Mental health system in Pakistan

Introduction

Although mental health illnesses are quite common in Pakistan, there is a lack of well-developed mental health resources to address them. The World Health Organization stresses the integration of mental health into primary health care (PHC) as a means of delivering effective mental health services.

Global public health is burdened by the rising prevalence of mental disorders, which are a major and central component of mental health. The burden of sickness worldwide is estimated to be 14% caused by mental illnesses (1). An estimated 450 million individuals worldwide are thought to be affected by mental illnesses, and 25% of people will at some point in their lives experience some form of mental illness(2).

Pakistan has inadequately developed mental health care. This is caused by inadequate resource allocation as well as a general lack of awareness of mental health-related concerns at all levels of government planning and execution. Although there is no dedicated funding for mental health, it is estimated that it receives 1% of the national health budget, which accounts for 0.8% of GDP. There are roughly one psychiatrist for every 0.5–1 million people in the population. Psychologists are also few in numbers. Psychiatric social workers do not exist.

The bulk of people live in rural areas with virtually no access to mental health services, and most psychiatrists are found in large urban centers. There are 3 729 mental health facilities in the nation overall, with 46 percent of them expected to offer community-based mental health care. There are five mental health hospitals in the nation, with 1.9 beds for every 100,000 people. Most of these institutions are found in urban areas (3).

Therefore, it's critical to incorporate mental health into PHC in order to provide easily accessible mental health care. In implementation, stakeholders—including decision-makers—play a critical role. Their opinions have been noted as obstacles to integration in certain research (3). It is crucial to investigate their perspectives on integration as a result.

The perspectives of stakeholders regarding the integration of mental health into PHC and the perceived obstacles to this integration were investigated in this study. We also looked into their opinions regarding the resources needed for the process of integration (4).

How important mental health is?

Every participant acknowledged the importance of mental health on an individual, communal, societal, and national level. They went on to say that as communities are made up of individuals, mental health issues affecting one person will have an impact on the entire community as well as the country. They emphasized that Pakistan's current state of mental health was appalling, considering the nation's lax law and order and frequent terrorist incidents. They said that preventive actions were not prioritized.

They agreed that there was a pressing need to integrate mental health into PHC since social stress levels were quite high and individuals were experiencing emotional and psychological anguish. "I think mental health is extremely important at all levels," said one of the attendees. It goes without saying that a mentally sound person will contribute to the development of a more wholesome and functional community and society.

Integration-related obstacles

Although most of the participants stressed the value of mental health and its integration into PHC, they also identified a number of potential roadblocks to the integration process. The system, implementation, and community levels presented obstacles.

Lack of political commitment was thought to be a significant systemic obstacle to integration. Many participants believed that since integration was a big decision, the current system would need to be significantly changed in order to make the process easier. Such systemic reforms were not feasible without a strong political will. "So the biggest barriers are resources and the lack of political will and commitment," said one attendee.

Pakistan is a South Asian developing country with a majority Muslim population and a current estimated population of about 200 million. The country faces a number of health challenges both for communicable and no communicable diseases (3). The country does not have a strong publicly funded primary health care (PHC) system and most people (as high as 90%) seek health care in the highly unregulated private sector, paying out-of-pocket (3).

The nation's Mental Health Ordinance of 2001 integrates contemporary notions of mental disorders, therapy, recuperation, and observance of civil and human rights. The provinces are in charge of enacting mental health laws through their assembly, though, as the 18th amendment to the constitution transferred health responsibilities to the provincial governments. There are only two provinces with mental health laws: Sindh and Punjab.

There are 3,729 mental health facilities in Pakistan, five of which are hospitals. The majority of these institutions are found in urban areas, and 46% of them are meant to offer community-based mental health care.

Five districts, one in each province, and Azad Kashmir have seen the introduction of mental health services within primary health care (PHC) in Pakistan. This is in line with Pakistan's mental health strategy, which was most recently updated in 2003 and has as one of its main objectives "developing a mental health component in primary medical care." In this context, the federal government has disbursed roughly 20 million PKR. In order to deliver high-quality care, PHC must integrate mental health, according to the World Health Organization (WHO).

In conclusion

Our results demonstrate that stakeholders operating at the implementation level as well as decision-makers in Pakistan view mental health as a critical aspect of overall health. It was underlined how crucial mental health is on an individual, community, and governmental level. The study also demonstrated that mental health issues are not being appropriately handled and that there are numerous shortcomings in Pakistan's current mental health care system.

The stakeholders believed that strong political commitment, financial and human resources, community knowledge, and vigorous advocacy were necessary in order to integrate mental health into PHC.

Before integration to be put into practice, the current PHC system would need to be reinforced. At the same time, since these factors are likely to have a significant impact on the services' overall acceptability and effectiveness, integration and development of the services must be carefully planned in accordance with the local population's current health-seeking behavior as well as other demographic, cultural, and socioeconomic factors.

 

References 

(1) Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet. 2007 Sep 8;370(9590):859–77. http://dx.doi.org/10.1016/S0140-6736(07)61238-0 PMID:17804063

(2) Malata AA. Gap analysis for the national health research agenda of Malawi. 2010.

(3) Malik MA, Khan MM. Economic burden of mental illnesses in Pakistan. J Ment Health Policy Econ. 2016 Sep;19(3):155–66. PMID:27572143

(4) Preventing suicide: a global imperative. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf, accessed 8 November 2017).