Mental health anxieties

October 17, 2019

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THIS year, World Mental Health Day (Oct 10), with the focus on ‘preventing suicides’, received more attention in Pakistan than in the past, and what leading psychiatrists said at various events increased public anxiety at the scale of mental health problems in the country.

A Peshawar gathering was told that over 34 per cent of Pakistanis suffer from anxiety, and that the incidence of mental health problems is increasing day by day. The psychiatrists attending the meeting said the incidence of suicide in KP was increasing, with the highest number of cases being reported from Chitral.

The Punjab health minister told a meeting in Lahore that depression is the root cause of mental disorders and that the trend towards suicide is highly deplorable. At another meeting in Lahore, the audience was told that the number of people suffering from mental illness in Pakistan is increasing, that mental illness is the most common disease in the world, and it could become the number one disease by 2030.

Experts agree that reports on suicides in Pakistan are not reliable.

Perhaps the most meaningful of all events, with focus on the theme of the day — ‘preventing suicides’ — was organised in Karachi by the Pakistan Association for Mental Health. Three detailed presentations on factors contributing to suicides, another three on the sufferings of the survivors (the bereaved families), and the story of efforts to decriminalise taking one’s own life facilitated a comprehensive understanding of suicides in Pakistan.

The struggle to have Section 325 (which says attempting suicide is a criminal offence, punishable with imprisonment) deleted from the Pakistan Penal Code is worth recalling. In 2017, a bill was moved in the Senate for omitting Section 325 from the PPC. The reason offered was that suicide indicated an extreme form of depression, and that those who attempted but failed to take their own lives deserved treatment and not punishment. The bill was adopted by the Senate but it lapsed as it was not passed by the National Assembly before it was dissolved. There was near-consensus among the audience on the renewal of efforts to decriminalise suicide attempts. In view of the resistance from the conservative lobby the passage of a new bill may not be easy but the attempt to push it through should still be in order.

The experts found that 71 per cent of the people who decided to end their lives suffered from depression, 12pc from anxiety, 11pc from behavioural problems, 2pc from bereavement, another 2pc from eating disorders, 1pc had suffered sexual abuse, while 1pc of the cases could not be diagnosed. Since all of these risk factors are increasing in Pakistan and threats to security of life are growing, the rate of suicide is bound to rise.

According to a 2018 report by WHO, the suicide mortality rate (that is, suicides per 100,000 deaths) in Pakistan in 2016 was 2.9, while it was 16.3 in India, 15.3 in the US, 15.6 in Austria, 12.5 in Canada, 12.8 in Denmark, 15.9 in Finland, 17.7 in France, 13.6 in Germany, 16.5 in Japan, 11.6 in South Africa, 8.9 in the UK, and 26.9 in South Korea. This reveals among other things a more factual reporting of suicides by developed countries than by developing states.

Experts agree that reports on suicides in Pakistan are not reliable; on the one hand, suicides are underreported, and on the other, many murders, especially of women, are wrongfully put down as suicides. Even then, the latest figure for the suicide rate in Pakistan is 7.5, more than twice the 2016 figure, and the conclusion is obvious.

The whole world realises that suicide can be prevented. Awareness of the need to adopt preventive measures too is growing. Describing suicide prevention as a global imperative, the WHO member states in 2013 committed themselves to reducing suicide rates by 10pc by 2020. While drawing up the Sustainable Development Goals, the United Nations perhaps chose to be realistic and only called for the promotion of mental health as one of the targets to be achieved under SDG 3 to ensure healthy lives and promote well-being for all.

SDG 3, even with a vague target with respect to mental health, poses a daunting challenge to Pakistan. With its total allocation of less than 1pc of GDP for health, and mental health receiving a tiny bit of this allocation, the prospects for a significant improvement in mental health care are quite bleak.

Unfortunately, the realisation of the SDGs has become uncertain at the global level because of resource constraints. The latest studies say that the annual shortfall in funds needed for the SDGs the world over is estimated at $2.6 trillion. In view of the acute economic crises it faces, and its long tradition of giving health low priority, the government of Pakistan is unlikely to be able to seriously address mental health issues.

Under these circumstances, the organisations of psychiatrists in the country and their allies in civil society will have to seek increasing support from philanthropic associations and public-spirited citizens to raise the level of mental health in the country. They will also be required to address, in addition to arranging for treatment of mental disorders, the factors that contribute to these illnesses, including the signs of a death wish.

Considerable help can be received from the research done in various parts of the world on the specific causes of mental illnesses that include poverty, unemployment, feeling of social failure, poor nutrition, the plight of abandoned children, reliance on witchcraft or religiously inspired ‘exorcism’ of ‘evil spirits’, the stigmatising of mental illness, exposure to violence at workplace (sexual harassment, bullying, rude behaviour, physical or even verbal aggression and threats to one’s physical/ mental integrity), and the alienation of members of a family from one another.

The level of mental health should improve if we start caring for every other human being and don’t leave him or her to drift from frustration to mental illness.

Published in Dawn, October 17th, 2019