THE WHO’s theme for this year’s World Mental Health Day is a call to invest more in mental health. This means not only training human resource to provide effective, affordable, timely and sensitive treatment, but also promoting mental health and preventing circumstances that can adversely affect it.
Social justice is pivotal to preventing such circumstances. There is strong global evidence of conflict, violence, childhood adversities. gender, class and racial discrimination, and poverty contributing to the rise of mental illness. There is also recognition of how factors such as working and living conditions contribute to it, besides individuals’ ability to manage and regulate their own emotions and deal with stressors.
A piece in Dawn.com, Pakistan’s Silent Suicide Problem, highlights the possible role of toxic family, social and financial pressures, gender expectations, sexual identity, bullying and child abuse in suicide. Public mental health activists such as Dr Vikram Patel stress the importance of addressing the social, structural determinants and root causes for the prevention of mental illnesses. There is evidence of increased well-being and lower suicide rates among females in countries such as China when living and economic situations are improved and gender equality issues addressed. It is acknowledged that when people are free from fear of violence or do not have to worry about daily survival, they will have better mental health.
Just a few recent examples are enough to highlight the dismal state of social justice in the country. When katchi abadis are demolished as part of anti-encroachment drives, but properties of the influential are legalised, or when terrorists like Ehsanullah Ehsan make their way to freedom there remains little faith in the justice system. Rights violations generate lack of trust and hope among the less-privileged sections.
Mental health should also be viewed as a human rights concern.
When the family of those languishing in jails without proper trial, or killed extrajudicially or disappeared, wait endlessly for justice, there is bound to be a devastating mental health impact. When there are delays and insensitivity in handling crimes of sexual violence or when victims of domestic violence don’t receive support, incidents of girls and women being killed or committing suicide won’t stop. Increased reporting of sexual crimes often results in populist measures with far less discourse or affirmative action to actually empower children and women or address power and gender dynamics and improve investment in the justice and response mechanisms.
Some reflections are due after working on mental health and gender-based violence in Pakistan for 20 years. There appears to be a lack of commitment and investment, the demand for quick results, apprehensions and preconceived notions about what may happen if women and children start becoming aware of and demanding their rights. These are possible barriers to doing preventive work at the institutional level.
Families are more comfortable addressing emotional difficulties faced by an individual as that person’s own shortcomings and weaknesses and less open to the possible impact of social and gendered expectations. The 2013-2020 Mental Health Action Plan passed at the 66th World Health Assembly urges member states to take stronger and more effective measures to uphold their human rights commitments, address violations and undertake a multisectoral approach to promoting mental health. And yet, public health spending in this country continues to remain low.
It is estimated that more than 75 per cent of people in low- and middle-income countries do not receive any treatment for conditions that are treatable. Factors such as the dearth of mental health services, lack of access, affordability and taboos on seeking mental health treatment contribute to this challenge.
While a lot should be rightfully demanded in terms of more investment in affordable, accessible mental healthcare and availability of trained health professionals, let us also demand more vociferously the need for structural changes in how we address poverty, discrimination, violence and the incidents of child abuse, rape, domestic violence, and enforced disappearances.
As a way forward, there needs to be a shift in our view of mental illnesses from a pure biomedical model to one that emphasises the psychosocial perspective. While this shift may have started to happen in Pakistan, it is neither visible enough nor has it led to more mental health professionals advocating for improved poverty, gender equality, and human rights.
Another aspect to consider going forward would be to view mental health not only as a public health agenda but also as a human rights concern to be equally owned and advocated by the human rights, social welfare and education departments as well as poverty reduction schemes.
The writer is a clinical psychologist.
Published in Dawn, October 13th, 2020