Neglect of mentally ill patients in Pakistan

Awareness of mental health issues is increasing, although stigma persists. Addressing the stigma and providing necessary attention to mental health within the family context is crucial for effective care. In a country where children struggle with hunger, it is unsurprising that mental health often goes unaddressed. In Pakistan, individuals with severe psychological disorders often face prolonged stays in mental hospitals and rehabilitation centers, largely abandoned by their families. This troubling phenomenon raises significant questions about societal attitudes and government responsibilities. Understanding the underlying causes of familial neglect and outlining actionable steps for the government to address these issues is crucial for improving the mental health care system in Pakistan.

“Family members can play a major role in ensuring that a loved one with a mental illness is able to receive the treatment they need and live a fulfilling life.” — National Alliance on Mental Illness (NAMI)

This statement from NAMI emphasizes the vital role of family involvement in the treatment and support of mentally ill individuals. Mental illness in Pakistan is heavily stigmatized, often perceived as a source of shame. Families may distance themselves from relatives with mental disorders to avoid social embarrassment and discrimination. This stigma is rooted in cultural and religious misconceptions about mental health, leading to a lack of empathy and support for affected individuals. Many families lack proper understanding of mental health conditions and their management. This ignorance leads to fear and helplessness, causing families to feel ill-equipped to care for mentally ill relatives. Without adequate knowledge, families may believe that institutionalization is the only viable option. Approximately 24 million individuals in Pakistan are estimated to require psychiatric care. However, there are only around 500 psychiatrists available, as noted in an article referenced by The Lancet. More than 90% of those with common mental disorders do not receive treatment.

“Mental illness is not a choice, but recovery is. Families can support their loved ones in making that choice by creating a supportive and understanding home environment.” — Unknown

Caring for a mentally ill family member can be financially burdensome. In a country where many families struggle to meet basic needs, the additional cost of mental health care can be prohibitive. As a result, institutional care, often perceived as a less expensive option, becomes the default choice. In 2024, Pakistan continues to grapple with high inflation, albeit at a reduced rate compared to the previous year’s peak. As of April 2024, the inflation rate has dropped to approximately 17.3%, down from 20.7% in March, following a record high of 38% in May 2023. While economic policies and international financial assistance have contributed to this gradual improvement, inflation remains a significant challenge. Due to these economic pressures, families often find it financially unfeasible to care for mentally retarded patients at home, leading to their institutionalization.

There is a lack of community-based support and resources for families managing mental health conditions. Without access to counseling, respite care, and financial assistance, families may feel overwhelmed and incapable of providing adequate care at home. The government of Pakistan has historically underfunded mental health care, resulting in inadequate facilities and services. Mental health policies, if they exist, are poorly implemented, and there is a lack of a comprehensive mental health strategy that addresses the needs of patients and their families. Existing laws related to mental health care are not strictly enforced. The absence of accountability mechanisms means that hospitals and rehabilitation centers often operate without proper oversight, leading to substandard care and conditions. Mental health is often overlooked in the broader public health agenda. Government resources are typically directed towards more visible and immediate health crises, leaving mental health issues underfunded and under-prioritized.

“Caring for someone with a mental illness can be challenging, but it is also an opportunity to show love, patience, and understanding in ways that can transform both your lives.” — Unknown

This quote speaks to the transformative potential of compassionate caregiving for mentally ill family members. The government should launch nationwide awareness campaigns to educate the public about mental health issues, dispel myths, and reduce stigma. Collaboration with religious leaders, community influencers, and media can help shift societal attitudes. Developing and enforcing robust mental health policies that ensure adequate funding, resources, and infrastructure is essential. Policies should include provisions for regular monitoring and evaluation of mental health services. Enhancing community-based support systems can reduce the reliance on institutional care. Programs offering counseling, financial assistance, and respite care can empower families to take an active role in their loved ones’ care. Establishing community mental health centers that offer accessible and affordable care can bridge the gap between institutional care and home care. These centers can provide outpatient services, crisis intervention, and ongoing support for patients and families. Integrating mental health services into primary health care can ensure early detection and treatment of mental health conditions. Training primary care physicians in mental health care can improve diagnosis and reduce the burden on specialized facilities. The government should enact and enforce legislation that protects the rights of mentally ill individuals and ensures their access to quality care. Incentives for families who actively participate in the care of their mentally ill relatives can also encourage more involvement.

“The simple act of caring is heroic.” — Edward Albert

By addressing these issues through comprehensive and sustained efforts, the government of Pakistan can significantly improve the mental health care system, ensuring better outcomes for mentally ill individuals and their families. This shift towards shared responsibility can foster a more inclusive and supportive society for those suffering from mental health disorders. The government of Pakistan should establish scholarships for families of mentally retarded patients to ease the financial burden and encourage home care. Additionally, a tracking mechanism should be implemented to ensure patients are returned home and accompanied by mental hospital staff to verify their well-being and support family integration efforts. —Sadaf Iqbal (The writer is a clinical psychologist)