~Written by Sarah Khalid Khan (Contact: firstname.lastname@example.org)
Lahore Mental Hospital
Source: CNN.com Available at http://i2.cdn.turner.com/cnnnext/dam/assets/150812114127-01-cnnphotos-lahore-mental-hospital-restricted-super-169.jpg
As a Global Health student with a background in medicine I find all health issues interesting. Especially interesting are the mental health issues because of their lack of somatic manifestation like other physical ailments. It is surprising to know that depression alone affects almost 350 million people worldwide (WHO 2015). Even though I have been related to the medical field for quite a while, I underestimated the state of mental health in Pakistan. The fact that I grew up with a family member who was under treatment for bipolar disorder for many years did not do much to change my opinion. I am also related to a few undiagnosed cases of clinical depression but I still did not consider mental health an issue. During my medical college, the clinical rotations in the psychiatric ward also failed to show me the true picture of the burden of mental disease partly due to its scarce patient numbers.
I realise my ignorance even after becoming a clinician reflects poorly on the level of awareness of this issue in the medical community and the general population. I would have continued to be ignorant had it not been for one particular day in the Outdoor Patient Department at Services Hospital Lahore with one of the heads of medicine.
As the last patient left, the professor looked around at all the junior doctors sitting around the table, picked up one of the physician samples and said that if it were up to him, he would make the drinking water of Lahore enriched with it. Surprised at what could possibly plague our part of the world and cure it according to him, we looked at the sample. It was an anxiolytic. An anxiolytic is sometimes prescribed for people suffering from stress and often given to patients with depression (Pietrangelo 2013).
The fact that the number of mental disorders is increasing worldwide is not a secret. According to some sources, the number of people suffering from mental issues in Pakistan is estimated to be around 15 million (Anwar 2015). Most of these remain undiagnosed, often in the shadows of stigma and shame. Pakistan has many reasons to have escalating mental illness; political unrest, internal conflict, economic instability, rising poverty and crime rates, unemployment, natural disasters, the list goes on.
Unfortunately most of these cases are attributed (by the general public, doctors or both) to black magic and evil spirits (Gadit and Callanan 2006). Many such people end up at shrines and the doorsteps of spiritual healers. Some receive holy verses to recite while others get beaten, to scare away the evil spirit or “jinn” as it is called in this part of the world. While religion is good for many reasons, the fact that mental health involves underlying biochemical pathophysiology that could be treated with medical intervention needs to be addressed urgently.
But what about the people who specialize in managing and treating such disorders? According to WHO there are less than 350 psychiatrists in Pakistan, only 0.2 per 100,000 (Jooma et al. 2009). The numbers are worse for pediatric psychiatrists. With only five psychiatric hospitals in the country, the state of psychiatric wards and mental institutions is appalling (Anwar 2015).
Although psychiatry might be an area of increasing interest in medicine in Pakistan, the availability of opportunities that provide better compensation and benefits abroad cause many of these doctors to leave the country to work in “greener” pastures (Imran et al. 2011). With the prevailing conditions for doctors in general, Pakistan might even become an exporter of psychiatrists, which will only worsen the situation within the country.
The time to deal with the multi-headed monster of mental health in Pakistan is now. Raising awareness about mental issues is primary but the need to remove the stigma associated with it is a bigger concern. The truth about fraudulent spiritual healers also needs to be addressed vehemently. The number of psychiatric wards needs to be increased. Finally, the medical workforce needs to be given better incentives to stay within the country.
Anwar, Komal. “Mental Health Care: Mind Matters.” The Express Tribune. Web. 26 Oct. 2015.
Gadit, Amin A Muhammad, and T S Callanan. “Opinion and Debate Jinni Possession : A Clinical Enigma in Mental Health.” Journal of Pakistan Medical Association 56.10 (2006): 476–478. Print.
Imran, Nazish et al. “Brain Drain: Post Graduation Migration Intentions and the Influencing Factors among Medical Graduates from Lahore, Pakistan.” BMC Research Notes 4.1 (2011): 417. Web.
Jooma, Rashid, Fareed Aslam Minhas, and Shekhar Saxena. WHO-AIMS Report On Mental Health System In Pakistan. N.p., 2009. Print.
Pietrangelo, Ann. “Anxiolytics | Definition and Patient Education.” Healthline. N.p., n.d. (2013) Web. 26 Oct. 2015.
“WHO | Depression.” Fact sheet N°369. World Health Organization, n.d. Web. 26 Oct. 2015.