Depression is one of the most common mental illnesses worldwide. Approximately 280 million depression cases happen annually. It has been estimated that mental illnesses affect at least 3.8% of the population, including a large proportion of the youth. Most people confuse depression with bipolar disorder and often depression is understood as usual mood fluctuations and short-lived emotional responses to the challenges of everyday life. However, depression is a separate mental illness, which can become a serious condition if there is a recurrent pattern with moderate or severe intensity.
If depression is left unaddressed, it can cause the affected person to suffer significantly and function poorly at work, school, and in the family. At its worst, depression results in suicides. According to a World Health Organization report, globally depression is more common among women than men. The report also reveals that an estimated 5% of adults suffer from depression around the world. The ever-changing dynamics of the world has further contributed to the rise in depression amongst the youth. This includes increased competition, urban lifestyles, and hectic schedules, competing counterparts with the same results, etc.
Surprisingly, depression is seldom part of the popular discourse in Pakistan. The most horrifying part is the non-acceptance of its existence. Most people in Pakistan consider temperature as more dangerous than depression. However, research has revealed otherwise. Today, approximately 3.4% of total deaths are caused by depression. The Covid pandemic has led to a surge in depression amongst the youth in Pakistan. It is time to begin raising awareness and addressing depression. Awareness campaigns, seminars and workshops on the identification of the symptoms of depression and prevention methods must be conducted regularly. If we fail to address this effectively and promptly, it will result in the loss of many lives and have a negative impact on society.
The psychological health care system is woefully deficient in Pakistan, and the way it is mainly managed explains why accessing psychological help is a taboo subject. At the time of independence in 1947, there were three asylum-like hospitals, one each at Hyderabad, Lahore, and Peshawar, with a total of 2000 beds. These were in a miserable shape with no psychiatrists and managed by medical officers only. These hospitals were called mad-houses or “pagal khanay,” and patients were often brought there in chains. Before the Mental Health Ordinance (MHO) of 2001, the law related to mental health provision was the Lunacy Act of 1912. After the 18th Amendment, health became a provincial subject in Pakistan. The Sindh Provincial Assembly took the lead and passed the Mental Health Act in 2013. The Punjab government enacted the Punjab Mental Health Act in 2014.
Seven decades after independence, the health care system is still not adequate. Whereas the median number of mental health beds per 100,000 population is above 50 in high-income countries, and 11.3 in the more developed countries of the Eastern Mediterranean Region, this figure is around 1.7 for Pakistan. A recent survey showed that nearly a third of the respondents believed that people fail to access mental health services because mental health professionals are not accessible.
In the absence of a formal functioning health system that is adequate for the needs of the population, traditional spiritual healers call the shots in Pakistan. Popularly known as baba, pir, or Sufi, the spiritual healers are well respected in the community. They practice at their residences, clinics, shrines or mosques and explain mental illness in terms of possession by an evil spirit, or by magical influences cast by enemies.
The treatment includes amulets, spiritually treated water, burning incense, or reciting mantras. Much to the chagrin and resentment of mental health professionals, the spiritual healers enjoy the acceptance of large masses of people who approach them for their mental health problems.
Though collaboration between spiritual healers and psychiatrists, as is often suggested, under some formal institutional arrangement has some appeal, there could be no denying the fact that public investment is the key to overcoming the challenge. Given the limited fiscal space available to the governments for significantly increasing investment in mental health, how and when investment in mental health will take place is an open question. At least, the government should try its best to sensitize the population that mental disorders are just like physical disorders.
Abdul Khaliq
Lasbela
