Dhaka, Bangladesh
Neglected subject

Neglected subject

By Rukhsana Shah

RE­­POR­TEDLY, there are about 35 million to 50m people in Pakistan suffering from mental illnesses and disorders. There are only 400 psychiatrists in the country and the government's spending on mental health was only 0.4 per cent of the shamefully low health budget. It is not surprising that there should be such large numbers of people with mental health problems in the country, given the increasing insecurity, terrorism and violence in society, and because common mental disorders are left unrecognised, undiagnosed and untreated. Apart from the financial implications of this burgeoning public health problem, what is more frightening is our complete lack of capacity and human resources at the institutional level to address it. In 2009, a WHO-AIMS report on mental health systems in Pakistan had pointed out this gap: out of the number of professionals who had graduated in 2008, there were only 0.002 psychiatrists, 0.07 psychologists, 0.008 nurses, 0.005 social workers, and 0.002 occupational therapists per 100,000 persons in the country. On average, there is one psychiatrist for half a million people in Pakistan but because of demographic disparities, there may be none for millions of people in far-flung areas. Mental illness is an extremely neglected subject as far as legislation, policymaking and institutional infrastructure are concerned. Although mental health laws have been passed in both Sindh and Punjab, no visible steps have been taken by the respective governments to put in place an overarching framework of mental health education that can facilitate policy formulation and planning. There exists no comprehensive mental healthcare system in Pakistan today. A national mental health policy was developed by the health ministry in 1997 that can perhaps be used as a template. The dynamics of mental health policy formulation are cross-sectoral and wide-ranging: from assessing existing psychiatric and rehab facilities, to defining indicators and gathering data on different mental health morbidities, creating awareness on promotion and prevention and putting strategies in place with defined roles of other departments such as health, education, social welfare, police and local governments, it is a complex and challenging process involving many stakeholders. Mental health sciences must be included in curricula. The bureaucracy simply does not have the capacity to formulate holistic and coherent polices without substantive collaboration with local and international experts, practitioners and WHO. At the same time, the educational environment in higher educational institutions does not provide much space to mental health studies. Teaching of psychology in boys' colleges is rare, while comprehensive courses on mental disorders at medical colleges are absent with few doctors specialising in psychiatry because not much interest is generated in this subject at the graduate level, nor are any incentives offered. There is hardly any research on mental health prevalence and interventions at the postgraduate medical institutions. Standards of teaching at university departments of clinical psychology have actually fallen. The HEC curriculum guidelines for BS and MS in clinical psychology are explicit, but with the current emphasis on research and peer-reviewed publications, teaching hours and internships have been cut down to the detriment of students. A multi-pronged app­­­­roach involving government, professionals and CSOs can do much to ease this national emergency. The Pakistan Psychiatric Society and Pakistan Association of Clinical Psychologists need to meet members of the newly constituted mental health authorities in Sindh and Punjab to initiate immediate action. While a comprehensive mental health policy is ultimately required to deliver integrated and comprehensive community-based services to mental health patients, work must start on developing educational materials for awareness programmes in communities and media, creating a critical mass of trainers and teachers, and sensitising existing healthcare personnel at the district and tehsil levels, including general practitioners, lady health workers, and school health and nutrition supervisors. Provincial education and health departments should incorporate mental health sciences in school and higher educational curricula to recognise and identify common mental disorders which also breed extremism and violence among students. It is the responsibility of the Pakistan Medical & Dental Council and HEC to address the acute shortage of qualified and trained psychiatrists, psychologists, counselors and therapists through incentives, while bar councils must initiate regular mental health legislation workshops for lawyers and jurists.

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