In recent years, mental health as an industry has grown in Pakistan due to more awareness and acceptance among people. The idea of seeking help has increased, however, the professionals and resources devoted to this industry have not grown at the same rate. In this article we will look into the mental health industry in Pakistan, focusing on its contribution to the Gross Domestic Product (GDP), the labour force participation, its challenges, the government’s role, and the effects of Covid-19 on the overall picture of the industry. The following paragraphs will also give a brief historical analysis of how the industry has evolved over the years.
In a developing country like Pakistan, there are several social, economic and political issues. With high peaks in population growth and limited resources, the government has not yet been successful in providing satisfactory living standards to its citizens. In an abundance of such problems, lawmakers do not consider mental health a priority. “The proportion of the health budget to GDP is 3.9% out of which only 0.4% of the expenditures are devoted to mental health.” (WHO, 2009). This shows that the budget allocated for healthcare itself is quite low, and the mental health sector receives an even smaller proportion of this budget. The rich in the country have the privilege of receiving a share of the 0.4% for their mental health care, leaving the poor to suffer, with almost no access to treat their mental illnesses. The main reason for this is that most of this budget is spent in urban areas of the country, where only the privileged can access the facilities available.
A big contributor to the government of Pakistan investing less in the mental health industry is its low rate of return. There are not many professionals skilled in the field, resulting in a lack of contribution to the GDP compared to other industries, i.e., the agriculture industry. This can be seen by the fact that “mental care costs and productivity losses contributed 37pc and 58.97pc of the economic burden respectively”. Nonetheless, there are still professionals who practice privately, contributing somewhat to the GDP of the country.
To have an idea about the limitation of resources in this field, we must look at the following data: There are only 350-400 qualified psychiatrists in Pakistan, making it an alarming ratio of one psychiatrist to half to a million people. This shows that the lack of awareness is a major issue when it comes to mental health, as there are not enough professionals in this sector. There is a high demand for experts in this field, but due to stigmatization, there are only a limited number of professionals who can provide mental health care and assistance. Awareness campaigns and budget allocations are also not implemented resulting in a large gap between patients and specialists in this field.
The history of the mental health industry proves, yet again, that a lack of attention given to this industry, failed to make a significant impact regardless of several efforts. After independence, Pakistan continued running the British India Lunacy Act 1912 in regard to mental health. The Act did not have any treatment policies but was focused more on detentions. After the 1970s, mental health advocates became more active in mental health legislation which persuaded the Government of Pakistan to provide new reforms.
In 1992, the government once again circulated a new draft to psychiatrists for their comments. Furthermore, the Lunacy Act was last revised in 2001, which focused on providing less restricted mental health care. Since then, the mental health department has made some efforts to give rights to mentally challenged people. The policies were again revised in 2003 and the new goal was to provide service consumers with voluntary and involuntary treatments, and accreditation of professionals and facilities.
Despite the fact that the national mental health authorities and ministries give their recommendations to the government on mental health policies and legislations, only Punjab and Sindh are following these policies. This is due to the lack of sufficient resources present, as well as the inaccessibility of community work, which is only easily accessible in the big cities of Pakistan. In the community-based psychiatric inpatient units, only 1% of the 1.926 beds per 100,000 populations are available for children and adolescents. Currently, the country faces challenges in implementing the Mental Health Act because there is no organizational representation of mental health within the Province ministries. It is also evident that for these acts and policies to work the hospitals need a significant number of professionals and resources.
Additionally, as mentioned before, the budget for the mental health sector is only 0.4% (WHO, 2009), and this lack of funding makes it very difficult to run policies smoothly. In recent years, there have been increasing demands for a legal platform that can support mentally ill patients; however, the lack of trained lawyers in health laws, makes it difficult to voice these demands accurately. To relate these issues to the current times, the Covid-19 pandemic has further worsened the mental health of the citizens in Pakistan, putting greater pressure on the government to manage the increasing problem. These interventions by the government are necessary to ensure that the welfare of the citizens is their priority, as economic activity cannot take place if this priority is not met.
The government of Pakistan has made some efforts, one of them being a 26-page document advising people on how to tackle the psychological impacts of the pandemic. “It provides basic instructions for dealing with how to avoid stress, tension, anxiety, and help to each other during the lockdown” (Mumtaz, 2020). It is available in many of the local languages and strictly follows WHO guidelines. In addition, professionals in public hospitals are also trying their best to control the increase in mental health issues with the use of available resources. People living in urban areas often have access to mental health professionals such as psychologists and psychiatrists, however those living in rural areas are not as privileged, also considering mental illnesses are still a taboo for many in Pakistan. Therefore, civil society organizations such as “Amazai Development Program and Sarhad Rural Support Programme are actively working in collaboration with local administrations to extend facilities to manage mental health issues, especially in rural communities of the country. Furthermore, the government has also opened a few rehabilitation centres, providing access and services 24 hours a day for any mental health emergencies. However, these are only present in the big cities of Pakistan, ignoring most of the population that lives in rural areas.
After analyzing the state of the mental health industry in Pakistan, it can be concluded that it is not given the funding and resources that it should be. The stigma, as well as the lack of awareness in regard to mental health, is severely hindering the progress of the industry. It is impertinent that a significant proportion of the resources available in healthcare be directed towards mental health awareness and treatment. It is important for the ministries and the government to educate citizens about growing concerns about mental health in our community. The public and private sectors both need to play their respective parts to improve the well-being of their citizens- which will then help the nation move forward economically.
Authors: Rukaiya Habib, Sania Karim, Sara Jehangir, Sidra Saleem.
Ilyas, F. (2016). Mental illnesses cost Pakistan over Rs250bn annually. Dawn
Malik, M. A., & Khan, M. M. (2016). Economic burden of mental illnesses in Pakistan. Journal
of Mental Health Policy and Economics, 19(3), 155-165.
Mumtaz, M. (2020). COVID-19 and mental health challenges in Pakistan. International Journal
of Social Psychiatry.
S.H, Ahmad, MN, Siddiqi, & Raza-ur-Rahman (2015). Implementation of the mental health act; are we ready? The Journal of the Pakistan Medical Association
World Health Organization. (2009). Mental health system in Pakistan. WHO-AIMS