A stigmatised section

October 10, 2010


OCT 10 is designated as World Mental Health Day. The objective is to raise public awareness about mental health issues and to promote open discussions on mental disorders and treatment.

It is well recognised that people with mental disorders are stigmatised and often subjected to neglect and abuse. To mark the day this year, the World Health Organisation has released a document mhGAP (mental health Gap Action Programme) that focuses on the gap between what is needed to treat common mental disorders and what is available.

It is estimated that 75 per cent of those suffering from mental disorders in low- and middle-income countries do not receive the necessary treatment. Around 70 per cent of Pakistan's population lives in rural areas where there is hardly any mental health service. Millions of people suffering from mental disorders are deprived of the necessary treatment and care. Across the world, every 40 seconds a person (usually young) commits suicide. The latter is preventable only if common mental disorders are treated in time.

In addition to this huge burden, it is reported that the number of cases linked to mental disorders tends to double during emergencies as in the case of the floods. Currently, there are growing concerns about widespread infections, poor sanitation and child safety issues in IDP camps. Physical and mental health is intertwined. There is a real need to deal with the mental health problems of people which will then improve general health conditions.

The lack of tangible improvement in mental healthcare should be viewed in the context of the overall state of health in our country. Lack of political will and a dearth of resources might well be used to justify the existing state of affairs. But mental health professionals are collectively responsible for breaching service development. After the earthquake in 2005, the Lancet reported a severe shortage of psychiatrists in Pakistan. This was not the only problem. Despite good intentions, there was no coordinated effort at a national level, made worse by the lack of capacity, to use available funds effectively. Since then, many conferences have been held in the name of psycho-social services after traumatic events where all eminent psychiatrists would participate.

Despite all the money spent on these events, the severe shortcomings in service provision have not been addressed. Bold and practical recommendations are often missing from our endeavours. A strategy to monitor progress and evolve corrective courses of action in such moots would be more helpful.

Our failures far outweigh any success. The national mental health programme was launched in 1986 which brought academic laurels. Unfortunately, a quarter of a century later, mental health has yet to be integrated with primary healthcare. An editorial in Dawn some time ago pointed out that instead of the health minister briefing parliament on the number of suicide cases, it was the federal minister for human rights who did so.

The Mental Health Ordinance was promulgated in 2001. It is yet another example of our professional insensitivity that there has been absolutely no implementation of this so far. Except for an occasional mention here and there in the press, the matter is hardly ever discussed in a professional forum.

As for developing manpower resource, around 200 psychiatrists have been trained in the last decade. Although this number is increasing and far more qualified doctors are opting for this branch of medicine, it is simply not enough to meet the needs. Recently, the web resource Medscape reported that the US still faces a severe lack of psychiatric care resources and that the country is short of 45,000 psychiatrists . The main measure of the progress of any healthcare system lies in the ability to conduct and publish new research. On PubMed , the main digital library for medical research, there are just over 200 citations for psychiatry in Pakistan whereas there are more than 1,400 for India and about 12,000 for the UK.

Writer Mohsin Hamid believes that Pakistan's enemy is within — our own hypocrisy — “so rampant that one would think it's a state-sponsored ideology”. As for other institutions, it might also be true for the Pakistan Psychiatric Society. The latter holds elections every year with a vague and undefined mandate. Other than temporary prominence, the elected leaders do not enunciate well-defined programmes for improving services. The training programmes lack objectivity. No doubt, there is a dearth of trainers but even existing resources are not adequately utilised.

A small group of custodians runs highly personalised training programmes without exposure to the needed experience. Unfortunately, the trainers end up assessing their own wards during examinations, clearly depriving themselves of impartial assessment of professional prowess. The malady of professional inadequacy allows easy exploitation by the pharmaceutical industry. Research that is a result of sustained inquiry, thorough application, knowledge and honest data collection is manipulated by the industry.

The entire issue of training and attitude of the profession needs to be revisited on this day for the future healthcare of the population. We must search our souls and resolve to develop healthcare in this area. Our challenges are clearly outlined. We need to get together and integrate mental health with primary healthcare. Getting more psychiatrists is not enough; we need scientifically and ethically trained leaders. We need to implement the Mental Health Ordinance. For now, we must respond urgently and focus on having mental health services in flood-affected regions.

The writer is associate professor of psychiatry at the Rawalpindi Medical College.