By Fizza Haider Zaidi
According to World Health Organization, mental disorders in Pakistan account for more than 4% of total disease burden and around 24 million people need psychiatric assistance. These statistics herald a mental health emergency in the country especially when there is just 1 psychiatrist available per 10,000 people with mental disorders.
This article briefly reviews some aspects of provincial mental health acts and gaps/issues in the mental health system in Pakistan. This is discussed in the advent of recent incidents that occurred because of underlying mental health issue or cases where the victims are vulnerable to developing one after experiencing something traumatic in their lives.
To quantify the scale of the mental health problem, suicide has become a global epidemic that costs a life every 40 seconds worldwide. A study published in 2018 identified depressive disorders to be the third leading contributor to overall mental health issues in global burden of disease in East Mediterranean region only. The situation is equally grave in Pakistan with estimated suicide rate of 2.9/100,000 in 2016 (WHO statistics). The prevalence of mental health issues is high among young adults especially students, mainly due to family and societal pressures.
Reviewing the relevant laws and policies, the provincial mental health acts in Pakistan state that in case of failed suicide attempt, the individual is required to undergo psychiatric assessment. However, according to Section 352 of Pakistan Penal Code (PPC), suicide is still considered a criminal offense with a punishment of one-year jail time and/or PKR 10,000 fine. A bill tabled in Senate last year tried to decriminalize suicide attempt but it was deferred on religious grounds. By law, attempted suicide cases need to be reviewed by medico-legal centers (MLCs). However, due to embarrassment, fear of harassment and stigmatization, most people do consider approaching MLCs.
According to WHO-AIMS report in collaboration with the Ministry of Health (2009), number of psychiatrists and psychologists in Pakistan was 0.2 and 0.28/10,000 persons respectively with only 1% of psychiatrists and psychosocial professionals available specifically for addressing child mental health issues. These numbers are alarming especially with need to deal with increased cases of child sexual abuse and incidents involving pedophiles in the country. The horrific incidents of child abuse and murder in Kasur are ugly manifestation of the problem. There are many other victims and survivors of such heinous acts and their families who suffer from physical and emotional trauma.
Unfortunately, the provincial mental health acts do not specify the basic rights and provision of services for vulnerable groups including children. In some cases, even if psychiatric assistance is sought, there is discrimination on basis of gender, religion, culture or caste and there is no authority to ensure that such people get the penalty stated in the law commensurate with the crime committed.
Another pressing issue in Pakistan is the rise in incidents of violence including domestic violence, emotional or psychological abuse, and widespread physical abuse. A recent study reveals stark figures related to child abuse among students of a university in Punjab. It showed a higher percentage of male students being the victim of all kinds of abuse as compared to females (physical abuse 68% males, 46% females; emotional abuse 53% males, 54% females; sexual abuse 44% males, 39% females). Even more discouraging were the results of an anonymous online Survey (2018) conducted by Dawn, where most people considered stigma and lack of social support as barriers for seeking professional help in case of psychological trauma. Moreover, it was also reported that psychiatric/psychological help is both inaccessible and unaffordable.
These findings indicate a dire need to reform mental health system in Pakistan. While some changes may take time to implement, desperate times require for desperate measures and prioritization by the federal and provincial governments and respective institutions. To begin with, there is a need to decriminalize suicide, conduct awareness campaigns/conferences and organize free camps to reduce stigma and enhance social support. Moreover, more research needs to be conducted to have more reliable national statistics related to mental health disorders and related issues.
Mental health services can be made more accessible through free helplines and provision of tele mental health services using internet for screening, treatment and counselling for prevention of mental health disorders. Mobile community mental health teams can also be trained to cater the mental health needs of the community especially in the remote areas. Lastly, psychological first aid training can be given to ancillary staff like nurses, speech and occupational therapists, and lady health workers. In addition, by adopting “train the trainer” model to train internees and fresh graduates in the field, the dearth of psychiatrists/ clinical psychologists in Pakistan can be overcome to some extent.
The author has M.S in Clinical Psychology and has research interest and work experience focusing on autism. She is currently serving as a Clinical Supervisor/ Psychologist in Islamabad.
The Sindh Mental Health Act (2013); The Punjab Mental Health Act (2014); The Khyber Pakhtunkhwa Mental Health Act (2017)
GBD East Mediterranean Region Mental Health Collaborators. (2018). The burden of mental disorders in the Eastern Mediterranean region, 1990–2015: Findings from the global burden of disease 2015 study. International Journal of Public Health, 63(1), 25-37. doi: 10.1007/s00038-017-1006-1
WHO-AIMS report on Mental Health System in Pakistan.
Abbas, A. S., & Jabeen, T. (2019). Prevalence of Child Abuse Among the University Students: A Retrospective Cross-Sectional Study in University of the Punjab, Pakistan. International Quarterly of Community Health Education.