Pakistan finds itself in the middle of a crippling economic crisis. According to the World Bank, Pakistan’s economy is currently under severe stress with low foreign reserves, a depreciating currency and creeping inflation. While the cost of living has arguably doubled in the last five years, salaries have stayed almost the same. The job market is gloomy and a salary which would have been considered prosperous five years ago is barely enough to make ends meet now.

With rising inflation eroding the purchasing power of consumers and exorbitant utility bills, the general public is facing an economic quandary. There has been a surge in media reports on cases of self-harm and suicide due to financial hardships.

In August, a woman in Karachi’s Orangi Town, tired of starvation and money issues, used the few hundred rupees she had to buy some petrol and set herself on fire to end her misery. A man in Faisalabad killed himself over his 40,000-rupee electricity bill. Another man committed suicide along with his four-year-old daughter by jumping into the Abbasia canal at Head Panjnad in Muzaffargarh, apparently also due to inflation and poverty.

Financial strains jeopardise family and social dynamics, which can greatly exacerbate a person’s mental distress.

The prevailing economic crises in the country are aggravating the nation’s mental health distress

Financial trauma

Financial trauma manifests itself in terms of emotional, physical, mental and relational symptoms triggered by significant financial stressors. These stressors, which include job insecurity, poverty, accumulation of debt, homelessness, food insecurity and unemployment, can pose serious risks to one’s mental health. People struggling to cope with these stressors are more prone to depression, substance abuse, violence, and homicidal or suicidal tendencies.

The symptoms of financial trauma often present similarly to those who experience post-traumatic stress disorder (PTSD). Because of the lack of awareness and stigma around seeking mental health support in our society, money-related stress is often diagnosed through physical symptoms such as migraine, chronic back pain, ulcers, high blood pressure etc, caused by psychological factors.

A ground-breaking study conducted in 2020 revealed an association between financial stress and PTSD, indicating that the latter’s symptoms were indistinguishable from those of financial stress. Dr Galen Buckwalter, a research psychologist and an expert on financial trauma, characterises this as Acute Financial Stress (AFS) or Financial Trauma, which is a dysfunctional reaction to chronic financial stress.

In October 2022, the American Psychological Association reported the highest number of people experiencing money-related stress since 2015 — 66 percent of respondents said money is a significant source of stress.

What stress does to us

When it comes to stress, our body’s responses are usually fight or flight. In a person undergoing constant financial stress, these can show up in concentration issues, disturbances in sleep and appetite, frequent displays of aggression and mood swings. Alternatively, it can show up as bouts of depression, feelings of hopelessness and avoidant behaviour.

Rumination about financial problems can trigger anxiety attacks as well as other unpleasant symptoms, such as insomnia or irritability, palpitations and shortness of breath. This is because our body releases stress hormones such as adrenaline after perceiving a threat.

Social media plays a pivotal role in aggravating financial anxiety. Comparing oneself to the extravagant lifestyles of people on Instagram or other online platforms can plunge people into depression, or into a vicious cycle of unsustainable debt.

Pakistan’s economy

Last month, Najy Benhassine, the World Bank’s country manager for Pakistan, warned the country was at a critical juncture, where it must decide whether it wants to continue being the state where 40 percent of the population lives below the poverty line or change directions towards a better future.

He said Pakistan was in the middle of a human resource, capital and economic crisis. Pakistan’s per capita is now among the lowest in the region and the country has the largest number (20.3m) of out-of-school children in the world.

Economic crises destabilise public service budgets and, amongst other areas, affect education and healthcare systems. Research has shown that both man-made and natural disasters in developing countries increase the incidence of mental and emotional health problems in the affected communities and, at the same time, they divert limited resources to areas other than mental health.

In Pakistan, political instability and the devastating floods in recent years have had an adverse impact on our economy, wrecking the agricultural and business landscape.

The most economically disadvantaged section of society faces the brunt of the economic slump. Their poverty renders them a vulnerable group for developing mental health issues, while also preventing them from accessing mental healthcare. This will translate into an inability to secure good income-generating jobs, ensnaring them in a cycle of poverty.

In most low- and middle-income countries, social factors such as poverty, urbanisation, internal migration and lifestyle changes are moderating factors of the high burden of mental illness.

Social support is one of the major protective factors preventing mental health illness but, in Pakistan’s society, the close-knit family and social system can serve as a double-edged sword. While it can foster self-esteem, provide validation and facilitate coping with setbacks, at times, social comparison or financial pressure from family can adversely impact one’s mental health.

Mental health support

The attitudes towards mental health among policymakers have a huge role in mental health policy development and facilitating access. To mitigate the mental health fallout arising from the economic situation, structural changes are required.

Abraham Maslow’s ‘Hierarchy of Needs’ is a well-known theory of motivation that ranks the needs of individuals. Depicted in the form of a pyramid, the basic needs, such as food and shelter are at the base, while the less crucial ones are at the top. This paradigm illustrates how the satisfaction of fundamental needs is directly linked to an individual’s psychological well-being.

This holistic model can be used as a framework to create interventions to tackle mental health issues, including through legislation and policy, the allocation of resources, planning and implementation, and the capacity-building of mental health professionals.

Other factors that influence service utilisation are the prevailing misconceptions about mental health and the cultural belief system that mistrusts modern “psychology”. This can be mitigated by nationwide campaigns using different streams of media to raise mental health awareness and reduce the stigma around the subject.

Making mental health a priority

Historically, mental health is not given due priority despite its growing contribution to global health. The key barriers to mental health services in Pakistan are low accessibility, competing public health priorities, a lack of investment and a dearth of qualified mental health professionals.

For rural or far-flung areas, many organisations — such as Umang and Taskeen — are now providing tele-mental health services. Mental health should be integrated into primary care in order to make it accessible. Easy and early access with referral systems, efficient service delivery, training of mental health officials, integration of mental health into health policies and national strategic plans is imperative.

To prevent mental health illnesses, policymakers and mental health stakeholders should evaluate the burden of mental illnesses, draft policies facilitating mental health provision, and facilitate the allocation of resources for the awareness and development of mental health services.

The writer is a clinical psychologist and a freelance journalist. She can be reached at rabeea.saleem21@gmail.com

Published in Dawn, EOS, October 8th, 2023