BY M A L I K M U B B A S H A R | 2/17/2019 12:00:00 AM

ACCORDING to the World Health Organisation, one in four individuals suf fers
from mental illnesses or disorders. By 2020, depression will become one of the
leading causes of death across the globe.

This may be surprising for a layperson, but for those who have been paying attention,
there are no revelations in this data. At present, psychiatric diseases and behavioural
disorders constitute over 40 per cent of the global disease burden. This high number
has resulted in international movements for treatment and protection of those with
mental illness.

Mental illnesses include many disorders such as schizophrenia, psychosis, bipolar

disorder, post-traumatic stress disorder, eating disorders such as anorexia and
bulimia, anxiety, depression, neurosis. There are many other sinister disorders and
diseases of the mind. To not recognise their threat as a national health concern will be
a monumental failure. While we think of lifestylerelated illness such as diabetes,
heart disease and cancer as the leading causes of mortality, we forget that mental
disorders are, in f act, f ar more common than the aforementioned maladies.

Unfortunately, while a faulty heart or a failing kidney is not ignored, signs and
symptoms of mental disorders are grossly neglected through their non-detection,
misdiagnosis and inappropriate treatments. In typical cases, the symptoms are non-
physical and hence unclear for immediate detection or treatment. As a result, more
serious psychiatric cases are ignored or dealt with using measures that worsen the
patients` mental condition.

But the effects of such neglect do not end there. The stigma associated with these
illnesses has never really been addressed. In recent years, there has been growing
awareness and treatment for mental illness around the world. Our country, however,
fails to meet the universal standards of treatment and protection appropriate for such
mentally ill individuals. What follows for such a mentally ill patient raises bigger
concerns.

Since many a time such patients are accusedof or involuntarily involved in activities
that may be criminal, such individuals are of ten placed at the mercy of those within
the criminal justice system. According to official figures, approximately 188
recognised mentally ill prisoners are locked up in Punjab`s prisons alone. Meanwhile,
with 4,688 prisoners currently on death row, it is unclear how many of them are
mentally ill or have become so living under horrid, overpopulated prison conditions.

Reportedly, 10pc to 16pc of Pakistan`s population ie more than 14 million people

suffer from mild to moderate psychiatric illness. This epidemic was once highlighted
in the 1998 National Health Policy where it was placed as a component of
comprehensive primary healthcare under the umbrella of `health for all`. However,
following the ouster of the elected civilian government in 1999, a new health policy
was enacted in 2001. This policy made selective primary healthcare and donor
dependence for additional resources as its prime focus, and placed mental health
issues at the bottom of national health priorities.

It is no wonder then that Pakistan has approximately only one psychiatrist for every
10,000 persons suffering from mental disorders, one child psychiatrist for every 4m
children suffering from mental health issues, and only four major psychiatric
hospitals for the entire population. These shockingly low statistics contribute to the
rise in the number of mentally ill patients.

The Punjab Institute of Mental Health is one of those rare dedicated government
hospitals. But, disturbingly, the Punjab Health Department now wants to attach the
PIMHto the Services Institute of Medical Sciences.

The obvious problemwiththisislosing the opportunity to make the PIMH a teaching

hospital. We are in desperate need of more psychiatrists, yet, withouta teaching
hospital, this number cannot be radically increased.

The second problem is, again, one of placing mental health on the backburner. If
there are dedicated government hospitals for heart, kidney, and liver diseases, then
why not maintain at least one dedicated to mental health? Is even one dedicated
hospital too much to ask for? The third problem is expertise. Should a hospital, where
many patients are unfortunately violent and unpredictable, be placed under the
supervision of a doctor who supervises in surgery? Would such an arrangement be
acceptable anywhere in the world? The PIMH issue is, sadly, just one of the myriad
ones that the mental health sector faces. Mental illnesses are caused by a combination
of genetic, biological, psychological and environmental factors. It is incumbent to
adopt and implement measures and intervendonsfor prevendon of suchinnessesin
order to avoid problems caused by a lack of awareness and support.

The writer is a Sitar-i-Imtiazand Hilal-i-Imtiazdecorated emeritus professor of

psychiatry.