Daily Times

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 situation in the rise of mental disorders on one hand encourages the irrational use of psychotropic drugs, and on the other ‘quack’ practices.

In Pakistan, around 50 million people suffer from common mental disorders for whom there are only 400 trained psychiatrists in the country, which means there is only one psychiatrist available per half-million people. The illnesses afflict 15 to 35 million adults, which is approximately 10-20 percent of the population, and about 20 million children, which is approximately 10 percent of the population. These are the people who need immediate attention of policy makers and mental health practitioners.

Pakistan, one of the ninth most populous countries of the world, has been experiencing both general health problems and mental health issues. The country is far behind the developed countries in terms of trained mental health professionals, available psychiatric beds, provision of supportive healthcare, resourcing, infrastructure and, above all, coordination between different disciplines and effective leadership to efficiently run services in order to meet the current challenges.

The country is not keeping pace with the mounting prevalence of psychiatric disorders caused due to organised 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. Depressive and anxiety disorders are high, followed by bipolar, schizophrenia, psychosomatic disorders, obsessive-compulsive disorder and post-traumatic
stress disorder.

Alongside these is the high prevalence of depression and serious drug problems with a growing number of injectable 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. Financial resources are meagre and mostly limited to cities even though majority of the population is rural. Facilities are underutilised due to the social stigma attached to psychiatric labelling, and a popular misconception that mental illnesses are due to the possession of ‘jinn’ or evil eyes or magic. People consult traditional healers whose caseloads are often dominated by mental disorders.

The number of psychiatric beds is 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.

The behavioural sciences are not being taken seriously in medical schools with the absence of a structured rotation programme for senior medical students having low interest in the subject of psychiatry. Postgraduate training and education in psychiatry is available in certain teaching hospitals, but with no recognised sub-specialties such as child, forensic, geriatric and rehabilitation psychiatry and little exposure to the rural population. Some clinical psychology training centres/departments are providing clinical services and offering one or two-year courses, but the majority emphasises teaching rather than clinical supervision with no formalised
clinical placement schedule in multidisciplinary settings.

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 linked to BHUs/RHCs. Each district specialist psychiatric unit at district level or in teaching hospitals would have to adhere to the true principle of community psychiatry including multidisciplinary teams comprising a consultant psychiatrist, a clinical psychologist, medical social worker, occupational therapists and community psychiatrist nurse (male and female). That would reduce the social stigma and provide a cost-effective psychiatric service at the doorstep for a significant population utilising the existing infrastructure.

Dr M Tahir Khalily is a professor of Psychology at the International Islamic University, Islamabad.

Taj Nabi Khan is an Islamabad-based journalist and a freelance columnist