The most shamefully neglected health field in Pakistan, mental illness afflicts 10 – 16 per cent of the population; with a large majority of those affected being women.

According to the WHO, only 400 psychiatrists and 5 psychiatric hospitals exist within the entire country for a population exceeding 180 million. This roughly translates to an alarming psychiatrist-to-person ratio of 1 to half a million people.

Sadly, prospects for care are exceedingly bleak as many patients never seek treatment, quit prematurely, or are shunned by family members.

A patient at a school for special needs in Lahore. —Photo by Saad Sarfraz

I am personally invested in increasing awareness about the magnitude of this problem before it becomes too late. How many more mental illness patients will have to suffer in silence because of the stigma and shame in our society? How many more will get lost in this an entrenched resistance to care?

Impairing accessibility to mental healthcare

One of the most pertinent factors hindering mental healthcare within Pakistan is stigma. While stigma has many definitions; within Pakistan it limits an individual from gaining complete social acceptance; this can have devastating consequences.

Within our society, social acceptance is crucial to an individual’s livelihood and vitality. This includes getting married, working, making friends, socialising, productivity, and daily functioning.

Unfortunately, many people would not even be willing to socialise with someone who suffers from psychiatric illness in Pakistan. For all of us to fully comprehend stigma and its makeup, it is imperative for us to explore its key terms.

A mental illness patient at the Bibi Pak Daman Shrine in Lahore. —Photo by Saad Sarfraz

Attitudes

We form a settled way of thinking about something by looking at seemingly factual views of the world and adding our own values, emotional reactions, and input to these views.

Stereotypes

We accept widely held but oversimplified ideas about individuals based on their appointment to a particular category.

Prejudice

We value preconceived opinions that are not based on reason, this results in harboring negative affective attitudes towards a particular group or body of individuals, which essentially is the equivalent of a derogatory stereotype.

Discrimination

The behavioral component of stigma, it drives people to act on their prejudiced beliefs; deepening the hurtful realities for those afflicted with mental disease.

Across Pakistan discrimination towards individuals with mental disease is easily discernible. Depression, Schizophrenia, Post Traumatic Stress Disorder, and Anxiety are frequently written off as erroneous diagnoses by many members of society.

A homeless mental illness patient outside Data Darbar in Lahore. —Photo by Saad Sarfraz

It is largely acceptable to dismiss these patients as weak and more often than not, they’re asked to bolster their faith to reduce the disease. While religion is wonderful; it is critical for us to acknowledge that each one of these diagnoses has a biochemical process that we must recognise in order for adequate treatment to ensue.

As a direct result of inaccessibility to mental healthcare, patients will approach faith healers, hakims, or practitioners of homeopathic medicine, ultimately finding no relief.

This is especially tragic because of growing evidence that early intervention can prevent mentally ill people from further deteriorating.

Additionally, growing insecurity, pervasive poverty, political uncertainty, genetic factors and a lack of economic opportunity all pose a significant risk to mental health in Pakistan.

Pakistani women face an even greater risk as frequent targets of domestic violence, toxic in-laws, and are constant victims of gender-inequality. With such a volatile environment; I can only foresee that mental disease will be a growing problem.

A homeless mental illness patient at the Shrine of Baba Bulleh Shah in Kasur. —Photo by Saad Sarfraz

Our government needs to recognise its responsibility to monitor human rights, empower women, and increase awareness about mental illness.

On an individual level, stigma and shame must be uprooted from our communities. The therapy itself involves emotional suffering, vulnerability, anxiety and sadness.

The least we can do is to allow for mentally ill patients to seek adequate support.

In a country that is already casualty to many ills, the human toll of neglecting mental health can no longer be refused.