The Taboo of Mental Health in Pakistan
The whole healthcare system in Pakistan is nothing less than a sham. From underpaid healthcare providers, a lack of trained staff, and negligent doctors to a lack of medical equipment and fraudulent pharmaceutical companies, the healthcare system in Pakistan is somewhat facing a crisis within itself. But if we must put a finger on the most neglected and least talked-about healthcare department, it will be the mental health department.
We have only recently started talking about mental health and the stigma related to it. A few years ago, the only cure prescribed for any mental disorder was to be more religious. But now, with the alarming rise of suicide rates in Pakistan, especially due to academic and financial pressures, people have started to detach mental health from religious connotations. However, the healthcare system and people at large simply do not care how people with mental disorders are dealt with within and outside the hospital boundaries.
The mental health department involves the active role of psychiatrists, psychologists, and mental institutions. Mental institutions, or as a layman would call them, “mental asylums,” include all the institutes where all the patients are “kept” to treat their disorders. At its inception, Pakistan had only three mental hospitals in Hyderabad, Lahore, and Peshawar but as of 2024, the number has risen to almost 300. But the question is, how are the patients being treated in these facilities?
The Condition of Mental Health Institutes in Pakistan
At the surface level, things look fine but once a person starts to work in one of the institutions, it’s only then that they are able to see the harrowing conditions of those places. When visiting a mental institution, a few things are common among all the inpatients, regardless of their diagnosis and severity. The slow walk, the droopy eyelids, and the drooling mouth as if they all have been given the same dosage. When a patient enters a psychiatric facility, their words lose credibility; subsequently, their anecdote of being mistreated by the staff and management is brushed aside.
Upon admission into the ward, the most common practice is that families and patients aren’t allowed to contact each other for almost a month, which makes it seem more like a prison than a treatment center. The patients have to beg for a single phone call to their families that they may or may not be allowed to make. While this policy might have some pros, it’s hard to neglect the abuse that exists under the pretext of this policy.
Although the research data regarding the family’s active involvement in in-patient psychiatric treatment is insufficient, there are few studies that suggest that the non-involvement of the family leads to non-compliance with medication once the patient is released from the institution and, hence, more frequent relapses. There is no regulatory body that is monitoring these institutions as the Federal Mental Health Authority became defunct and was dissolved in 2010. Moreover, basic hygiene is questionable in these places.
Not only are these places severely understaffed but there is also a general lack of empathy among the doctors and psychologists working there. Isolating and tying up patients just because they are being loud or visiting the doctor/psychologist’s cabin too often is the norm. Someone who has worked in any such institution, like me, would know that the above statement is quite a common occurrence, and as inhumane as this practice is, it inculcates fear among the inpatients to say anything against the administration.
Research shows that there are approximately 400 psychiatrists and 500 psychologists in all of Pakistan, therefore the doctors and the psychologists in these institutions are understaffed and overworked. There are at least 100 severely disturbed patients under the observation of a single doctor/psychologist and exhaustion by the end of the day is inevitable. The staff in these facilities is untrained to deal with mentally unstable patients so they use some sort of abuse or violence to keep the patients “under control.”
There is also a lack of proper security, so the administration has to fend for itself in case of any mishap, which is another reason why healthcare providers avoid working in these places. After experiencing working in one of these mental health facilities, I cannot doubt that these places do provide the interns with a lot of experience, but multiple interns are assigned to a single patient, which overwhelms the patient, making them agitated rather than better.
Why Patients Relapse
The frequent relapse is another common thing among the inpatients of such facilities. After spending the set duration for the “treatment,” they are sent back home. The sad part is not only the reluctance of families to take them back but also that they are back in the institution within a short duration. There is a multitude of reasons behind this.
- The patients are not provided with adequate therapy to help them manage their disorder in the outside world.
- The high dosage of medicine is the patient’s main complaint while living in an asylum.
- The patients are non-compliant with medication as soon as they leave, making their disorder more severe than before
- The patients lack social support from their own families and are labeled for the rest of their lives.
- Families are neither actively involved in the treatment process, nor are they adequately psycho-educated about dealing with the patients. Therefore they prefer not to take their loved ones home and hence, the patient stays in the asylum for most of their life as a dysfunctional individual.
These mental institutions are not all bad as they provide temporary relief to families, and they do offer some level of treatment and rehabilitation, but the drawbacks outweigh the benefits. Pakistan should at least treat patients with mental illnesses with less abuse and more empathy. The government and healthcare regulatory bodies of Pakistan should also investigate the horrors of these places and make strict policy frameworks accordingly.
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Hareem Amna graduated with a degree in applied psychology from GCUF and a post-graduation certification in clinical psychology from Kinnaird College. She is an aspiring writer focused on writing about current issues.