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Mental Health in Pakistan: Myths and Facts

Submitted by on June 17, 2014 – 4:59 PM

jinn-mental-health-pakistan-photographer-faseeh5Mental health is very important just like our physical health. For a healthy body a healthy mind is very important. Mental health provides us resilience i.e. ability to cope up with the stress of daily life, it  provides inner strength, emotional well-being and enables us to adapt to the changes of daily life. Despite the above mentioned importance of mental health, it is notable that mental health is neglected in third world countries more specifically in Pakistan.

 

The real image of the mental health in Pakistan can be drawn through a case scenario which I have read in the Daily Dawn newspaper of Pakistan: a 25 year old girl named Sakina died due to physical torture of the religious authority (Aamil) in Badin city of Interior Sindh. According to the religious authority the girl was possessed, he was giving pain to the supernatural enity through the torture of the young girl. Many such cases are not reported and hushed due to myths and maltreatment. There are various reasons for hindrance in the development of mental health like lack of awareness, low facilities of the mental health sector, socio-cultural issues, and religious issues. In addition to above there are various myths related to mental health which are a barrier in the care of mentally ill people.

 

It is noted that among the general public every third individual defines or limits mental health as health of mad (pagaloon ki sehat) – this common stereotype in Pakistan hinders the care or treatment of psychiatric patients. But the fact is that mental health is an essential component of overall health. Mental illness can happen to any individual who has neuro-biochemical changes and it warrants proper treatment and care. According to Word Health Organization (2013) “mental health is defined as a state of well-being in which every individual realizes his or her own  potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.

 

There are various factors which play an important role in mental health. One of the important factors is the physical health which plays a vital role in mental health. The patient with  physical illness usually has low self-esteem and suffers from depression and anxiety which impair the mental health of that patient. Moreover the people who are physical healthy seem more active which boosts the self-esteem and improves mental health.

 

Another important factor is social life, which is an integral part of mental health. In developed countries there are social support groups for the psychiatric patients which play an important role in their rehabilitation. Furthermore, psychiatric awareness associations in society conduct the sessions on awareness for the prevention of the mental illnesses. One the other hand bad social habits like drinking alcohol and smoking etc. causes depression, anxiety and  psychological dependency. In addition to above factors another deep-rooted factor is culture which is comprised of social norms and religious values of any society.

 

In Pakistan it is notable people are unemployed or living below the line of poverty and that psychiatric patients are stigmatized that they are mad and people consider that these patients cannot be cured. Additionally, it is culturally considered that mental illnesses are due to supernatural causes e.g. sorcerer, witchcraft and evil eye which is a myth and becomes a barrier in availing the mental health services. The question arises here why myths are so common  in Pakistan? It could be because of many reasons but the main factor here is lack of awareness.

 

The awareness regarding mental health demystifies common myths by revealing the facts and promotes health seeking behavior in the public. That’s why people consider awareness as the preventive step in public, which is low cost and very easy to at achieve as compared to rehabilitation. The role of government in health especially mental health sector is very important in terms of human resource and material resource management. Human resource management is a very complex term which implies recruitment and training of staff.

 

In mental health sector government can manage the human resource through proper policy making and appropriate material resource allocations. It is not only recruitment of doctors, nurses and psychiatric health workers. It also covers proper staff retention through training and professional development of the serving staff. It is also the prime responsibility of government to develop effective work places through job classification, manual policy and termination procedure.

 

The government should raise the standard of infra-structure and manage the budget each year for the health sector. There should be monitoring system for the material resource which is provided in the name of budget. There should be short term and long term goal for the budget allocation for the transparency of the material resource usage. The allocation of resource should be on need basis for example there are greater number of psychiatric issues because of disparities like hike in the prices and terrorism. Above all government can involve health development partners like companies, institutions and organizations which are working for public health.

 

The most important factor is awareness which can be achieved through the participation of community and active role of medical and paramedical staff. Nowadays the major issue all across the world regarding mental health is stigmatization of mental illness. According to Kakuma, Kleintjes Drew Green, and Flisher (2010) awareness is the key component to change the attitude and behavior of communities having stigmatization in South Africa and other countries. Secondly, it is the duty of medical and paramedical staff of mental health setting to make the general public aware of the mental illnesses and their treatment modality.

 

The attitude of public shows that mental illnesses are not preventable or due to supernatural cause which can be changed through awareness. According to Schomerus, Schwahn, Holzinger, Corrigan, Grabe Carta, and Angermeyer,(2012)“increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness” ( p.440). The lack of public understanding about mental illness causes various types of myths which hinder the treatment of mental disease. For demystification of such myths and better outcomes, it should be in the knowledge of community that mental illnesses are like physical illness and mental patient have a right to health. It is very important to consider that public awareness can be achieved through social media, support group and active participation of the community.

 

Mental health is the most neglected field in Pakistan; there are insufficient facilities as compared to the prevalence of diseases. According to Muhammad (2012) Pakistan has one  psychiatrist for every 10000 patients and one child psychiatrist for every four million children suffering from mental disorders. There are only four major psychiatric hospitals for the 120 million population of Pakistan. There is no concept of psychiatric health workers and support groups. However there are number of Non-governmental Organization (NGOs) working for mental health in Pakistan.

 

Pakistan Association for Mental Health working for the mental health of community, Karawan-E- Hayat working for the rehabilitation of psychiatric patients, Edhi Destitute Home and Habitat for Mentally ill provides shelter for the psychiatric who cannot afford service charges at other institutions, Rozan provides counseling for psychiatric patients and Children Youth and Families Foundation is working on the developmental issues of children and youth. There are community based organizations working for the mental health of their own communities which are not registered with the government. According to press release of Pakistan Association for Mental Health (PAMH) in Pakistan, there were four mental health hospitals in Hyderabad, Lahore, Peshawar and Mansehra with a total capacity of 3,000 beds, while small  psychiatric units were attached to teaching hospitals and private psychiatric hospitals had a capacity of about 4,000 beds for patients reporting with mental disorders. There were only 419 psychiatrists in the country, concentrated mostly in urban areas, while there were no trained  psychiatric nurses and community mental health workers.

 

There had been a longstanding demand for a meaningful investment in the mental health sector, development of workforce and infrastructure (Daily Dawn, December, 2013) Mental illnesses are highly prevalent in Pakistan but cases are under report because of the  public or self-stigma. Secondly, there is not much awareness, which also causes under-reporting of the mental illnesses. The mental health indicators like unhappiness, stress, suicidal attempts, criminal activities and substance abuse show high  prevalence of mental illness in Pakistan. According to Dr Salamat, 2013 a report published in the Daily Dawn here has been an almost 100 percent rise in the incidence of mental disorders,  particularly stress and depression, in the country over the past 10 years, mainly due to the issues of personal insecurity, poverty, lack of education, rising inflation and ramshackle power supply.

 

According to Naqvi (2007) a recent random household survey of Bilal colony (n=425), shows the prevalence of depression as, 40% were identified to be Punjabi, 27% Pathans, 16% Sindhis and 9% Urdu speaking 4. According the last census 22.1% of the Karachi city’s population are migrants from other places. Therefore the study gives prevalence rates in a selected sub-group of Urdu speaking population residing in the semi-urban squatter settlement (p.10)

 

Recently, I was working in private tertiary care hospital on mental health awareness  project as part of my leadership and management subject. Looking at survey results I was amazed to know that only 10 % of the selected sample were aware about mental health service  provided by the same hospital. Twenty five percent of sample answered that they have self- perceived stigma people do not point them out, but they themselves hesitate to consult with a psychiatrist. Sixty percent of sample outlined the public stigma that is to be consulted with a psychiatrist is to be publicly proclaimed mad (pagal).

 

The most interesting finding was that 100 percent of surveyed people feel that there is need of mental health services in our country. The awareness component of not only public but also health care providers working in fields other than mental health setting was lacking. Most of the people have negative coping mechanisms (i.e. use of alcohol, drug addiction, lack of exercise and communication gap with friends and family). These negative coping mechanisms lead to further mental illnesses.

 

Lastly, myths are a result of unawareness of mental health and common mental illnesses, it is the necessity of time to demystify through awareness of public about the importance of mental health. For the awareness both community and health care professionals can play their role through active participation and mutual goal setting. Health care providers should consider the cultural and religious values of the community. There should be proper monitoring and evaluation of projects of mental health awareness. Moreover, electronic and print media especially social media can be used for the awareness  purpose.

 

Furthermore, local political, religious and institutional participation can be influential and an easy method to achieve the aim of awareness. The last but not least, the goal of any project cannot be achieved without participation of the community, it is very important to ask the community about possible ways of spreading awareness. For long term sustenance of awareness and health seeking behavior it is also important to find the human resource, who can work for the community. Behavioral change requires a long time and continuous effort of reinforcement for change, which is possible through selection of dedicated human power from the community. Surely, through demystifying the myths of mental illnesses we can save many lives who are still suffering in situations like Sakina’s.

 

References

Kakuma, R., Kleintjes, S., Lund, C., Drew, N., Green, A., & Flisher, A. J. (2010). Mental Health Stigma: What is being done to raise awareness and reduce stigma in South Africa. African Journal of Psychiatry,13(2).

Muhammad (2012, October 9). Mental health most neglected field in Pakistan – thenews.com.pk. Retrieved March 30, 2014, from:
http://www.thenews.com.pk/Todays-News-6-136490-Mental-health-most-neglectedfield-in-Pakistan

Naqvi, H. (2007). Tutorial Article: Page 10. Depression, 4(1). Retrieved March 30, 2014, from:
http://www.jpps.com.pk/display_articles.asp?d=172&p=art

 

 

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