Coping with mental health issues requires acknowledgement of their existence
arbouring a quarter of the world’s population, South Asian countries (i.e., Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) have a high prevalence of common mental health problems. 150-200 million people here suffer from anxiety, depression, bipolar disorder, suicidal behaviour, phobias and abuse of tobacco/ drugs/ alcohol. The World Health Organisation’s Mental Health Gap Action Programme (mhGAP) identifies depression, bipolar affective disorder, schizophrenia, and other psychotic disorders, dementia, intellectual disabilities and developmental disorders like autism as priority mental and neurological disorders. Among the eight nations in this region, Pakistan has the highest prevalence of common mental disorders (NCBI, Frontiers in Psychiatry 2020).
From aristocrats to ordinary people, there is a plethora of common mental health issues. There is a high disease burden and no support available to the patients due to weak health infrastructure and non-existence of a well-organised primary care set up. There is besides a shortage of psychiatrists and other mental health professionals and resources. Mental health problems therefore remain unaddressed and the vulnerable population unattended.
Many women are at a risk of developing depression due to marriage-related issues, attitudes of in-laws and domestic violence. An article in PubMed (2013) reported that post-partum depression in Pakistan was another neglected issue and has a prevalence rate of 28-63 percent.
Among men, owning up to a mental health problem is often considered a sign of weakness. Work and home-related stress, use of illicit drugs and alcohol, childhood trauma and family history of mental health problems are some of the contributing factors in depression among men. Poverty, illiteracy and unemployment are strong predictors of mental health problems. An association exists between gender-based violence and mental health problems. A higher percentage of physically abused women were found to be anxious and depressed, leading to a vicious cycle.
Depression seems to affect the young and old alike. A systematic review in 2020 showed that 42.6 percent of university students had depressive symptoms. A population-based cross-sectional study from Karachi showed a high preponderance (40.6 percent) of depression among the elderly population (BMC 2013).
The benefits of integrating mental health into primary care are manifold. Placing psychologists in primary care centres will provide a cost-effective method for mental health well-being and support at an early stage. This will not just improve access to the population as a whole but will also reduce morbidity and mortality from chronic diseases.
A surge in mental health issues during and post Covid-19 infection era have been noted. Social isolation in a lockdown situation, international travel restrictions and economic repercussions have led to the emergence of new cases or exacerbation of existing conditions of anxiety and depression. The unprecedented Covid-19 pandemic considerably affected the health workforce, through increased work demand, fear of illness, loss of patients/ colleagues and near ones etc.
Stress can greatly affect our mental health. Sometimes managing it is beyond our control. Every so often, we think that we can cope with it on our own, but at times, it is not easy. In terms of dealing with stress, it is important to recognise it and seek help. One may require help from sources like community-based family practitioners, therapists, counsellors, etc, to learn coping skills. Certain strategies like learning new skills, having a hobby and staying active may help develop resilience and positive thinking, raise self-esteem and improve mental health. Above all, simple acts of kindness and charity can help improve mental well-being, create positive feelings and release feel-good hormones.
Having supportive family, friends and relationships gives one a sense of belonging and self-worth. Sharing your positive experiences provides emotional support for you and others.
Primary care provides the first point of contact for people experiencing mental health problems. Improving access to psychological therapies like cognitive behaviour therapy, holistic therapy etc helps people improve their mental health, deal with negative thoughts and get back to their normal lives. Mental health problems co-exist with long-term conditions like diabetes, ischaemic heart disease and chronic obstructive pulmonary disorder. Conversely, those with mental health problems are at high risk of occurrence of a broad spectrum of chronic physical conditions. Improving mental health in such patients has shown to improve outcomes in people who have long-term/ chronic illnesses.
The benefits of integrating mental health into primary care are manifold. Placing psychologists in primary care centres will provide a cost-effective method for mental health well-being and support at an early stage. This will not just improve access to the population as a whole but will also reduce morbidity and mortality from chronic diseases. This helps to improve patients’ health outcomes and reduce the workload on hospitals and emergency care. This holistic approach can also help patients self-manage their long-term conditions. Common mental health conditions such as anxiety or depression can also be diagnosed and treated early.
Mental disorders are treatable. Prevention, early identification and initial management should be focused on. The population must have access to treatment and care.
Dr Hina Jawaid is an assistant professor in family medicine at the University of Health Sciences, Lahore
Dr Abdul Jalil Khan is an assistant professor in family medicine at Khyber Medical University, Peshawar