Pakistan’s Mental Health Affliction

mental health
Those with fragile mental health have been pushed to complete vulnerability during lockdown.

By Asra Haque

S* believes that she was seriously depressed when she was 9 years old when her grandmother, whom she was very close to, passed away. Her parents had assumed that her erratic behavior were part of her growing up, and her repeated requests to see a therapist by the time she was 15 were not seriously entertained. A year later though, when her symptoms worsened, her parents finally conceded and took her to a psychologist.

Even then, S was initially misdiagnosed with major depressive disorder (MDD) and anxiety, which she continued to take therapy for until it was discovered that she was actually experiencing borderline personality disorder (BPD), depression and anxiety and was diagnosed for these in 2018. By then, S had switched four psychiatrists and six psychologists. She recalls that her symptoms had gone into remission near the end of 2019 after she began a combination of a controlled medicinal schedule and proper therapy. But all the progress that she had finally made after all these years came undone when a country-wide lockdown was imposed due to the COVID-19 pandemic.

S’s symptoms have begun to resurface since the lockdown began. Intense mood swings and panic attacks that freeze her muscles have surfaced, causing immense joint and muscle pain. Sleep evades her, and she has lost all interest or drive to do even those activities that brought her joy. Having been confined indoors for nearly seven weeks now, her home feels like a claustrophobic prison to her – she is stuck in an environment that is exacerbating her condition to irreparable levels.

“I wake up feeling absolutely depressed. I don’t have the will to get up whenever I do get any sleep,” she says. “No matter how much I try to cheer myself up, at the end of the day, I’m back to square one.”

S is a photographer; she chose the profession because it allows her the opportunity to spend as much time away from suffocating home environments as possible. But because of the lockdown, she has not been able to find any work and can no longer afford her therapy sessions, which she is supposed to take once every week.

“I am genuinely afraid of losing myself completely,” she adds.

Mental health is a much neglected part of Pakistan’s already fragile healthcare sector. According to Dr. Ali Madih Hashmi, a psychiatrist at the Wilcare Hospital in Lahore, Pakistan only allocates roughly two percent of its GDP to health, a number well below the World Health Organization’s (WHO) recommended minimum of at least five percent – and mental health is given an even smaller fraction of that two percent. With this attitude the field seems to be in its infancy.

There is barely any research or mental health awareness among the public, and not nearly enough mental health professionals to treat a population as sizable as Pakistan’s. This is a serious concern because mental health issues are more prevalent in developing countries than in developed nations. In Pakistan, which is among the poorest nations of the world, the prevalence of common mental health issues such as depression and anxiety are twice that of developed countries such as the US and the UK. Citing what little and limited research that does exist, Dr. Ali Hashmi estimated that 30 to 50 percent of Pakistan’s population, mainly women, may be suffering from some sort of mental illness.

This is a situation that predates the pandemic. With the unique and troubling circumstances ushered in by a highly contagious and potentially fatal virus, an even greater number of Pakistanis may be facing some sort of emotional and mental trauma than before. Adults  are now plagued with immense stress as incomes take a hard hit especially with so many now out of jobs and more to come in the future. Children are growing anxious and restless due to extended school closures and restrictions on movement and travel forcing them to remain indoors.

All these anxieties have been reported to be tearing apart families and ruining relationships. According to reports received from 17 paralegal centers operating under the AGHS (Asma Jahangir) Legal Aid Cell, a law firm which offers free legal aid to women and children, there is a disturbing increase in incidents of domestic violence where mainly stressed out men are taking out their frustrations on women, and where men and women are abandoning their families because they are unable to bear the pressure of providing for so many.

Even those on the frontline of the war against COVID-19, doctors and police officials, are losing morale as more and more of their colleagues take ill, increasing the burden on those still unaffected by the virus. Doctors have been on their feet for nearly 10 to 12 uninterrupted hours and even longer duties than usual as more and more COVID-19 patients keeping pouring in.

As the government slowly eases restrictions – allowing mosques to conduct congregational prayers (even though the SOPs are being flouted), and businesses to resume operations as the generally unaware public flouts precautions, doctors warn the healthcare sector may possibly collapse.

Paranoia has also gripped Pakistan’s front line workers. As a worrying number of healthcare workers, police officials and other essential workers contract COVID-19, professionals have now begun to step down or isolate themselves to ensure that they do not spread the contagion.

The importance of mental health professionals is being felt more acutely now than ever before. However, given how Pakistan’s mental health sector is acutely short of experts, research and facilities, it is completely unprepared and unequipped for the mental health crisis emerging from the COVID-19 pandemic.

To a limited extent, private and public mental healthcare units are conducting therapy sessions and prescribing medicines through online video calls, such as Skype and WhatsApp. However, this means that only those who have access to quality internet and have not been financially deprived during the lockdown are able to attend therapy sessions.

Dr. Ayesha Rasheed, a practicing psychologist with nearly 22 years of experience, stated that there has been a notable increase in common mental health concerns amongst the general populace. In response to this trend, therapists and psychiatrists are conducting internet sessions for existing patients. However, they are doing so on an individual basis as there is no government-sponsored mechanism through which common folk can access mental healthcare and therapy online.

“There is no government website or public forum to facilitate the public,” she said. “These provisions, however, are available on an institutional level. The government has launched telemedicine initiatives in state-operated universities and hospitals, not just for mental healthcare but healthcare in general. This system is operating well in institutions and on an individual basis.”

However, due to a combination of socio-economic factors and cultural attitudes towards mental health, only a select few are able to benefit from therapy provided through telemedicine initiatives and online sessions. It is a reality that mental health experts are keenly aware of and have been trying their utmost to correct by creating awareness. Dr. Hashmi expressed his optimism seeing the progress mental health awareness has made in the past 10 years, yet he acknowledges there it still a long road ahead of them.

“With COVID-19 of course, (mental health concerns) are now more apparent,” he said. “But on the other hand, provisions such as manpower and other services require a little more effort, more money, more training. And it’s going to take it’s time.”

“I’m hopeful that things will change. I’m not hopeful that they will change tomorrow, or even next month. But if we keep trying, I’m sure that things can change for the better.”\

For S, her tomorrow has been pushed back by a considerable while. In the meantime, she has to struggle to make through every day without breaking down physically and emotionally.

“I talk to my friends, they try to keep me distracted. I try to keep my mind diverted by watching a movie, cleaning my room or even talking to my goldfish. But I lost any enthusiasm for these things a month ago,” she says. “I don’t know how long I can keep this up, but I’m not going to stop trying. That’s all I can do now.”

*Name omitted to preserve privacy