The impact of environmental challenges and social exclusion on mental health: A phenomenological study on the river gypsies of northern Bangladesh

Abstract

Bede (“river gypsy”) communities in Bangladesh live with recurrent flooding, riverbank erosion, and displacement, alongside entrenched stigma and service exclusion, placing them at high risk of climate-related mental distress. We conducted a hermeneutic phenomenological study to examine how environmental hazards, social exclusion, and access barriers affect mental health and coping among Bede communities living along the Jamuna River in Sirajganj district. Seven in-depth interviews and one focus group discussion were carried out with adult community members. Data were analysed using reflexive thematic analysis, informed by Conservation of Resources (COR) theory, structural stigma theory, and a patient-centred access framework. Four interconnected domains were identified. First, environmental shocks and resource loss : hydro-climatic events (flooding, erosion, forced moves) triggered cumulative losses of shelter, assets, income, and schooling (hydro-climatic shocks → resource loss → demoralisation; COR loss spiral). Second, sleep disruption and persistent arousal : unsafe, damp sleeping spaces and anticipatory fear of future floods generated chronic insomnia, fatigue, and irritability (resource loss → unsafe sleep → persistent arousal). Third, gatekeeping and structural exclusion : stigmatising labels, lack of fixed address and documentation led to denial of water, exclusion from relief and social protection, and humiliating encounters in services (structural gatekeeping → disrupted ability to seek, reach and engage with care). Fourth, coping repertoires and collective strategies : prayer, quiet reflection, family pooling of resources, community solidarity, and pluralistic help-seeking from biomedical and traditional healers provided important but fragile buffers. Mental distress among Bede communities arises from the interaction of cumulative resource loss, sleep disruption and structural exclusion. Disaster-risk-reduction and health policies for mobile, climate-vulnerable populations should secure safe dry sleeping spaces, lighting, food and small assets; introduce portable ID and flexible registration; implement low-threshold, co-designed mental health and psychosocial support through outreach-based primary care; and reduce stigma at initial point of contact.