Suicide rate among 100,000 people in Pakistan reaches 4.4pc per year

Rawalpindi: A significant increase in number of cases of mental and neurological disorders, from mild to moderate and severe cases of depression and anxiety to substance abuse, there is a high and ever-increasing demand of mental health services from the Institute of Psychiatry and WHO Collaborating Centre for Mental Health Research & Training at Rawalpindi Medical University.

Awareness and provision of mental health though has picked up momentum over the past few years, a lot still remains to be done. Globally, 15.5 per cent of the population is estimated to have mental or substance abuse disorders. In the Eastern Mediterranean Region, of which Pakistan is a part – mental and neurological disorders are responsible for 12 per cent of all disability adjusted life years (DALYs) lost due to disease and injury, and account for 27 per cent of years lived with disability.

Substance abuse is responsible for nine deaths per 100,000 population, whereas the crude suicide rate per 100,000 per year in Pakistan reaches as high as 4.4. However, the levels of public expenditure on mental health are very meager, especially in low and middle-income countries like Pakistan.

This was expressed by Chairperson of Institute of Psychiatry and WHO Collaborating Center for Mental Health Research & Training at Benazir Bhutto Hospital Professor Dr. Asad Tamizuddin Nizami while talking to ‘The News’ on Sunday on upward trend of mental health disorders reported among population in 2018, the work being done to cater to the needs of patients and the plans needed to be followed.

He said globally, the median number of mental health workers is nine per 100,000 population but there is extreme variation (from below one in low-income countries to 72 in high-income countries). More specifically, the median rate of psychiatrists per 100,000 population in Pakistan is estimated to be 1.31, whereas globally this figure is 4.2, he said.

Similarly, whereas the median number of mental health beds per 100,000 population reaches above 50 in high-income countries, and 11.3 in the more developed countries of Eastern Mediterranean Region, this figure is around 1.7 for Pakistan, said Professor Nizami.

He added that equally large disparities exist for outpatient services, child and adolescent services and social support. “Globally, the median number of child and adolescent beds is less than one per 100,000 population and ranges from below 0.2 in low and lower middle-income countries to over 1.5 in high-income countries.”

To make the disparity even more obvious, he said the median total government funding for mental health services in Eastern Mediterranean region is just $0.70, in contrast to $96.89 in Europe. However, Pakistan ranks the highest among the region with respect to the number of mental health promotion and prevention programs reported, he added.

Professor Nizami informed that the Institute of Psychiatry, an academic unit of RMU is the only public sector institution providing mental health services in Rawalpindi. It caters for not only patients from Rawalpindi and its suburbs, but also for a large area ranging from Murree, Chakwal and Attock to other districts of central Punjab, he said.

Data from 2008 till 2017 shows that a total of 276,429 patients (12,125 of these in the Child and Adolescent Psychiatry Unit) were seen in the outpatients department with the numbers having increased 140 per cent (from 16644 in 2008 to 40032 in 2017) over these last 10 years, he said.

Similarly, a high number of patients are managed in the inpatient as well; with the numbers of inpatients being 899 (514 male and 523 female) in 2017, and 900 (523 male and 377 female) in 2018. Out of these, 40 were medical opinion or forensic opinions in 2017 and 51 in 2018.

Professor Nizami also informed that other than forensic opinions, the Institute formulated medical opinions of 79 cases seen in liaison with DHQ hospital Rawalpindi in the years 2016 to 2018 alone. The residents at the Institute of Psychiatry are also actively involved in the psychiatric patient care of the inmates of Adyala Jail, visiting the prison once per week to manage a patient load of around 60 on each visit. The Institute has also been conducting psychological assessments of the police department since 2011, he said.

The Institute also provides liaison psychiatric services to the patients admitted not only in the parent Benazir Bhutto Hospital, but also to Holy Family Hospital and District Headquarters Hospital. Data from the liaison services shows an upward trend in the number of cases being referred, with an increase of 54 per cent between one year and the next. Currently, 100 to 150 patients are being seen per month through the liaison referral system, said Professor Nizami.

He said the Institute of Psychiatry is a center for excellence for medical education and research and is now setting role models for mental health service delivery with the innovation of establishing and upgrading specialty mental health services like Old Age mental health services, Drug Detoxification services and Forensic mental health services.

He appreciated the personal interest of the Minister Health Punjab Professor Yasmin Rashid and Vice Chancellor at RMU Professor Muhammad Umar in providing support for the infrastructure for developing specialty mental health services.