In a tragic incident that took place recently, a young girl took her life when she jumped off a building at a university in Lahore. The name of the girl, the university she went to or the way she took her life is somewhat inconsequential. What is important for us to understand are the reasons that led her to take this action and whether we, the people around her or professionals, failed to get her the help she needed.
We are told that 57.9% of the population in Pakistan comprises of those under 21 years of age. These youngsters are an asset to Pakistan. However, their problems are widely overlooked. There is an alarming increase of mental health problems among the young-population. And yet this is sadly the most neglected area in health-care field.
Dr Ayesha Mian, the Chairperson of the Department of Psychiatry at the Aga Khan University, estimates that around 50 million people in Pakistan are suffering from common mental disorders.
It is believed that the illness afflicts 15 to 35 million adults, which is about 10 to 20 per cent of the population. Approximately 20 million children or 10 per cent of the population need attention from mental health practitioners.
Of this, depression accounts for six per cent cases of mental illness in Pakistan. We are told that depression is a disorder that can be reliably diagnosed and treated in primary care. But for that to happen, we would need access to qualified practitioners.
The ratio of psychiatrist to patient is depressing in Pakistan. We have one of the lowest mental illness patient-to-doctor ratios in the world. Only about 400 trained psychiatrists practice here. That means there is roughly one psychiatrist available per half-million people.
Our laws have also not helped matters. Before the 2001 Mental Health Ordinance (MHO), which has marginally improved the treatment and management of the mentally ill and their affairs, the law presiding over patients in need of psychiatric attention was the Lunacy Act (1912). If the name of the colonial-era law is already unfortunate, its contents had even more glaring problems.
The text had no concept of informed consent for the patient — it was not necessary for doctors to inform patients or their guardians about the nature, effects, risks and costs of prescribed treatments or offer alternatives before carrying them out. It also called patients “idiots” and spoke of “criminal lunatics” — an oxymoron, given that a “lunatic” should be provided care and treatment, as opposed to punishment.
Perceptions play a major role in addressing this problem. People with mental illness are seen as violent, look different from others and are believed to never get better. Such misleading stereotypes impact these people’s struggle to cope with their condition. It seems not much has changed on ground despite the change of the laws.
Suicides are a big part of mental health. One of the leading authorities in this field, Dr Murad Moosa, terms suicide a major public health problem in Pakistan.
In an interview, he said that despite the high numbers, suicide prevention is not a government priority. The intensity of this growing problem can also be understood by looking at the fact that limited research has been carried out at national level in the sector of youth mental disorder. According to the World Health Organisation, the outgrowth of mental health problems has reached a dangerous level.
Economic pressure and loneliness are two important factors for suicides in the youth. All over the world, suicide is one of the three leading causes of death along with Alzheimer’s disease and drug overdose. Pakistan is no exception.
Even when patients fighting something as common as depression or anxiety recognise their symptoms, overcome the stigma, gain the support of their families and start looking for medical help, there simply isn’t much help to be had. The first step towards tackling a problem is to recognise it. It is time we take mental health more seriously.
EndNote: I dedicate this column to Dr Anwar Mangi, a leading name in addressing mental health issues in the country. She recently passed away in New York. In her lifetime, Dr Mangi saw thousands of patients – who she helped in fighting their inner battles and bettering their lives. She made a difference in the lives of many. You will be missed. We will all be poorer without you.
Published in The Express Tribune, December 3rd, 2018.