Mental health services

Published September 24, 2022

LAST December, the National Commission for Human Rights (NCHR) received a complaint that 35-year-old Rukhsana (not her real name), who was working for an MNC, was being illegally detained at an inpatient psychiatric institution in Islamabad. Investigations revealed that the institution was not registered with the relevant authorities and didn’t employ qualified mental health professionals. It was later established that Rukhsana had been ‘admitted’ upon the instructions of her mother who wanted her to agree to an arranged marriage.

This case is a glaring example of how lack of regulation of mental health services is damaging Pakistanis’ human rights. While psychiatrists are required to register with the Pakistan Medical Council, no government institution licenses clinical psychologists and mental health counsellors. Even with valid credentials, there must be oversight and processes to ensure professionals are operating ethically. In developed countries, this is the role of regulatory bodies. Although each province has created its own regulatory bodies post 18th Amendment, they remain only partially active. Inappro­priate healthcare services may further harm the patient or compromise their rights.

Last month, the NCHR and Taskeen Health Initiative launched a report that revealed the experiences of users of mental health services. Zaibunnisa (not her real name) stated: “I have witnessed staff at a mental health clinic physically punishing patients of drug abuse, and the organisation head using the worst kind of language towards patients.” This ‘incarceration’ type mental healthcare is just one example of the ways in which the current system fails those seeking mental health support.

Unlike most countries, Pakistan has no set verification requirements for therapists and psychologists to practise. This implies that they are not legally required to have a minimum level of education or a licence to be able to provide clinical services. Anyone can pose as a psychologist or counsellor to dupe clients and cause further harm. Raheela (not her real name) stated: “Banners outside read ‘child psychologist’, somewhere else on the internet he claims to be a psychiatrist and during the session it was revealed he was a palmist.”

Lack of regulation can further harm a patient.

In addition, provincial mental health regulatory bodies remain either dysfunctional or dormant, preventing checks and balances on mental health services. This results in rampant abuse, especially in in-patient settings and rehabilitation centres. These provincial legislations and regulatory bodies are based on the 2001 Mental Health Ordinance. Additionally, the legislation that these regulatory bodies are based on is the 2001 Mental Health Ordinance, which is over 21 years old and has not been updated in its language, intent, or methodologies, creating an outdated framework for managing mental illness.

Legal loopholes make malpractice and abuse of patients of mental illness inevitable. It includes overprescription by psychiatrists who are financially incentivised by pharmaceutical companies. One woman reported: “She over-drugged me consistently without ever informing me of the side effects of any of the medicines I had been prescribed. When I would get these side effects, I would tell her, and she wouldn’t know and then would say no one else has this problem.” This may also result in jail-like conditions in rehabilitation centres and in-patient facilities where patients are hospitalised indefinitely.

Another person stated: “He asked me to come in weekly, and in those sessions would touch me without consent, as well as vape in his office.”These egregious examples illustrate how vulnerable members of society are exploited and their mental health issues further exacerbated by such experiences.

It may be argued that with the existing stigma against seeking help for mental health problems, raising awareness about malpractice may further dissuade patients from getting the necessary support. However, not highlighting these issues will mean that unethical practices will continue to occur and patient rights will continue to be violated, which will automatically decrease trust in mental health services. Therefore, addressing this issue is the need of the hour.

While there are some mental health professionals and organisations involved in malpractice, there are several who offer good quality mental health support. If you or your loved ones need mental health support, it is important to conduct some background research on providers, confirm their qualifications, and ask for references from people you may know. In addition, there is an urgent need for lawmakers to pass relevant legislation to ensure that all mental health professionals are licensed and that regulatory bodies are activated to perform their due role in safeguarding the rights of individuals with mental illness.

Dr Mekaiel Zia is a health policy and management professional. Dr Taha Sabri is a public health practitioner focusing on mental health and COO, Taskeen.

Published in Dawn, September 24th, 2022

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