LAST year we celebrated the 60th anniversary of our independence. As we look back, we can see many instances that we can truly be proud of. Gaining independence in 1947 was itself a momentous occasion.
We have produced a Nobel laureate, developed the nuclear bomb, built a highway on the roof of the world and excelled in sports notably cricket, hockey and squash. We have weathered many crises, survived and progressed.
Unfortunately, whatever little progress we have made is offset by the huge problems faced by our population. A third of our population lives below the poverty line and a quarter just above it, deprived of the basic needs of education, housing and food. Clean drinking water in homes is a luxury available to only a minority. The vast majority remain deprived of access to social and legal justice as they are of their civic rights. Millions live a hand to mouth existence, not knowing from where their next meal will come. Millions remain unemployed.
Our health indicators make for sorry reading. We have one of the highest prevalence rates of child mortality, tuberculosis, hepatitis, rabies, hypertension and diabetes. The list is endless.
Of course, when we talk of health, most people including health professionals and policymakers refer to physical health only. What is hardly ever mentioned, but remains an integral part of health, is mental health, enshrined in the World Health Organisation’s (WHO) landmark definition of health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.
Mental health problems afflict more than 450 million people worldwide, and are on the rise. WHO estimates that by 2020, globally, after heart disease, depression would be the second most common disorder causing disability and distress, exacerbating human suffering that will be difficult to contain with the resources available, currently or in the future.
For developing countries like Pakistan these findings have grave implications. Studies have shown that the prevalence of common mental disorders (CMD) like depression and anxiety is abnormally high even when compared to other developing countries with similar socio-economic indicators. Even by conservative estimates, more than a third of our adult population is suffering from CMDs. This includes almost 10 per cent of our men and more than a quarter of the women.
Translated in real numbers this would amount to almost four million adult men and 10 million adult women. Add to this the one to two per cent suffering from serious mental illnesses like schizophrenia, three to four million from drug addiction, one to two per cent of children suffering from mental retardation, probably another 10 per cent children from other mental disorders and countless others from various psychosomatic disorders like high blood pressure and ulcers — and we have, literally, millions of our people suffering from mental health-related problems.
Where are these millions ending up? How are their problems being addressed? What is being done to relieve their suffering? The sad but true answer is: nothing much. Our health spending is only around one per cent of GDP. Mental health does not even have a separate budget. One can add to this the extreme shortage of psychiatrists — the ratio is about one psychiatrist to 500,000 to one million population (in UK it is one to 25,000). In addition, there is discrimination, stigma, ignorance and lack of treatment facilities. All this adds up to a serious mental health crisis in Pakistan.
This crisis is already spiralling out of control and taking a heavy toll on our population. There has been an alarming rise in suicides over the last few years, from a few hundreds to thousands annually. We have more than three million drug addicts — the majority are young men — in the country, suicide bombings, increasing levels of violence and intolerance in society and aggressive behaviour that we come across in our daily lives. All these are indications that the mental health of our people is seriously compromised. Pakistanis are living with unprecedented levels of stress.
Research conducted at various centres in Pakistan shows that the number of patients with psychosomatic disorders has gone up exponentially over the last few years as has the consumption of tranquillisers which can easily be bought at any pharmacy.
What can we do about this state of affairs? We cannot remain silent observers as this terrible tragedy unfolds in front of us. For where they are problems, there are also solutions. However, to be effective these solutions have to be culturally relevant, cost effective, replicable and sustainable. Given that we have limited resources that are squandered by massive corruption, poor governance and mismanagement, this is no easy task.
Programmes must address core issues that underlie mental health. While we require more psychiatric facilities the focus should be on primary prevention through mental health promotion. We will never have enough resources to tackle the huge numbers of mental disorders in this country. Hence looking at ways to prevent mental disorders from developing and helping people enhance their mental health holds out the best promise. Initiating life skills programmes for young people in schools is an example of mental health promotion.
There also needs to be greater and stronger collaboration between voluntary and charitable organisations and academic centres as research is relevant to the problems of society. An example of this is an experiment that was conducted for managing mild to moderate depression in women in a low-income district of Karachi through psychological counselling. Other women from the same community were trained as counsellors. The results showed that this method was highly successful as well as cost effective. Based on the results, training workshops have been held for health professionals of various organisations.
Research and intervention strategies like these can address the real mental health issues of our society as these would be indigenously developed rather than being imported from the West. There is need for research on other psychiatric disorders as schizophrenia, drug addiction, dementia, suicide and childhood disorders. We need to come up with models of care and training that would directly address problems of mental health in the people of this country.
The challenge for tackling mental health problems is a formidable but not insurmountable one. What is required is political will, research evidence and good governance to establish and implement mental health programmes. Mental and public health professionals, non-governmental organisations and policymakers in government must work together to take up this challenge.
The writer is professor of psychiatry at the Aga Khan University, Karachi.
Source: Daily Dawn, 2/5/2008