THIS year, World Mental Health Day, that will be observed on Oct 10, is dedicated to ‘Young people and mental health in a changing world’. Young people include adolescents aged 10 to 19 years. This is a critical period for psychological development as individuals mature towards adulthood, evolve in their identity and assume more autonomous social roles. Across Pakistan’s social classes this is also a time when life situations are in transition, from villages to cities, homes to hostels, or from giving up education to looking for livelihood. The proliferation of digital technology is an additional psychosocial challenge that can work to the detriment of traditional social networks, sense of identity, and self-esteem.
With a staggering population growth rate of 2.4 per cent, Pakistan has the second-largest young population in the world. Every fourth Pakistani today is between the ages of 10 and 19 years. Pakistan’s National Human Development Report, 2018, defines the youth as a critical force “which will prove to be either a dividend or a disaster” for the country. Clearly, this human force needs to be in a state of well-being in which they realise their potential; can cope with the normal stresses of life; can work productively; and are able to make meaningful contributions to their community. This is also how WHO defines ‘mental health’.
Mental health and socio-cultural challenges are closely related and must be examined within our specific local context. A quarter of Pakistanis today live below the poverty line; 45 per cent of Pakistani children suffer from stunted growth as a result of malnutrition; over 22 million children do not go to school; approximately 8m children even under the age of 14 are employed as labourers. Adolescent mental health needs are known to intensify in humanitarian and fragile-state settings. Pakistan qualifies for both categories. Like elsewhere in South Asia, young Pakistanis are compelled to take on adult responsibilities, including dropping out of school, seeking work opportunities, and caring for their families to meet basic survival needs, before they reach adulthood.
Adolescent mental health needs are known to intensify in humanitarian and fragile-state settings.
For those still in school, there is little awareness about emotional development, or the costs of abrasive methods of disciplining that are commonly employed. Despite a 2013 bill passed by the National Assembly to prohibit corporal punishment of children in educational institutions, this misguided and damaging practice continues. Earlier this year, the Lahore High Court ordered a ban on corporal and other punishments meted out to students in government and private schools. Similarly, there are major concerns about the treatment of children and adolescents enrolled in unregistered madressahs, estimated to be 40,000 in number, across Pakistan. From a clinical standpoint, the abuse of children, which ranges from the physical, emotional and sexual, is highly prevalent in these institutions. When it comes to abuse, young girls are even more disadvantaged; despite existing legislation, one in three girls is still married off before reaching the age of 18. High rates of domestic violence and pregnancy-related health complications are frequently reported. Teenage girls are more likely to die from complications during childbirth than older women.
Not only is adolescence a period of life when young people are particularly vulnerable to certain health issues, it is also a time when critical behaviours are shaped in ways that irreversibly affect long-term health. These may include unhealthy eating habits, physical inactivity, unsafe sexual practices and drug use. Drug use among 15- to 19-year-olds is a global concern. Pakistan is one of 15 countries worldwide with a heavy burden of tobacco-related ill health. It is estimated that over 10 per cent of Pakistan’s youth use tobacco or a tobacco products. Unofficial reports also indicate a steep escalation in the use of marijuana, alcohol and opioids among young Pakistanis. It is known that ‘every drug is a gateway drug if used during adolescence’ because the brain is still developing and there is a heightened risk of addiction.
Only 6pc of young Pakistanis today acquire more than 12 years of education. On university campuses, awareness about mental health needs is virtually nonexistent. Students are exposed to challenges like academic pressures, a widespread culture of drug use, and sexual harassment. Last week, there were violent clashes between students at Peshawar University and the police resulting in serious injuries. Violence on campuses is neither rare nor can be seen in isolation of a larger social context. The tendency to resort to violence and the consequences of such hostility are associated with grave psychological implications. Once incriminated, young people in Pakistan experience a discriminatory and persecuting juvenile justice system where they are exposed to further violence, abuse and drugs rather than remedial courses of action.
A little known fact is that half of all mental illness begins in adolescence, and most cases go undetected and untreated because neither parents nor teachers are able to recognise common signs and symptoms. Pakistan must have a remedy for this. Depression is the third leading cause of illness and disability among adolescents, and suicide is the third leading cause of death in older adolescents between the ages of 15 and 19. Back in 2012, this newspaper reported an “alarming rise of teenage suicides in Pakistan”. Since then, reports of young people killing themselves have only escalated. Self-harm or attempted suicides are at least 10 to 20 times higher than the number of actual suicides, which means there is room for intervention. We must also recognise how socioeconomic adversity, insecurity and violence, academic and livelihood pressures, and abuse in various forms contribute to mental disorders.
Some strategies that can preserve and protect the mental well-being of young people include promoting healthy behaviours; imparting positive attitudes including tolerance; stress-coping strategies to build resilience; developing life skills curricula; raising awareness about mental health issues on campuses; and training parents and teachers to recognise the early signs of mental disorders.
Effective programmes for controlling drug use and counselling services to help manage stress would greatly help young Pakistanis trying to navigate daily social and urban challenges. The government needs to integrate social, health and education sectors to implement evidence-based programmes for young mental health.
The writer is a consultant psychiatrist.
Published in Dawn, October 8th, 2018