IN Tharparkar recently, a man killed three of his children by throwing them down a well, and then proceeded to take his own life. A report published by the Sindh Mental Health Authority has revealed high rates of suicide and mental illness in Tharparkar, one of the most impoverished regions of Pakistan. While most mental health research in Pakistan has occurred in urban and peri-urban areas, this groundbreaking study is one of the first of its kind to be conducted in an impoverished rural area.

Some startling discoveries have been made, such as the fact that most suicides are in the age bracket of 10-20 years which is vastly different from the rates commonly seen in the rest of the country with most victims being in the age range of 20-35.

So why are young people from impoverished communities taking their own lives and what can we do to stop this?

The Asian Development Bank estimates that roughly a quarter of Pakistanis live below the poverty line. The relationship between poverty and poor physical health is well known, with the prime minister in his first speech highlighting the imp­a­cts of poor nutrition on the health of young children from impoverished families. However, little attention is paid to the psychological problems resulting from the stressors stemming from poverty.

Psychological traumas associated with poverty don’t just arise due to material deprivation.

Realising this gap, the World Federation for Mental Health selected ‘Mental Health in an Unequal World’ as the theme for this year’s World Mental Health Day that was observed yesterday.

Research has shown that the psychological traumas associated with poverty don’t just arise due to material deprivation but also the self-perception that one has less as compared to others. Access to social media has made this even more pronounced with a click of a button allowing affected youth to view the luxurious lifestyles of the privileged and draw unhealthy comparisons with their own quality of life. This results in a sense of deprivation, resentment, despair and eventually ends up in mental health problems.

Psychological problems result in a myriad of problems for youth living in poverty. Compromised cognition results in poor academic performance, early school dropouts and reduced productivity. This further entraps them in the vicious cycle of poverty by preventing them from securing gainful employment and achieving their full earning potential. Poor economic conditions and lack of employment opportunities further compound these problems.

To deal with the unpleasant thoughts and emotions, they often resort to unhealthy behaviours such as substance abuse, which is steadily increasing with addiction reportedly claiming 700 lives every day in Pakistan, and suicide, the majority of whose affectees are the disenfranchised youth.

Displacement of stress on others in the form of anger and aggression results in dysfunctional interpersonal relationships leading to increasing rates of domestic violence and divorce. All these problems may also encourage impoverished youth to take up criminal activities, causing an increase in violent crime, encounters with law enforcement, and subsequent incarceration.

It is no coincidence that in a recent study 85 per cent of male prisoners in a local jail were suffering from depression. Coupled with the societal stigma and lack of awareness about mental health, the impoverished youth affected by mental illness also become vulnerable to abuse. Instances of chaining to trees, harmful treatments by quacks and neglect by family members are common.

For us to address this crisis at a population level, along with supporting financial empowerment, poverty alleviation programmes need to address mental health concerns. While government-run poverty alleviation programmes such as the Ehsaas and Kamyab Jawanare groundbreaking in their scope, their impact is still limited since they don’t address the psychological problems that may be preventing affectees from escaping the cycle of poverty.

The best time to address psychological problems is as soon as possible. Early detection and intervention is also cheaper, since it prevents the onset of severe psychological problems which require costlier specialised services. Pakistan already has a vast network of Basic Health Units which offer primary care in rural areas. If mental health services were integrated into this system, many young, underprivileged Pakistanis would have early access to mental healthcare in their communities, allowing us to nip the problem in the bud.

Furthermore, research has found that every Rs1,000 invested in mental health yields a return of Rs5,000 to the national exchequer due to increa­sed productivity and decreased treatment costs.

It may be argued that the main connection between poverty and mental health is material need and financial empowerment alone can be sufficient in addressing the problem. However, this ignores the fact that psychological problems cut across class and are also quite prevalent in higher-income communities. In addition, research has shown that the connection between money and psychological well-being only matters up to the point at which basic needs are met. Therefore, poverty alleviation must work hand in hand with mental health interventions to truly be effective.

Investing in poverty alleviation is a bold and positive step, by the current government, that may serve to put Pakistan on the right track. However, to ensure that the gains made in poverty alleviation are not overturned, adequate attention must be paid to the mental health of impoverished communities, particularly youth. Let us pledge then to act to ensure that impoverished youth affected by psychological illnesses are looked after so we can establish a healthier and happier Pakistan for all.

Dr Taha Sabri is a public health practitioner focusing on mental health and is the co-founder and COO of Taskeen Health Initiative.

Dr Mekaiel Zia is a Fulbright scholar and a health policy and management professional with a focus on mental health.

Published in Dawn, October 11th, 2021