THE theme for this year’s World Mental Health Day, which falls on Monday (Oct 10), is ‘Make mental health and well-being for all a global priority’. For Pakistan, the theme is both pertinent and poignant. One in seven Pakistanis is facing a complex humanitarian catastrophe caused by a pressing climate crisis and the devastation it has unleashed on our political, socioeconomic and healthcare systems. The human cost of the tragedy goes beyond the numbers of lives, homes, schools, acres of agriculture land, roads and bridges destroyed. The consequent rebuilding of lives and villages will be arduous.

Horrifying stories continue to surface. One man saw his child swept away in front of him as he contemplated whether to save the drowning child or his cow that could feed his six remaining children. Babies are starving to death, young children dying of infectious diseases, pregnant women are giving unaided births, women facing harassment and sexual assault, and religious minorities, refugees and those with special needs struggling to get shelter and rations. Even those involved in rescue and relief services are facing mental and physical exhaustion.

Over the past few decades, mental healthcare has come to be considered a critical part of the public health challenges brought on by humanitarian crises. Most countries are working to develop mental health action plans based on scientific evidence that can address the mental health effects of complex emergencies. These countries have learnt lessons from previous crises and developing systems to deliver focused Mental Health and Psychosocial Support (MHPSS) services, when needed.

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The case for advocating MHPSS services by no means implies that all or most people are likely to become unwell following a humanitarian crisis. A vast majority are likely to be resilient and able to deal with the challenges without any symptoms. A significant proportion experience stress-related symptoms and gradually recover with social reconstruction. A vulnerable minority will develop mental disorders; while those already living with mental health conditions tend to suffer a chronic and disabling course. Each of these categories benefit from MHPSS services, starting from integrating humane and empathic care in rescue and relief operations, providing support for the stressed, traumatised and grieving; and treating mental disorders and referring the more severe cases to specialist services.

Mental healthcare has come to be considered a critical part of the public health challenges brought on by humanitarian crises.

According to WHO estimates, one in five (including children) might need mental healthcare in a humanitarian crisis. Preliminary research in Pakistan shows that of the 80 districts most affected by the calamity, 26 (out of 31) in Balochistan, 13 (out of 23) in Sindh, 12 (out of 17) in KP, two (out of three) in Punjab, and two (out of six) in Gilgit-Baltistan do not have a single psychiatrist. So how can MHPSS services be provided given the scale of the calamity in a poor-resource environment?

According to a conceptual framework provided by the World Health Organisation, a community-based plan may be developed where community workers, teachers, youth, healthcare and emergency responders and community leaders can be trained to provide basic support and identify individuals who require mental healthcare. The next level is to train non-specialists including counsellors and primary care staff to provide treatment for common mental health conditions and identify those who need specialist care. The final level consists of treatment for severe mental disorders offered by specialists at the district level or referred to the tertiary care centres, when needed.

Pakistan first started considering MHPSS initiatives after the Army Public School attack in 2014, but lacked a comprehensive plan up until the pandemic when the Ministry of Planning, Development and Special Initiatives developed a MHPSS model, as part of an emergency response during the Covid-19 pandemic. The exclusive mandate of the ministry to identify an overlooked area needing attention and to launch it as a special initiative is a vital opportunity to address the potentially growing national burden of mental health conditions, dearth of specialist resources and multifaceted challenges involved in providing mental healthcare. These challenges include protecting the rights of people with mental disorders, overcoming a crippling data gap, dealing with a lack of scientific interventions adapted to local context, arranging robust multi-sectoral collaboration (eg with PDMAs, ministries, NGOs and community organisations) and linking existing mental health services in an effort to develop meaningful pathways to care.

Under this initiative, the ministry developed an innovative digital model for evidence-driven, multilayered mental healthcare that is both rights-based and scalable, while taking into account local needs and resources. As part of this model, a strong web portal which is the main interface for service users (and which can be easily integrated with a telecom solution to provide a helpline); a Learning Manage­ment System to train specialists, non-specialists, hea­lthcare workers, teachers and community workers; and the three iOS and Android mobile applications (to support community workers, rescue staff and primary care staff) have been developed. These resources are evidence-driven, adapted to the local context, already translated into Urdu and can be further translated into the regional languages. A specialist force comprising 40 mental health specialists have also been trained and can be a valuable resou­rce for providing services in districts without any specialists. This digital plan is designed to collect vi­­tal data, pool mental health resources, provide training and supervision to build the capacity for an effective mental healthcare response, provide and regulate essential services and set up a referral system.

As a first step, the Mental Health Coordination Unit at the Ministry of Planning, Development and Special Initiatives needs to be urgently revived. International donors and humanitarian agencies need to be actively engaged to commit resources. Intersectoral collaboration with relevant stakeholders needs to be immediately organised at the provincial levels. Even then, it will take a few months to identify and build mental health workforces in the affected districts.

Today, Pakistan faces an unprecedented economic and humanitarian crisis. Investment in a cost-effective MHPSS plan can be of immense value. The present calamity is also an opportunity. But are we ready to rise to the challenge?

The writer is a consultant psychiatrist. She has been the national technical adviser for the Ministry of Planning, Development & Special Initiatives.
Twitter:@AsmaHumayun

Published in Dawn, October 8th, 2022