PAKISTANIS are rightfully upset at US President Joe Biden’s categorisation of their country as “one of the most dangerous nations in the world”. Perhaps our ire would be less if he had referenced urgent present-day challenges — climate change, food insecurity, domestic militancy — than the tired trope of nukes in unstable hands. The fact is, Pakistan may well be a dangerous nation — but not for the reasons Biden suggests. And sadly, we are probably a greater danger to ourselves than any external party.

One reason for this is the unprecedented and mounting mental ill health in the country. The mental health crisis has yet to be taken up and prioritised by our policymakers, but it is likely driving widespread social and economic challenges. Left unaddressed, Pakistan’s collective mental health will become increasingly dangerous.

In a recent column on these pages, Asma Humayun laid out the mental health challenge created in the wake of this year’s devastating floods. She quoted WHO estimates that one in five people need mental healthcare in a humanitarian crisis, and highlighted that 55 out of 80 districts most affected by the floods do not have a single psychiatrist. This is today’s crisis, but it may be worse in the future.

A recent study in the Journal of Child Psychology and Psychiatry found that the stress expectant mothers experience during a natural disaster significantly increases the risks of childhood anxiety, depression and other behavioural disorders, including attention deficit and disruptive behaviour. The study — based on children who were in the womb during Hurricane Sandy in the US in 2012 — found that 53 per cent of children exposed to the hurricane in utero suffered from an anxiety disorder, compared to 22pc who were not.

There is a material economic cost to a mental health crisis.

Given that approximately 650,000 pregnant women have been affected by the floods, we can expect a marked uptick in childhood mental ill health over the coming years. And this will have future repercussions because poor mental health in childhood and adolescence is known to increase the likelihood of poverty and other health implications in adulthood.

For Pakistanis, the flood-related mental health challenges come in the wake of the pandemic, during which the global prevalence of anxiety and depression increased by 25pc, according to the WHO.

And before that, Pakistanis endured over a decade of conflict in the form of widespread militancy and terrorist attacks (this in addition to the routine and horrifying levels of violence that inhere within our fragmented cities, feudal systems, law enforcement and patriarchal structures). WHO estimates published in a 2019 study in the Lancet found that one in five people in an area affected by conflict suffers from some form of mental disorder, ranging from mild depression to anxiety or psychosis. In the late 2000s and early 2010s, there were many reports of rising levels of PTSD among civilian populations. The resurgence of the Pakistani Taliban in the northwest will be deeply triggering for many.

The drivers for poor mental health among Pakistanis are increasing and intersecting, but support is not forthcoming. Pakistan has one psychiatrist for every 100,000 people and 90pc of people with mental disorders remain untreated, according to a 2020 write-up by Siham Sikander in the Lancet.

The cumulative national mental health crisis has serious social implications. For many, particularly men, mental ill health manifests as substance abuse, anti-social or violent behaviour, and the inability to work. This means increases in crime, domestic violence, addiction and other challenges — but at unprecedented scales, likely sufficient to destabilise families and communities.

There is also a material economic cost to a mental health crisis. Men­tal health and poverty exist in a vici­ous cycle: people suffering from mental health issues struggle to find and keep jobs, and their family members are impoverished as they are burdened with caring responsibilities. At the same time, poverty and widening income inequality fuel depression and other mental health challenges, which in turn drive further poverty.

The World Bank has estimated that up to nine million Pakistanis have been dragged into poverty due to the loss of livelihoods, livestock, homes and harvests in the flooding; mental health implications may cause this number to soar.

So here’s what lies ahead: more despair, more conflict, more poverty, a socioeconomic spiral and an endemic mental health crisis, affecting youth and adults alike. As our government tries to forge a future for our flood-affected country, it must prioritise both mental health support and poverty alleviation programmes to ensure that Pakistan doesn’t find itself in a truly dangerous position.

The writer is a political and integrity risk analyst.

Twitter: @humayusuf

Published in Dawn, October 17th, 2022