Health is non existent in this region for a common man, when we talk about South Asia, only affluent people can afford it in the private sector, as it has never been a priority of the ruling juntas. In the first of a 3 part series, Dr. Syed Ali Wasif speaks about the state of Mental Health Services in Pakistan.

According to UNDP report published in 2004 approximately 44% of Pakistanis are living below the poverty line and just impure drinking water is one of the major causes for 80% of the diseases. Health is a low priority and an isolated subject in our region and especially psychiatry and mental health are the most neglected and non-existent spheres in the health delivery system.

According to the WHO, mental, social, and physical wellbeing is defined as health and not merely the absence of disease. The concept of health needs to be viewed in a broader perspective, rather than just that of the physical health. Health in a nut shell it is not just a healthy body, but it also includes the mind and the social wellbeing of an individual.

Unfortunately psychiatric illnesses are considered as a major social stigma. They are ignored and overlooked in the same manner as social injustice, discrimination, crime and violence in our society. The root cause of this is illiteracy, indifference, intolerance and ignorance, which is meshed in the social fabric of our society.

Patients suffering from psychiatric illnesses are kept locked in their rooms or are chained at shrines were they are abused in every possible form (physically, psychologically, sexually, and emotionally) by the faith healers. On the other hand faith healers and pirs have a strong net work of their followers and are patronized by the people and the governments (ministry of Auqaf and religious affairs) because of their pseudo religious influence on the society and their dogmatic approach, which is acceptable to the common people of our society and it equally serves the interest of the ruling classes.

A common ailment like chronic headache, depression, hysteria and psychosis are treated by emulates / “taweez” which are given to them after attaining lots of gratification “nazranas” from them. At times they are smoked with “Chilies” and “Onions” or are burned and bruised with red hot Iron (Dum) on their affected parts, to demonize them of bad spirits, gins and the spells of black magic. All of this abuse is acceptable to the man and his family, who is subjected to a faith healer; the reason is the social acceptability towards these pseudo-religious rituals, lack of awareness and the callous attitude of our society towards the mentally unwell and un-firm people.

When we review the historical development of psychiatric services in Pakistan, it is necessary to keep in mind the historical development of health services in the subcontinent. The socio-cultural economic and political changes that followed the introduction of British rule had given almost a fatal blow to every facet of life including the medical and public health services. Health services were subordinated to the commercial political and administrative interests of the imperial government, which is unfortunately still prevalent.

The colonial masters had introduced the western system in the later half of the 18th century principally to serve their colonial aims and objectives. A royal commission on health conditions was appointed in 1858 that brought the need for extending services to the civilian population. In spite of which a very thin population was provided with these services and mostly services were only provided when there were any out brake of massive epidemics of cholera, plague, smallpox and other infective diseases.

What ever is true for the general medical services, it is also true for the services in the field of mental health. The very few institutions, which were built in the pre-partition times, were large custodial type of mental facilities in Lahore, Bareilly, Patna and Bombay. When Pakistan came into existence there was only one mental hospital in Lahore built in 1940 and a small institution which was privately donated by a Zoroastrian/ Parsi Philanthropist of Karachi named Sir Cowasjee Jehangir, who built it in 1865. What has been designated as government mental hospital Peshawar was a small ward built in the premises of the prison in Peshawar which now has been extended and later another hospital was established at Manshehra.

National Health Services were evolved during 1947 to 1957 which continued on the same old faulty policies, left to them by their colonial masters. The Government of Pakistan was advised that it would be more economical and prudent to lay out massive investment in large mental hospitals. However in few years it was decided that instead of mental hospitals each teaching hospital should have a psychiatric unit in the first phase. This would be followed by psychiatry wards in the district hospitals. This concept was further extended in 1972 to provide psychiatric services down to the Taluka hospital, which served a population of 500,000(but this happened only on paper).

At present there are about 3000 beds in state sector (a little more than 2000 in mental hospitals and about 1000 in state run teaching medical institutions). In private sector estimated beds are approximately 2000. There are 200 psychiatrists in Pakistan mostly located in major cities like Lahore and Karachi.

It is true that all teaching hospitals now have a psychiatric unit in some form or the other, but lacking in its proper structure, to serve the special needs of the special segments of the society.

Dr Syed Ali Wasif lives in Karachi and works with children and on child abuse in Pakistan. He can be contacted at wasif_ali@hotmail.com

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