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Running Head: MENTAL HEALTH SERVICES IN PAKISTAN

Mental Health Services in Pakistan Valerie Griffith Western Washington University

MENTAL HEALTH SERVICES IN PAKISTAN

Pakistan is a South East Asian country with a population of over 176 million people. 70% of the population resides in rural areas with a tribal value system and heavily rely on agriculture as their main means of economic growth/stability and 35% are below the poverty line (Karim, Saeed, Rana, Mubbashar, & Jenkins, 2004). Those who are most likely to have mental illness are women and children in rural areas, especially those who are burdened by war, but mental illness in Pakistan can affect anyone (World Health Organization (WHO), 2009). Mental health services in Pakistan are impacted by many different systems including: political, educational, economical and religious. Mental health services in Pakistan are offered by psychiatric facilities and traditional healers. The number of mental health providers is small in comparison to the population of Pakistan, so if those with mental illness are fortunate to receive services it would possibly be traditional psychiatric services. If the individual is poor or religious, they will usually go to a traditional healer. According to Karem et al (2004), The traditional healer is the local practitioner of ancient or herbal medicine (Pakistan mental health country profile, pg. 85). There are also alternative medicine services offered. If individuals receive treatment, they can improve their mental health. Those who dont receive attention could continue to decline in health and even commit suicide. A major system that effects the people of Pakistan at a personal level is the political system. Pakistan is involved in the war on terrorism and has seen increased volumes of violence since 2001. Continued exposure to violence and a constant threat of death shows damaging effects to the psychological health of any person (Khalily, Fooley, Hussain, & Bano, 2010). Depression and anxiety tend to be the most prevalent followed by schizophrenia, bipolar, and post-traumatic stress disorder (Suhail, 2005). These mental health issues can also be found in the Afghan refugees in Pakistan. There has also been an increase in the amount of drug addiction

MENTAL HEALTH SERVICES IN PAKISTAN which has been estimated at around 4 million people (Khalily, 2010). It is known that there has been an increase in the prevalence of mental health due to the effects from war, but exact numbers are not known. The increasing amount of individuals needing attention for their mental health issues is resulting in a need for more mental health facilities and providers. At an interpersonal level, those with mental health disorders in Pakistan may not know what is going on with them or know where to turn to receive help because they have not been exposed to mental illness and have not been involved in discussion around mental health. Interpersonal communication around mental health is uncommon because of the stigma surrounding mental illness. There is stigma because of a lack of an education system. The government only spends 2.1% of the GDP on education resulting in a literacy rate of 57% (Farooq, 2009). With general literacy rates low, mental health literacy rates are even lower. Without interpersonal relationships and conversation about mental health, the stigma around

mental health will continue to effect mental health services. There is also a large gap between the number of mental health professionals to the population of Pakistan. There needs to be more knowledge and awareness on the need for mental health professionals in the healthcare field. It is also important to note that there is a need for more mental health services in rural communities where there is even lower literacy rates (Suhail, 2005). Next, the community is effected by economical systems. Mental health care is provided by the government and private healthcare facilities. According to Karem et al (2004), In 2001, less than 1% of the GDP was spent on health and less than 1% of that on mental health (Pakistan mental health country profile, pg. 87). Even with financial help from The World Bank and WHO, the funding for mental health services in Pakistan is insufficient. Without the financial resources to provide mental health services, there wont be a sufficient amount of services

MENTAL HEALTH SERVICES IN PAKISTAN provided to the amount of mental health that needs treatment. Another economic factor is that 35% of the population in Pakistan is low income. If those who need services cant afford to receive services then they cant get the help that they need. When an individual cant afford services, they will go to the traditional healer where they can usually trade goods for services. If there is no option of services available then the community must support each other to take care of those who are ill. Mental health services in Pakistan are also greatly affected by culture. Religion is the

system that has the greatest cultural effect on mental health services. First of all religion creates a stigma around mental health. According to Karem et al (2004), It is widely perceived that mental illness is caused by supernatural forces such as spirit possession, jinni, black magic or exaltation, or testing by God as punishment for ones sins (Pakistan mental health country profile, pg. 84). However, religious followers treat those with mental illness with care because of the belief that they will be rewarded in the afterlife for good behavior. Religious communities will tend to seek out the help of the traditional healer to provide mental health services over the modern western psychiatric services. Mental health services are scarce in Pakistan. In Lower Dir District of northwestern Pakistan, there are only a couple of psychologists in ratio to the 1.2 million people who reside there. Saida is a counselor in the emergency department at Timergara DHQ hospital. Saida states: People have no idea about mental health. They think all body pains and other symptoms are due to physical problems. They do not make the link between distressing events and body pains. They ask for medicines instead of counseling. We explain that this is actually due to the stress and we can talk about it (Doctors without Borders, 2012).

MENTAL HEALTH SERVICES IN PAKISTAN Saida and her team raise awareness of mental health and provide services to those who are suffering. Saidas experience reiterates the need for mental health awareness and an increase in the amount of mental health service providers and facilities. In conclusion, mental health services in Pakistan are affected by many different systems including: political, educational, economical and religious. The war on terrorism and its increasing violence personally effects those who are forced to live through the horrors and constant fear of death and destruction. The people of Pakistan are uneducated on mental health due to the lack of education and interpersonal communication around mental illness. 35% of the population is living below the poverty line and the economic system has failed to put health and mental health as a financial priority of its people. Religion and culture add a stigma to mental health and promote traditional healers over psychiatric services. In order to improve mental

health services, the most important aspect is education. There needs to be more education around mental illness and more people seeking higher education to provide mental health services to rural communities. The more awareness around mental health that is raised through education, the more mental health will be looked at as a serious issue that needs attention in Pakistan.

MENTAL HEALTH SERVICES IN PAKISTAN References Doctors without Borders. (2012). A race against time in the emergency department of Pakistan's Timergara District Headquarters Hospital. Retrieved from: http://www.doctorswithoutborders.org/news/article.cfm?id=6087&cat=field-news Farooq, U. (2009) Ministry of Finance Economic Survey 2009-10; Pakistan Economic Survey 200910. Retrieved from: http://finance.gov.pk/survey/chapter_10/ 10_Education.pdf

Karim, S., Saeed, K., Rana, M., Mubbashar, M., & Jenkins, R. (2004). Pakistan mental health country profile. International Review Of Psychiatry, 16(1/2), 83-92. doi:10.1080/09540260310001635131

Khalily, T. M., Fooley, S., Hussain, I., & Bano, M. (2010). Violence, psychological trauma and possible acute post- traumatic interventions in Pakistani Society. Australasian Journal of Disaster and Trauma Studies, 11(7), 1-7. Khalily, T.M (2010). Developing a coordinated response to drug abuse in Pakistan. Journal of Interprofessional Care, 24(2), 168172. Suhail, K. (2005). A study investigating mental health literacy in Pakistan. Journal of mental health, 14(2), 167-181. World Health Organization (WHO). (2009). WHO-AIMS report of mental health system in Pakistan. Retrieved from: http://www.who.int/mental_health/pakistan_who_aims_report.pdf

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