PAKISTAN: Millions lack access to mental healthcare

Photo: David Swanson/IRIN

Mental health issues are largely kept under wraps given the stigma associated with it

LAHORE, 8 November 2007 (IRIN) - There are no exact numbers for the mentally ill in Pakistan, due largely to the associated stigma, but some estimates put the figure at more than 14 million people, out of a population of some 160 million.

Speaking at a seminar to mark World Health Day in October, Ijaz Haider, of the Allama Iqbal Medical College in Lahore, reported that “mental problems had increased from 6 percent to 9 percent in the population in the past decade”.

And while comparisons with other countries are difficult as no official reports are made to the World Health Organization, Syed Haroon Ahmed, of the Karachi-based Pakistan Association for Mental Health (PAMH), told IRIN: “Rates of mental illness in Pakistan are higher than in many other developing countries because of the uncertainty and insecurity here.”

This view was confirmed by Riaz Bhatti, head of the department of psychiatry at the King Edward Medical University in Lahore, who said there had been a 10 to 15 percent increase in psychiatric patients since the latest wave of political instability after emergency rule was introduced last week.

According to Lahore’s University of Health Sciences Vice-Chancellor Malik Hussain Mubashir, there is only one psychiatrist for every 10,000 people in Pakistan, one child psychiatrist for four million children estimated to be suffering mental-health issues and only four major psychiatric hospitals and 20 such units attached to teaching hospitals.

Many people, most particularly in rural areas, still believe mental ill-health is caused by 'evil spirits' entering the body of a person.

Superstition

Many people know little about mental disease or its treatment and as a result thousands still turn to "holy men" (pirs) for treatment.

"Many people, most particularly in rural areas, still believe mental ill-health is caused by 'evil spirits' entering the body of a person. This kind of superstition makes it crucial that awareness and sensitivity be created," said Amina Owais, 40, a social worker who has been engaged for the past decade in welfare work in the Multan area in the southern Punjab.

In addition, the Mental Health Ordinance, introduced in 2001 to replace the Lunacy Act of 1912, remains poorly implemented, say specialists.

The ordinance attempted to introduce more enlightened psychiatric care, particularly in state-run institutions, and laid down rules to prevent the mistreatment of patients.

But little has come of it. Even at leading institutes for mental health, there are continued reports of patient mistreatment or a failure to provide adequate care.

Efforts by various expert groups, including the PAMH, set up in 1970, to improve care for the mentally ill have continued.

"There has been slow progress," concedes Syed Haroon Ahmed, one of Pakistan's leading psychiatrists and founder of the PAMH, who, like many other specialists in the country, believes more needs to be done.

The government's Director-General of Health, Aslam Chaudhry, accepts that mental health should be on the government's agenda.

Photo: Kamila Hyat/IRIN

Socio-economic factors have contributed to both an increase in mental illness and an inability to find expert help. Over 70 percent of the country's population lives on less than US$2 per day

Suicide rate increasing

PAMH has reported that up to 44 percent of people, the majority women, were clinically depressed due largely to their marginalised status in society. Estimates are based on patients treated by PAMH and research into mental-health issues.

PAMH believes socio-economic factors are responsible for this, while the high rate of suicide, with 1,717 people taking their lives in 2006 alone, according to figures compiled by the Human Rights Commission of Pakistan, provides evidence of the extent of depression and desperation.

PAMH attributes the high rate of suicide in part to growing mental-health issues.

A paper in the Journal of the Pakistan Medical Association in 2006, by Murad Khan of the Aga Khan University in Karachi, confirms that suicide has become a major public health problem in Pakistan over the past few years.

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