Pakistan Is In Dire Need Of Understanding And Tackling Mental Health
Human health has two main categories, namely, physical and mental health. Physical health problems (PHM) like high blood pressure, diabetes, appendicitis etc. are treated by internists, endocrinologists, and surgeons, respectively.
People find it comforting to consult a physician for physical health problems. Unfortunately, this comfort turns to fear when it comes to mental health problems (MHP). Mental health problems are stigmatised in almost all societies. It is considered as a smirch and a blot. Consulting a psychiatrist is deemed to be verboten.
PHM is treated by physicians, whereas MHP is associated with a lack of faith. People resort to faith healers and quacks when it comes to their MHP. If you have a fever with a sore throat, you go to a primary care provider (PCP) and take the prescribed medications.
On the other hand, if you have low energy, lack of motivation, unresolvable sadness, suicidal thoughts, etc., you are asked to offer prayers and review your faith. During one of my outreach visits to villages, I saw a poor girl, bound in chains and tied to a tree. She was hearing voices in her head and seeing things invisible to other people. She was paranoid and believed that her mother in law was conspiring to kill her. She was taken to a local faith healer and was diagnosed with demonic possession. He hit her with a hot iron road as a treatment. We took her to our inpatient psychiatric unit and treated her psychosis with medications.
There are some other factors associated with the lack of mental health awareness. Lack of qualified mental health providers, including psychiatrists, psychologists, mental health therapists, and social workers is one of the most critical factors. Psychotherapy is a crucial part of treating MHPs, but it’s difficult to find a qualified clinical psychologist or mental health therapist even in bigger cities like Lahore and Islamabad.
PCPs including internists and general practitioners (GPs), are first-line soldiers rescuing patients from diseases. It is cataclysmal that most of them have very little to no training in diagnosing and treating MHPs. Can you consider the misery of a sick patient who musters up the courage to seek help for their mental health problem, only to be mismanaged by PCPs; it is horrendous and spine chilling.
To add insult to injury, psychiatry training in Pakistan is below par and lacks structure. Psychiatry postgraduate residents (PGs) are not exposed to some of the central concepts of psychiatric diseases.
One significant lacuna in their training is the lack of exposure to psychiatric emergencies like acute psychotic episodes, suicidal patients, agitated and combative patients, etc. The correct analogy will be giving a gun to a policeman without bullets. There is minimal training in neuromodulation techniques like electroconvulsive therapy and transcranial magnetic stimulation etc.
Mental health awareness has exponentially increased throughout the world. Psychiatrists are one of the highly paid physicians. Unfortunately, in Pakistan, we have achieved minimal success in raising mental health awareness. We have failed to educate masses and have been unable to train our physicians properly to diagnose and treat MHPs.
The solution to these problems requires a multidisciplinary approach. We need to educate the public about the common signs and symptoms of psychiatric diseases through print and television media. We should hold seminars to train PCPs in treating MHPs and referring patients to psychiatrists. We should also improve the psychiatry training structure all over the country.