The launch of a local community-based mental healthcare initiative in Karachi has been a source of sorely needed good news from the city. The project, appropriately titled "Shamil" (inclusive), will initially start its operation in Korangi, and focus on providing information on mental healthcare via lady health workers, who will move from door to door and identify patients in middle and lower income communities.
This collaborative initiative by local NGOs and mental health professionals is a well-meaning gesture, as it would provide much-needed relief to those who traditionally do not have access to such help and treatment. Health in Pakistan is generally a neglected sector. Mental health carries the additional weight of lack of knowledge among people and a strong social stigma attached to it. Since focusing to improve the mental health of the population is at the periphery of the decision-makers' priorities, there has been no authentic nation-wide survey to determine the portion of the population living with this burden.
However, according to the World Health Organisation (WHO), "as many as 67 percent of women and 25 percent of men in [Pakistan] suffer from psychiatric illnesses at any given time." Owing to the country's security situation, rising inflation and energy crises, and their adverse effects on the psyche of the general population, it is difficult to contest the WHO figures. In fact, a survey conducted by a local NGO in North and South Waziristan found that 80 percent of the residents had been affected mentally.
The lack of importance given to people's mental condition throughout our history can be illustrated with the fact that till the start of the 21st century, the primary mental healthcare-related legislation in Pakistan was an archaic law titled the Lunacy Act of 1912. True to its outmoded and derogatory name in today's world, the law was woefully inadequate. It undermined the subsequent progress made in this field in getting the society to understand and accept such illnesses.
The subsequent legislation, Pakistan Mental Health Ordinance of 2001, which was a culmination of a long struggle of mental health practitioners and advocates, is a much more comprehensive and updated piece of legislation, emphasising the rights of mentally ill people. Unfortunately, however, mechanisms essential to implement this legislation have been widely missing. Thus even after more than 10 years, there has been no groundbreaking achievement in raising the public's mental health literacy, especially of the middle and lower-income groups, or improve the availability of mental health services.
These two problems - insufficient knowledge about the nature of such disorders and inability to seek help - are the biggest challenge facing the already struggling mental healthcare sub-sector. The social stigma of being a "lunatic" is so strong that people either ignore mild disorders or resort to superstitions and paranormal reasons for the fear of being ridiculed or ostracised.
Today, the need of the day is an extensive programme, backed by a massive media campaign, aimed at effectively incorporating mental health into primary healthcare. While doing so, voices need to be strong enough to cut down the fence of silence surrounding this issue. The National Mental Health Programme developed in the 1980s was a positive step in this direction, since it aimed to promote understanding about mental health and give poor people access to mental healthcare services by promoting community involvement. But the pace of progress has been painfully slow.
Countries across the globe recognise the importance of the psychological well-being of the individuals in the overall health of communities. The tiny Himalayan kingdom of Bhutan employs a unique concept of Gross National Happiness (GNH) as opposed to Gross Domestic Product (GDP) to measure its progress. Instead of measuring only the physical output - production and consumption - the concept of GNH focuses on the social, emotional and spiritual needs of the people, ie, how they feel about themselves and their lives.
Our policymakers would do well to learn from their Bhutanese counterparts in giving more importance to the emotional and psychological wellness of the people. It is perfectly legitimate to allocate a large portion of the budget to defence and development spending. But such expenditure should not come at the cost of neglecting those areas, which directly affect peoples' ability to lead happy, fulfilling lives. Mental healthcare is too important to be ignored. The sooner we, as a society, learn to accept this reality, the better chance we will have to effectively combat it.
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