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Good news for mental health.

Byline: Mohsin Jamil

The suicide rate in Pakistan has risen in the past couple of years. According to a study conducted in 2009 by Aga Khan University (AKU), an estimated 6,000 to 8,000 suicides take place in Pakistan every year.

What is more astonishing is the finding that almost 34 per cent of the population, mostly under 30 years of age, suffers from common mental disorders in Pakistan whereas more than 90 per cent of suicides can be linked to depression.

Mental health in Pakistan has remained a subject of debate since the last few years. The incidence and prevalence have both increased tremendously in the background of growing insecurity, terrorism, high inflation, political uncertainty, unemployment and disruption of the social fabric.

Mental Health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the World Health Organisation's definition of health: "A state of complete physical, mental and social well-being, and not merely the absence of disease". It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.

Every year WHO celebrates World Mental Health Day where it supports its slogan 'No health without mental health.' World Mental Health Day on 10 October raises public awareness about mental health issues. The Day promotes more open discussion of mental disorders, and investments in prevention and treatment services.

This year, WHO is launching its Mental Health Gap Intervention Guide (mhGAP-IG) on 7th of October which aims to encourage the treatment gap for mental, neurological and substance use disorders especially in poor resource countries.

The Program intends to highlight the need to deal with mental health problems of people with chronic physical illnesses and that physical care of mental health consumers through a continued and integrated care is very necessary to ensure a healthy recovery.

Talking about the state of mental health in Pakistan, many perceive it as a disease that can never be cured. There are others who are very less aware about mental health let alone its diagnosis or treatment whereas there are still others who seldom realize the importance of a strong healthy mind. WHO defines mental health as not just the absence of mental disorder but as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Keeping this definition in mind it can be safely said that most Pakistanis are completely unaware about the state, and if given the choice might discard it as a mere luxury whereas many brush the topic under the carpet. Ignorance about mental illnesses is highly rampant in rural society of Pakistan, whereas in most cases, the urban society reacts with a general indifference towards it.

Mental illnesses may vary from common depression and anxiety to severe personality and dissociative disorders. However, WHO has described depression as one of the major causes of death through out the world in general and in the developing nations in particular.

In Pakistan, depression and anxiety are common psychiatric disorders and if not treated on time, turn into other severe problems leading to a dysfunctional personal/social life. However, this is a subject many do not want to talk about, so strong is the stigma attached to it. Yet it has relevance for the lives of a large number of people.

Research shows that nearly 10 per cent of the population suffers from mental illness at one stage or another in life. Given the insecurity and conflict that grip Pakistan today, it is likely that the 'burden of mental disorders', to use the World Health Organisation's terminology, is greater in the country than is believed to be.

What further aggravates the situation is the marginalization of this vulnerable group in terms of development aid and government attention. Pakistan lacks appropriate policies and programs to address the problem, which results in less or no intervention for mental, physical, institutional and personal health of the sufferers.

The social stigma attached to mental health is another area which needs serious consideration. Given the somewhat conservative nature of a Pakistani society, mental health is something which largely goes unnoticed or is linked to possession of djinns within more conservative fractions. In case of female patients, mental illnesses are often misunderstood as some kind of a 'social drama' to collect sympathy or even as an indirect signal from the woman to be married at once. These complications on social level make it difficult to diagnose the problem, let alone cure it.

Healthcare is the basic right of a citizen anywhere in the world. In developed countries, human rights dimension is an important aspect of mental illness. Intervened by the state, this dimension is considered with a delicate balance where both the sufferer and the society at large are encouraged to take at face value the problem, supported by social and health groups, peer company, special health programs at hospitals, through community welfare and other volunteer groups. The basic aim of all these is to help the distressed and integrate them into the society so that they do not feel left out. This support structure on social and state level encourages the individual to fight the illness with vigor and integrates them well into the society. Many developed nations, therefore successfully strike a balance between rights of a person who suffers from a mental disorder and is not well enough to take care of himself and the rights of a community which may become vulnerable to violence or violation of its dignity by

the presence in its midst of a person suffering from a mental disorder.

Unfortunately this doesn't hold true for Pakistan. Since policymakers and people generally had no understanding of the significance of this aspect of mental illness, Pakistan remained saddled with an obsolete law, the Lunacy Act of 1912, for 54 years after independence.

This law betrayed a total lack of understanding of mental illness. Patients were not perceived as having any rights. If they were prone to violence, they were treated as criminals and locked up in prisons in what were derogatively termed 'charya (fool) wards'. An attempt to commit suicide was considered a crime and could land an ill person in jail.

Fortunately and mercifully though, the government was prompted to promulgate the Mental Health Ordinance (MHO) in February 2001. The MHO brought the definition and treatment of mental illness at par with current understanding and practice of mental health care. However, nine years after its promulgation, MHO remains a dead letter.

Its implementation could ensure that persons with mental illness or developmental delays are accorded their civil, legal and human rights.

With the absence of an active law on mental health in Pakistan, persons with mental illness are routinely abused in the name of treatment, e.g. chained at mazaars, chained to bed in a treatment facility or given electric shock treatment without anesthesia. Their families may abandon them and/or may confiscate their assets/property by claiming their mental illness. The treatment gets worse with prisoners with mental illness who are housed along with other inmates instead of being treated/rehabilitated.

Pakistan needs to address the problem at a quick pace. Reaching out at the grass root level through community outreach programs can be effective initially. However, in the long run there is an urgent need to make people in general and the opinion leaders in particular to understand that mental illness is curable and that a mentally ill person can lead a healthy life, one free from being a social outcast. It is time that the issue of mental health in Pakistan does not remain shrouded in privacy and instead gathers stakeholders who are willing to champion the cause.

The writer contributes articles on social and health issues to various publications.
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Publication:South Asia
Geographic Code:9PAKI
Date:Oct 31, 2010
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