Pakistan & Gulf Economist

Mental health – most neglected field in Pakistan

Dr-Shahid-Ziapic

Lahore Mental Health Association a home of happiness

On February 11, 2022 Mr. Asad Qaiser, Speaker National Assembly Pakistan visited Fountain House, Lahore to grace the occasion commemorating its 101 year old Building.

Pakistan is home to 227,787,129 (227 million) people as of Friday, February 11, 2022, based on Worldometer elaboration. That is 2.83% of the total world population ranking it 5th in the list of countries. 35.1% of the population is urban with the median age being 22.8 years.

Mental health is the most neglected field in Pakistan where 10-16% of the population suffers from mild to moderate psychiatric illness, majority of which are women. With only one psychiatrist for every 10,000 persons suffering from any of the mental disorders, while one child psychiatrist for four million children, who are estimated to be suffering from mental health issues. Only four major psychiatric hospitals exist and it is one the major factors behind increase in number of patients with mental disorders.

This paucity of mental health professionals in Pakistan creates a massive treatment gap, leaving more than 90% of people with common mental disorders untreated. Thus, majority of the sychiatric patients go to traditional faith healers and religious healers who believe that mental illness is caused by supernatural forces such as spirit possession or testing by God. “All this is due to acute shortage of mental health professionals and relatively low levels of awareness about mental disorders”.

Pakistan among the other developing countries, has a higher prevalence rate of depression because of the current social adversities. Major mental disorders in Pakistan are depression (6%), schizophrenia (1.5%) and epilepsy (1-2%). Mean overall prevalence of depressive disorders and anxiety is 34%. Province wise prevalence is: Sindh 16%, Punjab 8%, Balochistan 40%, Khyber-Pakhtunkhwa 5%.

Lahore has the highest number of depressives that is 53.4% as compared to Quetta (43.9%) and Karachi (35.7%). The current situation in Pakistan along with other basic health problems, the social upheaval, political instabilities, lawlessness, terrorism, economic disparity, problems with security, safety, gas and electric load shedding, escalating prices of petrol, gas, and other basic necessities of life has created a ground fertile for depression which has almost taken the first position among all the psychiatric conditions.

The healthcare systems in this part of the world and particularly mental health systems had a major shift following colonization by the British. Influenced by British systems and custodial nature of care, treatment, and management of the mentally ill were mostly confined to big mental hospitals in the Indian subcontinent. Lahore Mental Hospital (Punjab Institute for Mental Health – PIMH) was an example of this type of service that continues serving large part of the country even after its independence in 1947. Following British traditions, people with psychiatric illnesses were mainly treated and managed in big institutions. The initial aim of institutionalization of those with mental illness was to segregate them from the community. But with time, it became evident that these patients required care and management in the community. This movement certainly witnessed a well-deserved recognition in Pakistan during the 20th century.

It was in this perspective that Lahore Mental Health Association (LMHA) was founded in 1962 to mobilize efforts and resources for the uplift and promotion of mental health and development of psycho-social services in the community. Lahore Mental Health Association is a registered NGO and its governing body includes eminent personalities of the nation, from many walks of life, having deep regards for the cause of mental health. Dr. Muhammad Amjad Saqib is the Executive Director/Chairman of the Association and Dr. Syed Imran Murtaza is the Medical Superintendent of Fountain House.

Late Prof. Dr. Rashid Chaudhry, founding member of the Association, worked out a plan for establishing the first rehabilitation center for the mentally ill in Lahore. A formal project entitled, “Establishment of a half-way house and day-night rehabilitation unit for persons with mental illness” was submitted to the Government of Pakistan in 1965. This proposal was supported by a formal expression of collaboration with Fountain House, New York. In 1971, Mr. John H. Beard, Executive Director of Fountain House, New York, visited the rehabilitation unit of LMHA and streamlined the close technical collaboration between the two houses. This link led to the adoption of the name of Fountain House to the newly established facility in Lahore-Pakistan that is now functioning for more than 50 years.

Fountain House was formally established in Lahore in 1971 as Pakistan’s first psycho-social rehabilitation facility. The work for setting up of such a facility was supervised by Lahore Mental Health Association (LMHA). Taking its ideology and concepts from Fountain House New York, late Prof. Dr. Rashid Chaudhry modified the services with some cultural adaptations and retaining & emphasizing an active participation of the community for this project. This was the time when most of the services for mentally ill were provided by a century old built asylum (Lahore Mental Hospital) following a system of custodial care. There was no concept of community psychiatry and patients were only kept behind high walls of the hospital without any provisions of psycho-social or community rehabilitation.

Fountain House was started in a small, rented building with a group of five schizophrenic patients who were discharged from the Mental Hospital. These patients were named as “members” of the House and were offered services to motivate and encourage them for their participation in community-oriented programs, vocational services & different social and therapeutic activities to boost their self-esteem. These initiatives gave them good feeling and espousal in the time when the mentally ill were brought for treatment in chains and most of the mental health care setups were restricted to big institutions.

With the success of initial pilot project, the services of Fountain House were extended, and more patients were taken to the facility that was moved to another rented place that could accommodate 25 persons. With the passage of time, a need was felt to have further extensions of the premises and Fountain House moved to its present building (given on lease by Government of Pakistan) where an increased number of members were accommodated.

With the help of the philanthropists, volunteers and friends of Fountain House, the services continued expanding and now the place accommodates 400 bedded in-patient units -300 beds for Males & 100 bed for females). Fountain house Lahore has also started its services for free outpatient departments; acute, subacute and long term based indoor treatment and rehab facilities; allied therapy units including art therapy, psycho drama, occupational and vocational therapy and music therapy unis along with sports therapy unit. Similarly, units for social evenings and recreational activities, library and gymnasium and physical activity are added to keep the members of the house occupied. Recent additions to the facilities at the House are transient employment programs and social workers follow up club.

Pakistan being an agricultural country, it was felt a need to extend these services to a rural area. In 1982, an extension of Fountain House was provided with an “agro-therapy unit” at Fountain House Farm Farooq Abad (a rural town around 100 kilometers from the city of Lahore) for the members (patients) coming from rural background. Recently, long term care units for women with intellectual impairment who have no care givers to take care of them as “compassion homes” have been established.

In 2015, Fountain House model was replicated in the district of Sargodha as well on a land of 8 acres. These 80 bedded facilities provide an excellent facility for the treatment and rehabilitation of mentally ill in central Punjab province and is coming up as a state of Art service in mental health.

In 2018. Fountain House, in collaboration with another charity organization (Akhuwat) extended its first kind of services to the transgender community. Addition of new services continued and Day care centers and outreach programs for children and adolescents with intellectual impairment were established. Fountain House also started a drug rehab unit for the persons suffering with substance use disorders.

This Home of Happiness has been able to rehabilitate 65000+ members (patients) back in society and benefited 200000+ by its free OPD during the last 50 years of its service. This facility has also helped in promotion and better recognition of mental health awareness reducing and overcoming of stigma linked to mental illnesses. During the pandemic COVID-19, it further extended its services by conducting free online counseling sessions, consultation services and helpline for the community.

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