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Mental health crisis

February 17, 2019

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The writer is a Sitar-i-Imtiaz- and Hilal-i-Imtiaz-decorated emeritus professor of psychiatry.
The writer is a Sitar-i-Imtiaz- and Hilal-i-Imtiaz-decorated emeritus professor of psychiatry.

ACCORDING to the World Health Organisation, one in four individuals suffers from mental illnesses or disorders. By 2020, depression will become one of the leading causes of death across the globe.

This may be surprising for a layperson, but for those who have been paying attention, there are no revelations in this data. At present, psychiatric diseases and behavioural disorders constitute over 40 per cent of the global disease burden. This high number has resulted in international movements for treatment and protection of those with mental illness.

Mental illnesses include many disorders such as schizophrenia, psychosis, bipolar disorder, post-traumatic stress disorder, eating disorders such as anorexia and bulimia, anxiety, depression, neurosis. There are many other sinister disorders and diseases of the mind. To not recognise their threat as a national health concern will be a monumental failure. While we think of lifestyle-related illness such as diabetes, heart disease and cancer as the leading causes of mortality, we forget that mental disorders are, in fact, far more common than the aforementioned maladies.

Mental illness is more common than cancer, diabetes or heart disease.

Unfortunately, while a faulty heart or a failing kidney is not ignored, signs and symptoms of mental disorders are grossly neglected through their non-detection, misdiagnosis and inappropriate treatments. In typical cases, the symptoms are non-physical and hence unclear for immediate detection or treatment. As a result, more serious psychiatric cases are ignored or dealt with using measures that worsen the patients’ mental condition.

But the effects of such neglect do not end there. The stigma associated with these illnesses has never really been addressed. In recent years, there has been growing awareness and treatment for mental illness around the world. Our country, however, fails to meet the universal standards of treatment and protection appropriate for such mentally ill individuals. What follows for such a mentally ill patient raises bigger concerns.

Since many a time such patients are accused of or involuntarily involved in activities that may be criminal, such individuals are often placed at the mercy of those within the criminal justice system. According to official figures, approximately 188 recognised mentally ill prisoners are locked up in Punjab’s prisons alone. Meanwhile, with 4,688 prisoners currently on death row, it is unclear how many of them are mentally ill or have become so living under horrid, overpopulated prison conditions.

Reportedly, 10pc to 16pc of Pakistan’s population — ie more than 14 million people — suffer from mild to moderate psychiatric illness. This epidemic was once highlighted in the 1998 National Health Policy where it was placed as a component of comprehensive primary healthcare under the umbrella of ‘health for all’. However, following the ouster of the elected civilian government in 1999, a new health policy was enacted in 2001. This policy made selective primary healthcare and donor dependence for additional resources as its prime focus, and placed mental health issues at the bottom of national health priorities.

It is no wonder then that Pakistan has approximately only one psychiatrist for every 10,000 persons suffering from mental disorders, one child psychiatrist for every 4m children suffering from mental health issues, and only four major psychiatric hospitals for the entire population. These shockingly low statistics contribute to the rise in the number of mentally ill patients.

The Punjab Institute of Mental Health is one of those rare dedicated government hospitals. But, disturbingly, the Punjab Health Department now wants to attach the PIMH to the Services Institute of Medical Sciences. The obvious problem with this is losing the opportunity to make the PIMH a teaching hospital. We are in desperate need of more psychiatrists, yet, without a teaching hospital, this number cannot be radically increased.

The second problem is, again, one of placing mental health on the backburner. If there are dedicated government hospitals for heart, kidney, and liver diseases, then why not maintain at least one dedicated to mental health? Is even one dedicated hospital too much to ask for?

The third problem is expertise. Should a hospital, where many patients are unfortunately violent and unpredictable, be placed under the supervision of a doctor who supervises in surgery? Would such an arrangement be acceptable anywhere in the world?

The PIMH issue is, sadly, just one of the myriad ones that the mental health sector faces. Mental illnesses are caused by a combination of genetic, biological, psychological and environmental factors. It is incumbent to adopt and implement measures and interventions for prevention of such illnesses in order to avoid problems caused by a lack of awareness and support.

The writer is a Sitar-i-Imtiaz- and Hilal-i-Imtiaz-decorated emeritus professor of psychiatry.

Published in Dawn, February 17th, 2019