Mental health problems in Pakistani society

By: Horia imran

Mental health is a state of well-being in which a person understands his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
Both physical and mental health are the result of a complex interplay between many individual and environmental factors, including:
family history of illness and disease/genetics ,lifestyle and health behaviours (e.g., smoking, exercise, substance use), levels of personal and workplace stress, exposure to toxins ,exposure to trauma, personal life circumstances and history, access to supports (e.g., timely healthcare, social supports), coping skills.
When the demands placed on someone exceed their resources and coping abilities, their mental health will be negatively affected. Two examples of common demands are: i) working long hours under difficult circumstances, and ii) caring for a chronically ill relative. Economic hardship, unemployment, underemployment and poverty also have the potential to harm mental health.

Mental health is the most neglected field in Pakistan where 10- 16% of the population, more than 14 million, suffers from mild to moderate psychiatric illness, majority of which are women.
Pakistan has only one psychiatrist for every 10,000 persons suffering from any of the mental disorders, while one child psychiatrist for four million children, who are estimated to be suffering from mental health issues. Only four major psychiatric hospitals exist for the population of 180 million and it is one the major factors behind increase in number of patients with mental disorders.
This year the theme for World Mental Health Day is ‘Depression ’: A Global Crisis’. According to WHO, depression affects more than 350 million of ages, in all communities and is significant contributor to the global burden of disease and contribute to a high suicide rate. Although there are known effective treatments for depression, access to treatment is a problem in most countries.
In Pakistan, majority of the psychiatric patients go to traditional faith healers and religious healers who believe that mental illness is caused by supernatural forces such as spirit possession or testing by God. “All this is due to acute shortage of mental health professionals and relatively low levels of awareness about mental disorders”.
There is also no political will and no proper mental health policy in Pakistan. All this adversely affects the integration of care delivered by government health care professionals for patients with with mental illnesses. Major mental disorders in Pakistan are depression (6%), schizophrenia (1.5%) and epilepsy (1-2%).
Mental Health Pakistan believes that the incidence and prevalence of mental disorders in Pakistan is tremendously increasing in the background of growing insecurity, poverty, violence, terrorism, economical problems, political uncertainty, unemployment, stressful working conditions, gender discrimination, unhealthy lifestyle, physical ill health, genetic factors, unrestricted urbanization, and disruption of the social fabric and loss of protective family networks. “Sinking below poverty line by almost 39% of the individuals is an alarming factor worth noting. In view of the poverty, low health budget, high cost of medicine, there is huge economic burden on the patients.”
Mental disorders are among the risk factors for communicable and non-communicable diseases. They can also contribute to unintentional and intentional injury. At the same time, many health conditions increase the risk for mental disorder for example obesity has been associated with significant increase in depression. Stigma about mental disorders and discrimination  against patients and families prevent people from seeking mental health care.
Pakistan among the other developing countries, has a higher prevalence rate of depression because of the current social adversities. Mean overall prevalence of depressive disorders and anxiety is 34%. Province wise prevalence is: Sindh 16%, Punjab 8%, Baluchistan 40%, Khyber-Pakhtunkhwa 5%.
Lahore has the highest number of depressives that is 53.4% as compared to Quetta (43.9%) and Karachi (35.7%). The current situation in Pakistan along with other basic health problems, the social upheaval, political instabilities, lawlessness, terrorism, economic disparity, problems with security, safety, gas and electric load shedding, escalating prices of petrol, gas, and other basic necessities of life has created a ground fertile for depression which has almost taken the first position among all the psychiatric conditions.
Women in Pakistan often face domestic violence as well as restriction in equal rights, particularly in rural settings. Other risk factors being divorced or widowed status, conflict with in-laws, financial strain and the status of being a housewife rather than employed.
Studies reveal that depression is characterized by persistent sadness, loss of interest or pleasure, feeling of guilt or low self worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. Depression can be long-lasting or recurrent, substantially impairing an individual’s ability to function at work or school or cope with daily life. At its most severe, depression can lead to suicide. Almost one million people take their own lives each year.
Depression often starts at young age and affects women more commonly than men. One or two mothers out of 10 have depression after childbirth. Depression also limits a mother’s capacity to care for her child, and can seriously affect the child’s growth and development.
There is a dire need of developing psychiatric faculty in teaching hospitals where posts of consultant psychiatrists should be created. Mental health Act should be implemented with letter and spirit. Public awareness programs addressing mental health issues should be launched through media.
Talking of the remedies, Mental Health Pakistan suggested that mental health should be integrated into primary health care, should be provided in general hospitals and community based mental health services should be developed. Mental health promotion requires multi sectoral approach. “The focus should be on promoting mental health throughout the life-span to ensure a healthy start in life for children to prevent mental disorders in adulthood and old age.”
Mechanisms to monitor human rights should be established to protect people from inhuman and degrading treatment. “There is a need of socio-economic empowerment of women by improving access to education and microcredit schemes. Community and day centres should be built for them at district level and stress prevention programs should be started at work”.