Virtual University Of Pakistan Network
World Mental Health Day is observed on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health.
The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide.
Depression affects an estimated 350 million people around the world, and more women are affected than men. It is one of the main causes of disability worldwide.
A quarter of the UK population will experience some kind of mental health problem in the course of a year. The most common mental disorder in Britain is mixed anxiety and depression.
Around 47.5 million people worldwide have dementia. Dementia is usually chronic or progressive in nature. The condition means there is deterioration in the ability to process thought (beyond what might be expected from normal ageing).
Bipolar affective disorder affects round 60 million people worldwide. It typically consists of both manic and depressive episodes, separated by periods of normal mood.
Schizophrenia affects around 21 million people worldwide. Psychoses, including schizophrenia, are characterised by distortions in thinking, perception, emotions, language, sense of self and behaviour.
While there are effective treatments for mental disorders and ways to alleviate the suffering caused, in low and middle-income countries between 76% and 85% of people with mental disorders receive no treatment for their disorder. Even in high-income countries between 35% and 50% of people with mental disorders receive no treatment.
The dignity of many people with mental health disorders is not respected. This includes being locked up in institutions where they are isolated and potentially subjected to abuse.
Some people are deprived of the right to make decisions about their mental health treatment and care, as well as their personal lives – such as where they want to live. Some people are denied the right to work or education.
Stigma is rife and can have a knock-on effect on employment, which hinders someone socially and economically.
Thousands of people with mental health conditions around the world are deprived of their human rights. They are not only discriminated against, stigmatised and marginalised but are also subject to emotional and physical abuse in both mental health facilities and the community. Poor quality care due to a lack of qualified health professionals and dilapidated facilities leads to further violations.
The theme for this year’s World Mental Health Day, observed on 10 October, is "Dignity in mental health". This year, WHO will be raising awareness of what can be done to ensure that people with mental health conditions can continue to live with dignity, through human rights oriented policy and law, training of health professionals, respect for informed consent to treatment, inclusion in decision-making processes, and public information campaigns.
WHO’s comprehensive mental health action plan 2013-2020 was adopted by the 66th World Health Assembly.
Dr Margaret Chan, the WHO Director-General, described the new Comprehensive Mental Health Action Plan 2013–2020 as a landmark achievement: it focuses international attention on a long-neglected problem and is firmly rooted in the principles of human rights. The action plan calls for changes. It calls for a change in the attitudes that perpetuate stigma and discrimination that have isolated people since ancient times, and it calls for an expansion of services in order to promote greater efficiency in the use of resources.
The four major objectives of the action plan are to:
Each of the four objectives is accompanied by one or two specific targets, which provide the basis for measurable collective action and achievement by Member States towards global goals. A set of core indicators relating to these targets as well as other actions have been developed and are being collected via the Mental Health Atlas project on a periodic basis.
Hundreds of millions of people worldwide are affected by neurological disorders: more than 50 million people have epilepsy; around 35.6 million are affected by Alzheimer disease and other dementias globally.
Moreover, the extension of life expectancy and the ageing of the general populations in both developed and developing countries are likely to increase the prevalence of many chronic and progressive physical and mental conditions including neurological disorders
Over 800 000 people die by suicide every year – that’s one person every 40 seconds. Yet these deaths are preventable.
In WHO’s first suicide report “Preventing suicide: a global imperative” information is included on what is known about suicide across the world, groups at particular risk of suicide, and what can be done at both societal and individual level to reduce the number of deaths from suicide.
You’re walking back to your car after picking up groceries from the nearest medico store. Your heart rate is picking up, you’re feeling jittery, and it seems like your body is going into combat mode — it’s either fight or flight because there is a predator on your trail. You don’t have to be sure because the reaction of your autonomic nervous system is assuring you that your every move is surely being watched. However, every time you glance over your shoulder to check, no one is there. Except, of course, the usual market rush and the little boy selling kitschy toy guns on the side of the road. You quickly rush into the car, yank the door shut, and lock it, as a feeling of hopelessness overcomes you. Was it all in your head? This is what it’s like to undergo a persecutory delusion — a common symptom of schizoaffective disorder. Meet Saadia Yousafzai: bright and early on a March morning, her aunt brought her to a psychiatric rehabilitation centre, known as The Recovery House (TRH), situated on the bustling Tipu Sultan Road in Karachi. After fighting schizoaffective disorder — a combination of psychotic symptoms, such as delusions, and mood episodes, such as depression — for 15 years with various medications, Yousafzai was finally admitted into TRH’s six-week residential rehabilitation programme, to give therapy a shot. Yousafzai was once a vivacious young woman in her twenties, who, at a glance, met the general standards of Karachi’s cutthroat social culture: in appearance she wasn’t heavy, she had studied marketing in school, secured a job, was a lovely piano player, and as far as everyone knew, she was mentally sound. However, when Yousafzai hit 30, the symptoms of schizoaffective disorder began to settle in: she cornered herself into isolation, her self-esteem dwindled, and she had persecutory delusions that an elaborate conspiracy was being manufactured against her. Yousafzai’s doctor had prescribed effective medications, but due to a prescription change she experienced a relapse that brought her to TRH by her aunt under duress. Dr Gulshan Parvani, a visiting consultant psychiatrist at TRH, explained that the TRH team’s approach was to examine every potential variable affecting her disorder: “We took into account her social network, employment history, input of immediate relatives, and even her relationship with her charming Labrador, Marley — all to implement her treatment.” Skype sessions were arranged with Yousafzai’s elder brother to facilitate crucial discussions vis-a-vis anti-psychotic medications, and contact was maintained with her employer to ensure she had a job to return to.
Yousafzai shared that although she was tremendously resistant in the beginning of the rehabilitation process, “TRH has rectified the problem of my loneliness, and has enabled me to do things through monitoring myself, which would not have been possible if I were alone in my apartment during my illness. Being at TRH made me a little more confident, and lessons were learnt — I realised how important it is to be consistent with medication.
Not only for health reasons, but also economic reasons, because I support myself financially.” According to WHO’s Mental Health Atlas, among Pakistan’s population of 190 million, there were only 342 psychiatrists per 100,000 people in 2011. Now, there are roughly 520 — a leap to take pride in — but hardly enough. With the number of facilities that are community-based and provide in-patient services holding at 624, the math brings the number of beds to approximately two for 100,000 people. In terms of doctors, a lamentable reality check: only 13.1 per cent of Pakistan’s medical students aspire to become psychiatrists.
Hanaa Durrani, a current student of the Institute of Business Administration, stated that she has always been passionate and curious about psychology; but, alas, her family pushed her to pursue a more promising degree in the field of Accounting & Finance. She said, “The concept of working in counseling or therapy is just so alien here that I had to stick with a business school that would guarantee me a respectable job as per the requirement of Pakistani culture. There is little acceptance of this profession when you think in terms of your independence and financial stability in the long run because mental health is so taboo.” Durrani is now volunteering at TRH.
Because of the stigma attached even to a career affiliated with mental health, Pakistan’s government allocates insufficient resources towards strengthening the Psychology discipline in Pakistan’s universities. As a result, our next generation of psychiatrists and therapists is gradually transmuting into a mere illusion. Meanwhile, the current supply of those with the skills to address our mental health crisis continues to fail at meeting demand. Within the past couple of years, WHO’s statistics have been circulating throughout news publications, while scant progress has been made.
Over 14 million Pakistanis suffer from some form of mental illness, with two million in Karachi alone — and although rehabilitation centres do exist in Karachi — many behave more as psychiatric asylum centres. Some of TRH’s current clients complain about the hospitals or rehab centres they transferred from. “It was a mess — the patients were treated with disrespect, and conditions were unhygienic.
Even the chai we were served was filthy,” said a TRH client, referring to a psychiatric hospital in Karachi. A staff member at TRH reported that one of Pakistan’s major psychiatric hospitals allegedly chains their patients to their beds. When asked about her family and friends’ response to her disorder, Yousafzai replied: “Not many people knew, and the possibility of word getting out was prevented because I went on medication just in time. My family has not been supportive, and no one could understand. No one.
The only person who can understand is someone who has the disorder, and I haven’t come across many people who have this disorder.” Advocacy for positive reception of mental illness in Pakistan is lacking, making a vast mobilisation for mental health development even more unlikely. If stigma is reduced, with government collaboration, institutions can evolve so that patients are treated more like those at rehabilitation centres akin to TRH — less like chained prisoners, and more like patients receiving assistance for their illness. Pakistan’s public must recognise that protracted illnesses like schizoaffective disorder have challenged individuals with relapses; they’re battles — ones that require an exceptional willpower to fight.
For World Mental Health Day, we should applaud our heroes for their resilience — not only because of their fight to overcome schizoaffective disorder, but also because it’s with a society still struggling to accept it. The smile Yousafzai wore was almost begrudging; the look in her eyes was pessimistic and beaten, as if winning the battle against schizoaffective disorder wasn’t so rewarding—there was no support from the beginning, no one cheering her on. This World Mental Health Day, clean out your bookshelves and take a few good reads to TRH.
The Caravan of Life Trust’s psych rehab facility will be accepting book donations as a part of its next project to provide its patients with their own library. *Names have been changed to protect identity. *This article does not reflect the views of The Recovery House, World Health Organisation, or any other institution.
Published in The Express Tribune, October 10th, 2015.
By Zehra Naviwala