THIS is apropos your editorial ‘Mental health helpline’ (May 18). While the setting up of a helpline is a positive step, a helpline should be part of an integrated programme that should include a referral system and access to affordable mental health services.

The present coronavirus pandemic has cruelly exposed the criminal neglect of our health sector. Pakistan does not have an effective integrated health system but instead a mishmash of private, government and philanthropic health facilities, all working in silos.

We do not have a public-funded, primary healthcare system — the backbone of any effective health system where 70 to 80 per cent of health problems can be managed effectively.

The mental health situation is more dire. While prevalence rates for all mental disorders are very high in Pakistan, human and fiscal resources to address them are severely lacking. Mental health is neglected at all levels — from teaching and examining in medical colleges to integration in primary healthcare to policy-making.

There is no separate budget for mental health in the government’s annual budget. It is against this background that the mental health issues of the present pandemic need to be seen. Like in the past major disasters like the 2005 earthquake, when scores of mental health initiatives were launched only to fold up within a few weeks, the present pandemic has led to scores of helplines.

There is no monitoring or regulation of these helplines, no coordination and no quality control. And like in the earthquake in 2005, they will all disappear as soon as the situation eases off.

At the very least the provincial mental health authorities of all provinces should take on the responsibility of leading the mental health response to the pandemic. At least two provinces — Sindh and Punjab — have passed bills and established mental health authorities. The mental health authorities not only have the legal mandate but also access to provincial funds.

There is a need to develop an overarching strategy, which should include provision of clinical services, training, supervision and research. There is need for coordination of different activities by public, private and NGO/philanthropic organisations.

A communications strategy including public health messaging, needs to be developed. Some NGOs are doing excellent work in this connection and can be brought under the mental health strategy.

Vertical programme like the WHO Pakistan office and PPS are trying to promote should be discouraged.

Such an integrated approach would not only strengthen the provincial mental health authorities and establish their authority and credibility but hopefully also lead to laying the foundations of the long needed integrated mental health programme in the provinces.

Prof Murad M Khan

Karachi

Published in Dawn, June 7th, 2020