Daily Times

This year, Mental Health Day (October 10) is being celebrated by the World Health Organisation under the banner of “Mental Health Care for all: Let’s Make it a Reality.” The official theme set by the World Federation for Mental Health is “Mental Health in an Unequal World.”

Stable mental health is not merely the absence of any mental disorder but a requirement for overall viable health. Various socio-economic and biological divisors, physical climate, religious and cultural norms, state of governance, gender equality and geopolitics in varying degrees influence individual and collective mental and emotional states.

The prevailing pandemic has triggered many mental health issues. The department of economic and social affairs of the UN has cited that on average, one in every four people will experience a mental health condition in their lifetime. Every year, one million people die due to suicide, which is the third leading cause of death among young people. Depression is the leading cause of years lost due to disability worldwide. Mental health problems, including alcohol abuse, are among the ten leading causes of disability in both developed and developing countries. In particular, depression is ranked third in the global burden of disease and is projected to rank first in the year 2030. The aggregated worldwide impact of mental disorders is also generating huge economic damages. An estimated loss of US $16.3 trillion between 2011 and 2030 was stated by the World Economic Forum in 2011 based on a study by the Harvard School of Public Health. In the meeting of the World Health Assembly held in May 2021, the need and relevance to boost quality mental health services at all levels were recognised by the governments of member countries.

What is the state of affairs in Pakistan? According to the WHO, mental disorders account for more than four per cent of the total disease burden in Pakistan. The mental health burden is higher among women. It is estimated that 24 million people in Pakistan need psychiatric assistance. According to the WHO data, Pakistan has only 0.19 psychiatrists per 100,000 inhabitants-one of the lowest numbers in the WHO Eastern Mediterranean Region, and the entire world. In a research paper, “Mental healthcare in Pakistan” published in 2020, Javed Khan et al noted through desk review that although over 15 million people in Pakistan were suffering from some form of mental illness, for a population of 220 million, only four hundred trained psychiatrists exist with few state-run psychiatric hospitals and a small number of psychiatric units in teaching and general hospitals. To estimate the economic burden of mental illnesses in Pakistan, a study by Asher Malik and Moosa Khan was conducted in Aga Khan University Hospital, Psychiatry department on admission and ambulatory care for the year 2005-6. It was found that the economic burden of mental illnesses in Pakistan was Rs 250,483 million/USD 4264.27 million in 2006.

The writer is a public health, gender and inclusion expert and founder (Apna Wallet). She tweets at dr_rakhshinda.

The health-seeking attitude and behaviour of most of our people are shaped by conventional wisdom and many cultural, gender and finance-related barriers. In the case of mental health, stigma and discrimination remain an integral part of many decisions. It is no mystery that the concept of illness and willingness to consult qualified medical doctors is quite unbelievable, if not unscientific here. This “incaution” can be attributed to the web MD, lax over the counter sales, fake healers and soothsayers on popular tv shows and much more comfortable access to faith healers/peers etc. than professional health services providers.

A pertinent question that arises here is the professionalism of the professional therapists and psychologists and psychiatrists themselves. Barring rare exceptions, I have yet to see genuine professionals extending mental health care at many tiers. There are two extremes. At one end there are charlatans in this sector just like in general medical care and at the other end, there are qualified psychiatrists who are certainly (mal) practising without any burden of conscience and threat of a lawsuit. This genre of practitioners start writing a set prescription when the patient enters their room and seldom offer therapy, hope and health education. There are many clinical psychologists and (self-declared) therapists who unmistakably toy with the mental health of their patients/clients without being criminalized. The abrupt upsurge of psychologists and therapists in Pakistan and big cities should be seen with concern and from many angles. Psychology and short courses in psychotherapy is a known constituency in our homeland of not so studious students and elite socialites. Is not it scary that many untrained, inadequately prepared and ill-equipped people are proudly and confidently carrying the title of psychologist and therapist? Just as the loss of boundaries including demand and attempt for sexual favour is a well known hushed up fact in interacting with many lawyers it stays as a painful truth that sexual exploitation and judgment is not strange to mental health care receivers. There is a wide range of repugnant and rancorous trueness. The acceptance and “normalization” of arrogance, apathy, betrayal, deception and abuse in our conducts and official systems are indeed indicators of neglected and devalued mental health care.

No country can make any progress without sound mental health. Our legislators, civil society activists and concerned public servants must straightaway gauge the existing terrifying situation of mental health care. Psychology /Clinical psychology must be (re) introduced as high merit disciplines. Mental health must not be limited to a medical issue but cogitated as a human rights issue. The number of proficient mental health care services providers, facilities and budgetary allocations needs to be enhanced. An urgent, serious and sincere coordinated multisectoral collaboration is mandatory to affirm cost-efficient strategies to guard and upgrade the mental health of all Pakistanis equally. Mental health care for all can only be a living reality if all concerned decide to put it as a priority agenda on power tables. Are they ready?

The writer is a public health, gender and inclusion expert and founder (Apna Wallet). She tweets at dr_rakhshinda.