Mental illness in Pakistan: The toll of neglect

ARIF MAHMOOD P UB LI SH ED SEP 20, 2014 04:41P M

How many more mental illness patients have to suffer in silence owing to our entrenched
resistance to care? Photo by Saad Sarfraz
The most shamefully neglected health field in Pakistan, mental illness afflicts 10 16 per
cent of the population; with a large majority of those affected being women.
According to the WHO, only 400 psychiatrists and 5 psychiatric hospitals exist within the
entire country for a population exceeding 180 million. This roughly translates to an
alarming psychiatrist-to-person ratio of 1 to half a million people.

Sadly, prospects for care are exceedingly bleak as many patients never seek treatment,
quit prematurely, or are shnned by family members.

I am personally invested in increasing awareness about the magnitude of this problem

before it becomes too late. How many more mental illness patients will have to suffer in
silence because of the stigma and shame in our society? How many more will get lost in
this an entrenched resistance to care?

Impairing accessibility to mental healthcare

One of the most pertinent factors hindering mental healthcare within Pakistan is stigma.
While stigma has many definitions; within Pakistan it limits an individual from gaining
complete social acceptance; this can have devastating consequences.
Within our society, social acceptance is crucial to an individuals livelihood and vitality.
This includes getting married, working, making friends, socialising, productivity, and
daily functioning.
Unfortunately, many people would not even be willing to socialise with someone who
suffers from psychiatric illness in Pakistan. For all of us to fully comprehend stigma and
its makeup, it is imperative for us to explore its key terms.

A mental illness patient at the Bibi Pak

Daman Shrine in Lahore. Photo by
Saad Sarfraz

Attitudes
We form a settled way of thinking about something by looking at seemingly factual views
of the world and adding our own values, emotional reactions, and input to these views.

Stereotypes
We accept widely held but oversimplified ideas about individuals based on their
appointment to a particular category.
Prejudice
We value preconceived opinions that are not based on reason, this results in harboring
negative affective attitudes towards a particular group or body of individuals, which
essentially is the equivalent of a derogatory stereotype.
Discrimination
The behavioral component of stigma, it drives people to act on their prejudiced beliefs;
deepening the hurtful realities for those afflicted with mental disease.
Across Pakistan discrimination towards individuals with mental disease is easily
discernible. Depression, Schizophrenia, Post Traumatic Stress Disorder, and Anxiety are
frequently written off as erroneous diagnoses by many members of society.

A homeless mental illness patient

outside Data Darbar in Lahore. Photo
by Saad Sarfraz

It is largely acceptable to dismiss these patients as weak and more often than not, theyre
asked to bolster their faith to reduce the disease. While religion is wonderful; it is critical
for us to acknowledge that each one of these diagnoses has a biochemical process that we
must recognise in order for adequate treatment to ensue.
As a direct result of inaccessibility to mental healthcare, patients will approach faith
healers, hakims, or practitioners of homeopathic medicine, ultimately finding no relief.

This is especially tragic because of growing evidence that early intervention can prevent
mentally ill people from further deteriorating.
Additionally, growing insecurity, pervasive poverty, political uncertainty, genetic factors
and a lack of economic opportunity all pose a significant risk to mental health in
Pakistan.
Pakistani women face an even greater risk as frequent targets of domestic violence, toxic
in-laws, and are constant victims of gender-inequality. With such a volatile environment;
I can only foresee that mental disease will be a growing problem.

Our government needs to recognise its responsibility to monitor human rights, empower
women, and increase awareness about mental illness.
On an individual level, stigma and shame must be uprooted from our communities. The
therapy itself involves emotional suffering, vulnerability, anxiety and sadness.
The least we can do is to allow for mentally ill patients to seek adequate support.
In a country that is already casualty to many ills, the human toll of neglecting mental
health can no longer be refused.