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Mental health problems in Pakistan overlooked

World Mental Health Day is being observed on every 10th of October and the purpose of observing this day is to raise public awareness about importance of mental health and psychological disorders. According to the World Health Organization, mental health is defined as a state of well-being in which people realize their own potential, can cope with normal life stresses, can work productively, and can contribute to their community.

Mental illness refers to a wide range of mental health conditions that affect mood, thinking and behavior. People go through periods when they feel emotions such as stress and grief, but symptoms of mental illnesses last longer than normal and are often not a reaction to daily events.

When symptoms become severe enough to interfere with a person’s ability to perform day-to-day chores, they may be considered to have a significant mental illness.

Last year theme of this day is of providing psychological first-aid to those suffering from ailments such as depression, bipolar disorder, childhood trauma and psychosis. Mental health services lack human and financial resources in many countries, particularly low and middle income countries. More funding is needed to promote mental health to increase people’s awareness of the issue.

In response to making mental health a global priority, World Health Day was first celebrated in 1992 as an initiative of the World Federation of Mental Health (WFMH), which has members and contacts in more than 150 countries.

The perception is that people with mental illness are violent, look different from others, can never get better or cannot be productive members of society. These inaccurate and misleading stereotypes impact badly on people’s struggle to cope with their condition.

Studies show that people with mental illness are much more likely to be a victim. Mental disorders affect nearly 12 percent of the world’s population, about 450 million or one out of every four people around the world will experience a mental illness that would benefit from diagnosis and treatment.

WHO statistics for 2002 showed that 154 million people globally suffered from depression, which is a form of mental illness.

NOT PROPERLY PUT INTO OPERATION

In Pakistan around 50 million people are suffering from common mental disorders. These afflict 15 to 35 million adults besides 20 million children, according to local media. Only 400 trained psychiatrists are in Pakistan. This means there is roughly one psychiatrist available per half-million people.

Approximately 20 million children or 10 percent of the population, in our country need attention from mental health practitioners.

There are only five government-run psychiatric hospitals for a population of 180 million. There are fewer than 300 qualified psychiatrists practicing in Pakistan.

Pakistan has a mental health policy and related legislation, both remain unimplemented because of the abysmal public healthcare system.

WHO estimates Pakistan has some 320 psychiatrists only, demonstrating the lack of political will towards medical training and the provision of low-cost, accessible treatment.

Research shows that several social and environmental factors like poverty, social inequality, and terrorism, and migration, sexual and emotional abuse among them increase the risks of mental disorder.

Firearms, explosions, destitution, social injustice, natural calamities, illness, famine, and war signify the mental state of health in the country.

The most recent numbers indicate that of the overall 2.4 percent of the health budget, only a mere two percent is allocated to mental healthcare.

Silence surrounds the issue of mental health in Pakistan. Those with money can afford treatment but families in rural areas often fall back on ancient superstitions.

Hundreds of mentally-ill individuals from downtrodden families spend every season of their life here, chained to trees and waiting for a cure.

In a society where mental illness is often not acknowledged the families say the shrine offers a sanctuary.

Psychiatric experts say that most of the people brought here appear to be suffering from diagnosable and treatable mental conditions.

Instead of prescribing powerful drugs, trained primary healthcare providers must recommend relevant psychological therapies.

Family members, friends and the society in general have a vital role to play in helping people recover from mental illness. They need positive attitude and acceptance of their conditions.

The illness afflicts 15 to 35 million adults, which is approximately 10 to 20 percent of the population. Approximately 20 million children, or over 10 percent of the population, need attention from mental health practitioners.

One should take good care of himself with healthy eating, regular physical activity and sufficient sleep seven to eight hours for adults.

Also avoid conflicts in personal as well as professional life, try to participate in social activities and get together with family or friends regularly.

Common mental health problems have been identified in both rural and urban populations. Depressive and anxiety disorders are high, followed by bipolar, schizophrenia, psychosomatic disorders, obsessive-compulsive disorder and post-traumatic stress disorder.

Mental illnesses, despite being one of the most common disabling conditions in the developing countries including Pakistan, have been ignored over the years.

The alarming situations in the rise of mental disorders on one hand encourage the irrational use of psychotropic drugs, and on the other ‘quack’ practices.

Pakistan is not keeping pace with the mounting prevalence of psychiatric disorders caused due to organized violence, disruption in the social structure and natural calamities.

Mental illnesses, evidenced in suicide rates and deliberate self-harm, have reached an alarming situation. Common mental health problems have been identified in both rural and urban populations associated with socio-economic adversity, relationship problems and lack of social support.

Alongside these is the high prevalence of depression and serious drug problems with a growing number of inject able drug users in the urban population creating a public health predicament.

Mental health issues among children and the adolescent population is as common as in adults, but their incidence is underreported due to the associated social stigma.

Mental health services are still under-resourced in terms of qualified health professionals and patient care at the level of other models of community psychiatry in the developed countries.

Facilities are underutilized due to the social disgrace attached to psychiatric labeling, and a popular misconception that mental illnesses are due to the possession of ‘jin’ or evil eyes or magic.

People consult traditional healers whose caseloads are often dominated by mental disorders.

The number of psychiatric beds much smaller compared to the population with no waiting list in place, and progress in mental health care is not compatible with that in other medical disciplines; it is also undermined at the policy level.

Postgraduate training and education in psychiatry is available in certain teaching hospitals, but with no recognized sub-specialties such as child, forensic, geriatric and rehabilitation psychiatry and little exposure to the rural population.

Adequate training in psychiatry for general medical practitioners is needed in the primary care units in terms of an early diagnosis for eliminating referrals of people with schizophrenia to harmful practice, and reducing referrals to specialist psychiatric service.

At the district headquarter hospitals/teaching hospitals availability of clinical psychology services is of paramount importance to reduce the irrational use of psychotropic drugs, and to resolve psychological issues through talk therapies.

Universities need to introduce postgraduate courses embedded in inter-professional learning principles to train mental health professionals to facilitate the extension of specialist services to the district headquarter hospitals.

One of the greatest factors contributing to the nation’s instability is terrorism. A study by the Institute for Economics and Peace ranked Pakistan as third on its Global Terrorism Index, a ranking of the degree to which nations have been affected by terrorism.

As a result of the war on terror, an estimated 80,000 Pakistani civilians have been killed between 2004 and 2013. As terrorism has become a growing concern in Pakistan, the mental health of its people has also suffered. From 2001 to 2011, the country witnessed an almost 100 percent increase in the incidence of mental illnesses, particularly stress-related disorders and depression.

A study in Swat Valley, a region in Pakistan especially afflicted by terrorist violence as well as anti-terrorism drone attacks, found severe post-traumatic stress disorder symptoms in a majority of its participants. Recognizing the psychological implications of terrorism in Pakistan are of utmost importance, as the growing problems of mental health in the country has already cost it a great deal.

The Pakistan Association for Mental Health (PAMH) has highlighted the impacts of poor mental health on “national productivity, creativity, entrepreneurship and personal development”.

Severe mental illness has also been associated with health risk factors such as obesity and addiction, to the extent that the World Health Organization has predicted that depression will soon become the second leading cause of death in Pakistan.

A successful end to the war on terror would be the ideal solution to its detrimental consequences on the health of Pakistanis. The increasingly urgent issue of mental illness in Pakistan, exacerbated in the face of terrorism, is one that must be addressed.

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