The state of mental health in Pakistan

World Mental Health Day – 10 October – is a day for global mental health education, awareness and advocacy. On 10/10 each year professionals, health care organisations, advocacy groups, international and national agencies and individuals aim to bring attention to mental illness and its effects on people’s lives.

Over the years, as a therapist, I have observed an increase in awareness and focus by individuals and advocacy groups in Pakistan to highlight mental health challenges. Though that’s brilliant, it also serves as a reminder of the state of the mental health in Pakistan and the uphill challenges we have to face. A day of celebration and remembrance is gone by 11/10 but the suffering of someone facing psychological issues isn’t. And we’ve all got to think about it because there’s a high likelihood that someone you know is facing mental health issues: in your own home, your class, your gym, your club or at your workplace.

Here are some things that would be useful for you to know to educate yourself on this World Mental Health Day:

1. Stop stigmatising the topic

With the topic being stigmatised, most individuals don’t seek treatment believing that this wasn’t meant to happen to them, or it must be something else e.g. supernatural, temporary, etc. It’s a lot easier to ascribe our ill mental health to causes outside of us than to believe that we’re losing our mind. So people conceal their inner life and wear a mask showing they’re ok. The person sitting next to you may be wearing one, and you won’t know. In the rare instances that individuals open up to friends, coworkers and family about struggling the men are told that they are meant to be stronger; the women are told to stop thinking too much and serve families; the children are told to stop wasting time and focus on their studies; and the elderly are advised to attend to God and be grateful.

WHAT CAN YOU DO – If your brother, spouse, friend, co-worker seems distressed, irritated, gloomy, distracted, offer to listen to them if they’d like to share what’s bothering them. Don’t offer any advice, just listen to them and offer support and understanding. Validate their struggle and where you feel you can’t offer help, encourage them to seek professional help.

2. Emotional and psychological wounds don’t always show

Someone who was teased for their looks or weight, mocked for their grades, made fun of for their complexion, touched without their consent, humiliated in front of others or unfriended without explaining may seem okay on the outside, but even 20 years later be struggling very deeply as a consequence of it. We assume that someone who holds a degree, a job or having a family has come out okay, but there’s more to it than meets the eye.

WHAT CAN YOU DO – If you’ve caused this kind of sorrow to your child or friend, take responsibility. Commit to being mindful of your words from now onwards. As a parent, don’t break your child’s bones or their self-esteem thinking this is for their best. It is not, and chances are you’re reliving the trauma of your own parents treating you this way, and this cycle has got to stop with your seeking help.

As a friend, be a safe one, and not the jerk who’d be spoken about in my office 20 years later as the reason why someone quit university or didn’t aim higher in life. Be the friend that understood others when they were at our weakest.

3. Anxiety, depression, trauma, eating disorders are medically as valid conditions as hepatitis, ulcers and cholesterol.

Just like cholesterol can’t be exorcised away, and hepatitis cured by praying for it, anxiety, depression, trauma, eating disorders, etc also require attention. Mental illnesses especially psychosis, eating disorders, bipolar disorder and autism are understood to have biological roots. The estimated heritability for bipolar disorder, schizophrenia, and autism (80% or higher) is much higher than that of diseases like breast cancer and Parkinson’s disease.

WHAT CAN YOU DO – Refer them to a proper mental health specialist and encourage them to seek treatment. Don’t act doctor to your friend who says nothing makes them happy and they don’t wish to live. You won’t try to cure someone’s cancer would you? Stop trying to treat mental health concerns if you’re not qualified to do so.

4. A psychologist or therapist is not meant to give you medication

This one’s straight – if they’re doing that, they are acting unethically, and that is considered a good ground for malpractice in countries abroad. Only a psychiatrist (someone who holds a medical degree as well as a training to diagnose mental illnesses) is authorised to prescribe medication and that too if needed.

WHAT CAN YOU DO – If someone seeking help has severe symptoms (e.g. suicidal ideation and intent is strong, are hallucinating, have impaired functionality) they should first be assessed by a psychiatrist to determine if medication is necessary. For someone who feels they can work on their issues for weeks and months, a good starting point would be a therapist or psychologist.

5. People recover from mental health issues

Our brain over its entire lifespan is capable of changing and rewiring. Don’t assume that you visited a shrink 30 years ago and that didn’t help, and now it’s too late. Things have drastically changed since then, in terms of how and what we can do to help. Every year new technologies are emerging which promise better care, management, and treatments available.

WHAT CAN YOU DO – It is human to be affected by pain. If you’re in pain, seek help. It’s never too late. I work with people in a broad age range, professions, classes, sexual orientations, ethnic backgrounds, status who have benefited from being in therapy.

On this mental health day, let’s be more mindful of attending to the every day stuff that happens in our emotional lives as well as that of people whom we love and live with. Let’s not let these every day stressors become something more difficult. One day you’ll have to attend to them. So don’t wait for that. And if you or a loved one are in the midst of complicated emotional circumstances please seek help.