The World Health Organization (WHO) released a landmark report on mental health around the world last month. The report is pivotal in terms of the evidence it provides on the global burden of mental health as well as the strategies it recommends to transform mental health care in developing countries like Pakistan.
The report reinforces, once again, the fact that mental health care is not only a fundamental human right, but a vital requirement for the economic development of any country. Unfortunately, while many countries have made considerable progress since the last World Mental Health Report in 2001, Pakistan still lacks mental health policy, rights-based mental health legislation and a comprehensive plan to strengthen existing services.
Within a week of the report’s publication, this newspaper reported that in less than six months, at least 15 young people had committed suicide in Gilgit-Baltistan. In an insightful statement, the GB Chief Minister observed: “Young people are the future of our nation and its most valuable asset. The prevalence of suicide among them is a matter of great concern to all. Therefore, we must work together to eradicate the threat among us. Otherwise, posterity will not forgive us.
The reported situation is neither new nor limited to Britain. Mortality associated with poor mental health is just the tip of the iceberg. Mental disorders are also known to be the main cause of “years lived with disability” (also called YLD). Globally, one in eight people (over the age of 10) suffers from a mental disorder, and this burden tends to reach around one in five people in countries facing humanitarian challenges. And Pakistan’s current economic, political and environmental challenges only compound the population’s high mental health risks.
Internationally, there is an encouraging movement to support the cause of mental health.
On paper, Pakistan is committed to achieving the Sustainable Development Goals, including SDG 3.4 which is linked to the burden of non-communicable diseases and mental disorders; the WHO Comprehensive Mental Health Action Plan 2013-2030; and a National Vision 2025 to improve the health of all citizens, including the most vulnerable. Yet mental health deserves to be prioritized in a health system struggling to meet the challenges of the pandemic, overcrowding, polio and tuberculosis. Psychosocial support for mental well-being can and should, in fact, be an integral part of a comprehensive response to all public health challenges.
Although the provinces have the mandate and authority (in terms of human resources, infrastructure development and allocation of financial resources) to develop and implement localized health policies, it has been realized that it is important to develop the capacity to meet the mental health needs of their population. The perpetuation of the status quo is due in large part to, among other things, the absence of technical expertise and the dearth of cost-effective and tangible solutions.
To prevent and control mental disorders, the UHC benefit package includes the essential package of health services at five complex levels: community level, primary health care centre, first level hospital, tertiary hospital and population. Providing basic mental health care to 30 million deserving applicants is by no means easy. This task requires a major multisectoral endeavor to engage local communities, build the capacity of primary health care personnel through training and supervision to treat common mental disorders, fill a critical data gap that exists due to a system outdated health management information, strengthen specialized services at district level and develop an effective referral mechanism to specialized services.
There are avenues of hope. Charged with leading a long-term vision for the country, the Ministry of Planning, Development and Special Initiatives formulates a broad sector policy framework and undertakes strategic planning. It also has a mandate to identify an overlooked area that needs attention and launch it as a special initiative. In 2021, as part of the country’s emergency response to Covid-19 in 2021, and supported by Unicef, the ministry launched a Mental Health and Psychosocial Support (MHPSS) initiative, to develop and test a multilevel digital model for mental health care.
Based on evidence, this scalable, rights-based model took into account local needs and resources, and was designed to be integrated into a telecommunications solution for a helpline. To build the capacity of mental health personnel, internationally recognized training resources, including the WHO mhGAP guidelines, have been contextualized and translated for Pakistan. Under the model and as a pilot project in the Islamabad Capital Territory, a team of 10 mental health specialists were trained to strengthen existing services and supervise primary health care staff through training.
In addition, 20 clinical psychologists have been trained under the model to support stressed populations, even remotely if necessary. Due to the use of digital technology, including a learning management system and three custom-designed mobile apps, this workforce could be a much-needed resource for other parts of the country, including Great Britain. Strong cross-sector links have been developed at the community level in Islamabad to train hundreds of community workers, health workers, teachers and students to provide psychological first aid and identify citizens in need of health care. Mental Health. These experiences can now potentially be replicated in other regions, if they find the necessary political support.
The ministry is well placed to disseminate this model in provinces and special areas such as Britain and Azad Kashmir, and to support its implementation in collaboration with line ministries. Internationally, there is an encouraging movement to support the cause of mental health through increased commitment and funding. As a result, the WHO and many other humanitarian agencies seek to support low- and middle-income governments investing in mental health projects.
The MHPSS model therefore promises a way forward to achieve the minimum standards of mental health care as outlined in the World Mental Health Report and transform mental health care for our communities.
Asma Humayun served as Senior Technical Advisor, MHPSS, Ministry of Planning, Development and Special Initiatives. Mr. Asif is Chief of Health, Ministry of Planning, Development and Special Initiatives.
Posted in Dawn, July 7, 2022