Mental Health: A Pakistani Perspective
By: Rameen Javaid
As humans, we have three fundamental aspects of well-being: the physical, spiritual, and mental aspects. Though most of the time, the physical element seems to dominate our life choices, the other two are equally important in maintaining and achieving complete well-being. Specifically talking about mental health, it has a huge say in how we think, feel, and act. From childhood to adolescence and through adulthood, our mental health determines how we handle stress, relate to others, and make choices. Unfortunately, in Pakistan, the whole debate about the importance of mental health is swept under the rug. Around 14 million people suffer from mild to moderate psychiatric illness in our country, the majority of which are women, and still, mental health remains the most neglected field in the health care system; moreover, these facts and figures don’t include a significant ratio of people who strongly deny the need for psychiatric evaluation and have never seen a psychiatric. Tracing the roots of this worsened situation, we get to look at some policies and legislations that heavily influenced the whole scenario. Till 2001, the Lunacy Act (1912) presided over patients in need of psychiatric attention. The contents of this colonial-era law were even more disturbing than the name. Instead of treatment, the law was more focused on detention, with no concept of consent from the patient and un-informed guardians, the act was a total disaster and hence an updated and sane version of it was needed. In 2001, with the help of the 18th Amendment, Pakistan somehow managed to replace the Lunacy Act of 1912 with the Mental Health Ordinance of 2001. While the new ordinance was better than its 1912 predecessor, poor implementation remains an issue. Since then it has been revised a few times but no efforts are being made in terms of execution and awareness.
Every year on October 10th, the day marked as World Mental Health Day, influencers all around the country flood media with drastic statistics and remind us of the serious challenges faced by Pakistan in terms of Mental Health. And hence every year, the same question is asked, “What is the reason behind this?” The answer is rather complicated and embarrassing to some extent. The more understandable reason is the lack of practitioners and mental health facilities. Anxiety is considered the eighth most common health problem that causes disability among Pakistanis and the irony is that anxiety is a condition that can be dependably diagnosed and treated in primary health care but for that to happen, we need access to skilled and trained practitioners. Giving this kind of care in primary health care seems like a dream when one looks at the shocking ratio of a psychiatrist to a patient. Only around 350 trained psychiatrists practice here which means there is only one psychiatrist available for half-million people. It is saddening to realize that even when patients recognize their symptoms, muster up the courage, overcome the stigma, gain their family’s support and look for help, there isn’t much help to be had. There are currently 18 NGOs working to provide individual support activities such as counseling and support groups, but in comparison to the population of this country, it’s nothing but a drop in the ocean. Along with Alzheimer’s disease and drug overdose, suicide is one of the three leading causes of death all over the world and in Pakistan. Despite increasing numbers, suicide prevention is not a priority in terms of research carried out at the national level. The role of government in this regard is crucial as well, with only 0.4% set aside for mental health from the total budget allocated to health care, how are we supposed to make progress?
Now addressing the reasons which are both disappointing and senseless, stigmas attached to mental health are top of the list. In Pakistani households, discussion about one’s mental state is forbidden, our elders consider that there is no such thing as mental illness or anxiety disorders, they are just the creation of one’s mind. When we deny the existence of something, it is hard to think about its solution. It is also a common belief that a person feels anxious when he takes things too seriously or is ungrateful. Always looking at the negative side and ignoring the positivity or blessings, makes them sad and depressing which is to some extent true, if we keep in mind the excessive usage of social media among our youth, but that still doesn’t justify the ignorance and shameful treatment, people suffering from some mental disorder have to face. On top of that, the thought of being called “abnormal” or “mentally handicapped” keeps people from looking for help. The myths attached to mental disorders are also largely responsible for the current situation. Such as, people with psychosis are scorned as violent, and the concept of being possessed by some evil or external force. A major reason behind this attitude is lack of awareness, seeking professional help for such issues is considered unnecessary and the victim is called ‘melodramatic’ or ‘too sensitive to handle a little inconvenience’.
It wouldn’t be wise to leave out the contribution made by our mass media in terms of stigmatization. Whether it’s newspapers, Television shows, or social media, a mentally disturbed person is either portrayed as a laughing stock or a violent criminal. The most disturbing is the portrayal of mental illness as being untreatable or unrecoverable, depicting that there’s no way for these people to have a normal life. Once in a blue moon, a TV show or drama tries to portray the story of a mentally disturbed person but the poor execution and ignorant writing suck the life out of the whole concept. Instead of spreading awareness, the audience is left even more terrified about the way the world is going to treat them if they decide to get help for themselves or others around them.
Looking at this disturbing situation, the question of fixation and making things better come into the debate. The foremost way to stop stigmatization is to accept the fact that it exists, which can only be attained through meaningful awareness. It’s time we start showing compassion towards those who suffer from some mental disorder and encourage them to seek the help they need. Because in the end, people who created this thick wall of shame around those, who deserve their kindness, are the ones who could eventually break it and make way for them to have some relief.