October 10 is marked as World Mental Health Day and we are once again reminded that Pakistan continues to face serious challenges when it comes to mental health. It remains the silent killer as most cases are not diagnosed or treated.
About 60% of Pakistanis experienced moderate to high levels of mental health issues while eight in 10 individuals showed some symptoms of mental illness during the coronavirus pandemic, according to a global research firm, IPSOS, which recently carried out a study for an organisation affiliated with the Pakistan Mental Health Coalition. Covid-19 has created a major global mental health challenge, and Pakistan is not spared its psychological impact.
According to Dr Ayesha Mian, the chairperson of the Department of Psychiatry at the Aga Khan University, around 50 million people in Pakistan are already suffering from mental health disorders, including depression, anxiety, substance abuse, post-traumatic stress disorders, bipolar disorders and schizophrenia. It is believed that the illness afflicts 15 to 35 million adults, which is about 10-20% of the population. Approximately 20 million children or 10% of the population need attention from mental health practitioners.
Statistics tell us that 57.9% of the population in Pakistan comprises those under 21 years of age. There is an alarming increase of mental health problems among the young population. And yet this is sadly the most neglected area in the healthcare field.
In Pakistan, anxiety is the eighth most common health problem that causes disability, whereas depression accounts for 44.6% of the total disease burden for mental illnesses. What is ironic is 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 shocking. 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. 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 the national level in the sector of youth mental disorders. According to WHO, 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 recognize it. It is time we take mental health more seriously.
Published in The Express Tribune, October 12th, 2020.
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