, a helpline or a family in crisis is now a governance question.
The population the system does not count
The paper, led by Dip at Monash University, cites an estimated 13.7 million people with hearing loss in Bangladesh. Not all of them belong to the culturally and linguistically distinct Deaf community or use sign language, but the scale makes one point unavoidable: accessible communication cannot remain a niche accommodation.
While talking to The Business Standard, Dip calls the neglect structural. Most families love their Deaf children, he said, but lack information and support. Deaf people then face a double stigma around disability and mental illness, a health system built for spoken communication and policy tables where they are rarely present.
Dip estimates that Bangladesh has only about 30 accredited sign-language interpreters nationwide. The study recorded 270 psychiatrists and 543 psychologists in 2020; he says psychiatrists still number below 500 for a population above 180 million. The adult mental-health treatment gap exceeds 90%, and no specialist Deaf mental-health service exists.
"It is not one cause. It is invisibility in data, in services and in decision-making," Dip said. Bangladesh has no national data on Deaf mental health. That is how a population disappears from budgets, workforce plans and service design.
When distress has no name
The first effect is silence. Distress remains unshared and untreated, and families carry crises alone because they may not know psychological care is possible. One mother in the study said she had never considered that a mental-health professional might help her children.
The gravest risk appeared in the community's own priorities. In workshops held to decide which resources should be developed, all 10 Deaf participants selected warning signs of suicidal thoughts and how to recognise possible suicidality in another person.
That choice should disturb policymakers. A person in crisis may be surrounded by relatives and still have no private, precise way to say what is happening. International research, including a major Lancet review, has long linked communication barriers to higher rates of mental-health problems among Deaf people, and even in well-resourced countries, Dip noted, misdiagnosis remains common. Bangladesh has not yet produced the data to measure the harm here.
When the interpreter becomes the gatekeeper
The sign bank does not solve who controls the conversation.
Deaf patients commonly rely on caregivers because doctors do not sign and hospitals do not provide interpreters. That removes privacy precisely where it matters most. A relative can unintentionally simplify the story or deliberately conceal it.
The paper mentions a caregiver's account which proves that a major barrier to mental health care is the absence of sign language proficiency among doctors. Deaf individuals often rely on caregivers for communication, which can be problematic, especially in situations where caregivers themselves might be stressors or even abusers, as recounted by one caregiver.
"I know a Deaf woman whose husband used to physically abuse her. In front of the doctor, he would say she was inattentive and frequently fell down. After the visit, he laughed and mocked her, recounting how he had deceived the doctor. When I heard this, I knew she would never receive proper treatment."
The answer is not simply to provide any interpreter. Bangladesh needs accredited professionals with specialist preparation for mental-health settings, confidentiality rules, in-person or remote booking systems, and clinicians trained to address the patient rather than the companion.
The solution exists but the process is unfinished
The bank has since grown into a larger initiative. Its 17-minute video was split into 64 short reels, and Deaf participants chose the subjects for 10 sign-language videos and 25 sets of e-flyers in English, simple Bangla and Deaf Bangla, covering loneliness, sleep, anger and recognising suicidal thoughts. The resources were launched in Dhaka in February 2025 with representatives from the health and social-welfare ministries, and are freely available through MindSigns.
"This is the first time I feel included in this kind of mental health work," one Deaf participant said. But inclusion in a project is not access to care, and the researchers have not yet measured whether the materials improve outcomes.
The team is now co-designing a website, mood tracker and screening app with Deaf users; rural testing, regional sign variations, offline access and rigorous evaluation remain ahead. The solution process is under way. The public system around it is not.
Where Bangla Sign Language had no sign at all, the team drew on American Sign Language — but as raw material, not authority. A borrowed gesture may already mean something else in Bangla Sign Language or carry culturally awkward imagery, so unsuitable signs were revised, sometimes into explanatory phrases, and tested again with Deaf participants.
But why didn't the words exist in the first place?
Sign-language expert and adjunct faculty at the Department of Communication Disorders, University of Dhaka, Tahmina Poly argues that the problem extends far beyond mental-health vocabulary. Bangladesh, she said, still lacks a formally recognised, standardised sign-language system, only home signs, regional variations and terms borrowed from other countries. Deaf people can usually understand each other; the failure comes when they must communicate with a hearing public that understands none of it.
The way forward begins with recognition
Bangladesh is not starting from a legal vacuum. The Rights and Protection of Persons with Disabilities Act 2013 names Bengali Sign Language, proper healthcare and accessible public services as rights, implemented through the Ministry of Social Welfare. But a line in a law is not an institution.
"The state, unquestionably. Aren't deaf people citizens of this country, too?" Poly said when asked who should lead. State recognition must come first, she argued, but Deaf people must remain central; a language cannot be developed properly without the people who use it.
She points to how the state treats spoken Bangla. "We have institutions such as the International Mother Language Institute, and the Bangla Academy works on vocabulary and changes in the Bangla language," she said. "Yet no institution is doing comparable work on sign language."
What sign language gets instead is committees. "We often hear that committees are being formed to standardise sign language, that another committee is being established, and so on. But, in practice, very little seems to happen," Poly said. "Announcements are made that certain things are under way, but implementation does not follow through in the way it should."
Her first demand is recognition, "The first step must be for the state to recognise sign language as a language," she said. "Once the state grants that recognition, we can expect more systematic work to follow."
Dip, approaching the problem from the clinic, arrives at a similar agenda. His first priority is to make Deaf mental health visible in policy and data, by including Deaf and disabled people in the National Mental Health Strategic Plan 2020–2030 and in national surveys. His second is the workforce.
"Train and accredit far more sign language interpreters, including specialist training in mental health interpreting, so that families are not forced to interpret," he said.
He also wants health workers trained in basic Deaf awareness, and helplines and telehealth made accessible through video signing. Even public broadcasting needs fixing. "Health information on national television should use full-screen or clearly visible sign language interpretation with subtitles, not the small interpreter box that Deaf participants told us they cannot follow."
Above all, the resources that already exist need a home. Dip wants the sign bank and co-designed materials built into government health and education platforms, backed by sustained funding rather than one-off project grants, because language and trust take years to build.
"The resources need a permanent home in the health system, for example through the Directorate General of Health Services and national helplines, so they outlive any single project," he said.
On one point, the linguist and the researcher agree. "People with hearing impairments must play a central role in this process," Poly said. "Sign language cannot be developed properly without their involvement."
Dip puts it more bluntly. "Our work succeeded because we designed with Deaf people, not for them. Any future initiative that forgets that principle will fail, however well funded it is."
Yet the ownership question remains. Is this a disability-access responsibility for Social Welfare, a clinical standard for the health ministry and DGHS, a training obligation for medical colleges, or a language-development mandate requiring a permanent Deaf-led institution?