Psychiatrists from all over the country flocked to the Karachi launch of Shamil, a collaborative mental health initiative that will work on providing this type of healthcare to the most ignored of neighbourhoods in the city.
The I-Care Foundation, Aman Foundation, Karwan-e-Hayat, Pakistan Association of Mental Health and Health and Nutrition Development Society (HANDS) are all working together on it.
Shamil, which means “inclusive” was conceptualised at the Aman Foundation and is the brainchild of their CEO Ahsan Jamil. For him it resonates with Erich Fromm’s Escape from Freedom where he claims that man is emotionally in the Stone Age. The Shamil project is set to start this month and will focus on Korangi to begin with. Lady health workers, also known as Marvi workers at HANDS, will help treat women and children in the area.
The event kick-started with New York University Professor of Psychiatry Dr Zebulon Taintor’s presentation on the need for community mental health. He focused on how there was an unmet need in every part of society which resulted in violence, suicide, depression and substance abuse. “What you need to do here is develop a system to collect data, use surveys to identify symptoms and come up with a diagnosis,” he said. “The situation is much worse than expected as there are no biological markers for depression. The last set of studies which was conducted on schizophrenia was 20 years ago.”
According to Taintor, a lot of people from the upper-middle class suffer from depression but are afraid to come out and accept it. “Imagine, if every second person in the world was depressed then if it’s not me then it must be you,” he said. “We all have psychotic thinking and irrational anger, in a neo-Freudian manner we need to to release the child within.”
While advocating the need for people to seek treatment, he gave an example of Nazi Germany where patients in a mental institution where doctors, in order to protect their patients, started the rehabilitation process. “The social cost is obviously very high, but what does one do when the national suicide rate is 31,000 a year?” he said.
Dr Murad Musa from the Aga Khan University Hospital claims that there is no exact depression rate or count in the country. A study showed that in 100 reported suicide cases in Karachi, only two were being treated for depression. “There is an extremely high mental morbidity rate among married women in Pakistan,” he said. According to Taintor, there are something’s besides love and moral order which people need.
“Depression is a severe problem in the country and has to be acknowledged,” said Aman Foundation CEO Ahsan Jamil. “In Scandinavia, the depression rate is between 11 to 12 per cent, in Pakistan, statistics claim it is 16%, which is rather conservative,” he said. Jamil claimed that in order to be a good counsellor, you need to have received counseling first. “There are at minimum of 300,000 people in the country who suffer from mild to moderate forms of psychiatric illness,” he said.
Dissected the mental health situation in the country, Jamil claimed that there are 1,000 social workers, 2,000 health care providers, four mental hospitals, 232 drug abuse centres and 320 psychiatrists. “The absence of research and the stigma attached to depression can perpetuate neglect,” he said.
Long time psychiatrist Dr Uzma Ambareen from the PAMH claimed that their first priority should be to create awareness. “Many people are discouraged from seeking help from a psychiatrist or psychologist,” she said. “People from low socio-economic groups are more open to the idea of receiving help than others.”
Dr Feriha Peracha, who deals with internally displaced children from Swat, reasserted Ambareen’s point and added that some people just say that they are seeing things. “Not all of the children were being trained as suicide bombers, they were used as slaves and extortionists or informants,” she said. Her research shows that these children were given up by the mother as they were of no apparent use. “The mother evaluates her children and gives away the child she doesn’t need for money to the Taliban.” She added that some of the children she has worked with claimed that they were promised 70 houris for killing an army officer and 140 for killing a foreigner.
Published in The Express Tribune, August 2nd, 2011.