Thursday, February 27, 2020

Taboo: Pakistan's Mental Health Problem

It is no shock to South Asian's that our community has a problem around talking about mental health. Whether you are first or second-generation or like myself, a third generation Pakistani it is commonly known within our community that mental health is not something that is discussed at the dinner table.

As of 2015, reports have found that 40% of the population have mental health issues. This is hardly surprising considering the country has suffered from the Afghan war, ethnic tension and religious violence. The country is riddled with corruption which has done very little to reduce the poverty that many people are living in. With all of these factors at play, it is no shock that such a high amount of the population are suffering from some form of mental illness.

The problem is there is little to no support for the Pakistani people.

Throughout South Asia mental illness is unreported, diagnosis do not and therefore, it is not treated. Mental illness is certainly taboo in these countries, and often the recommended treatment is praying more. It is viewed as a lesser illness, compared to physical illnesses.

The World Health Organisation (WHO) report that 75% of people with mental illness in the developing world do not receive care.

Dr Saadia Quraishy, of the Pakistan-based Aman Foundation, says that: "It's very difficult to express mental health symptoms to -- not only the clinicians or professional but even to yourself and to the families. There's such a stigma related to that. But it's much more acceptable to say you have a headache or stomach ache or a backache, for which you can be taken out to get help."

This stigma around mental illness and the vilification of the mentally ill made itself known in early September 2015.

A Pakistani news channel reported that Bilawal Bhutto Zardari, the chairman of Pakistan Peoples Party suffers from bipolar disorder. There were people that claimed it was information planted by a political opponent.

This ramifications of the story were that Zardari was immediately branded a 'lunatic' and 'psychopath,' 'fit only for a madhouse.'

It is the very stigma around mental illness that allowed Zardari to branded with the above terms.

The problem lies in the lack of trained professionals and a lack of government funding dedicated to mental healthcare. But, also the general lack of knowledge around mental illness from the cause of symptoms and treatments for such conditions.

The culture of religion in the country does not help in the treatment of mental illness, as the popular belief of 'jinn possession,' as an explanation for psychotic disorders such as schizophrenia and psychosis. As well as recommended treatments for conditions such as depression is to pray more, read more Quran and then your depression will be cured.

But, the government do not help in breaking this stigma.

2.4% of the government budget is dedicated to healthcare, and measly 0.4% is directed at mental health care. As a comparative, 11% of the UK's NHS budget goes directly into mental healthcare, that is 11% of £133.9bn for 2019/20, that's £14.7bn, on mental health alone.

Spending aside, the laws surrounding mental health are incredibly poor and the improvements made on them have made a marginal difference.

Before the Mental Health Ordinance (MHO) of 2001, the law that existed originated from the colonial era. Pakistan inherited the Lunacy Act of 1912 after the Partition. This law has no specific clauses regarding consent, confidentiality and doctors were not obliged to inform patients or guardians about the natures, effects, risk or costs of treatments and did not have to offer alternative therapies.

If you fell under this Act and were deemed to be a 'lunatic,' you could be legally be detained for up to 30 days if permitted by the presiding magistrate, a clause that was repeatedly misused and taken advantage of.

The MHO has rectified some of the issues with the Lunacy Act, which include the addition of informed consent, and a maximum of 72 hours detention during which a psychiatrist must examine the patient to start treatment.

The law also specified that there would be penalties for those who make false accusations to discredit someone as mentally ill, for the incorrect treatment of patients at psychiatric facilities and the exploitation of a mentally ill individual by members of the public at large.

A vital clause surrounded the relationship between mental illness and Pakistan's blasphemy laws.

The MHO requires all blasphemy defendants to have a psychiatric assessment. The aim of this is to help the disproportionately high amounts of mentally ill people who had been victimised under blasphemy laws for personal vendettas or to remove a troublesome individual from the local community.

However, changes in law must be implemented, which simply has not happened.

In 2010 the Sindh High Court told a lawyer to refer his client to a psychiatrist under the Lunacy Act, showing that even the judiciary was unaware of the existence of the MHO.

Nine years later after it had passed.

The ambiguity of the MHO showed its face in 2016.

The Supreme Court ruled that schizophrenia is not a permanent condition and varies according to stress levels, therefore it did not fall under their definition of a mental disorder as per the MHO.

This is the same court that said a large proportion of its prisoners suffer from mental illness and that authorities cannot let everyone go.

There have been changes in regional laws surrounding mental health, but these changes have been insignificant. For example, the Punjab government brought in the Punjab Mental Health Act of 2014, which has few linguistic changes in comparison to the 2001 MHO. They also did this without consulting any mental health professionals or advocacy groups.

In a 2015 seminar held in Karachi, a prominent Pakistani doctor revealed that Pakistan has only 380 trained psychiatrists. Statistically, this is approximately one psychiatrist to half a million people.

So, even if you break through the stigma and taboo around mental illness and want to seek help, it simply is not there.

The next few stories highlight the human cost of the lack of discourse and provisions towards mental health.

In Chitral, there were reports of 44 suicides before the end of 2018, the majority of which were women who displayed symptoms of clinical depression. This forced the health department of Khyber Pakhtunkhwa to mandate a commission to be formed to assess the main causes and lack of psychological support available to patients suffering from mental illness in the region.

November 2018 saw the suicide of Rushaan Farrukh, a student from Beaconhouse National University in Lahore.

She had jumped from the fourth floor of a campus building, after posting a Facebook status a few days before on how we must be kind to one another and that words have a strong impact.

There were 50 students at the bottom, some of who accused her of being an attention seeker.

A student at the university later revealed that Rushaan had been suffering from bullying and had depression.

The mere notion that people thought her attempt and then suicide as attention-seeking show some of the harmful attitudes and opinions around mental health in the country.

Yet, there are organisations starting the dialogue, such as The Colour Blue, which aim to promote and encourage the empowerment of those facing mental health challenges through an inclusive platform for engagement, support and service provision.

There are local and provincial initiatives aimed at improving access to mental health care and starting a dialogue on mental health.  News organisations and online papers are discussing the topic more openly, such as DAWN which has several articles relating to mental health in Pakistan.



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