MENTAL HEALTH AND RELATED HEALTH INSURANCE POLICIES IN PAKISTAN

1. INTRODUCTION

There is an alarming increase in the number of cases of mental illness due to a persistent wave of

violence, political turmoil and frequent changes in the social fabric in many countries worldwide, and

Pakistan is one of them. As a subsequent result of this, a range of psychiatric disorders have been

reported, such as depression, substance and alcohol misuse, schizophrenia, bipolar disorder, and post-

traumatic stress disorder. More suicides are committed every year in both developed and developing

countries as a result of these mental health problems.

Mental health problems in Pakistan, a developing country, have in the last few decades reached an

appalling level linked to both the current violence in Pakistani society and disruption in its social

structure. Many researchers have agreed that the psychological outcome of the communities as a whole

will be that of resilience rather than psychopathology. Nevertheless, a greater magnitude of exposure to

traumatic events is known to be associated with the greater prevalence of severe mental health problems.

This continuous violence and threat to life has had a damaging effect to the psychological health of many

people in general and particularly in Pakistani society.

The health care treatment system’s way of dealing to these problems is different in developed and

developing countries across almost all dimensions including: policy, the role of educational institutions,

financial resources, infrastructural development, public-private partnership, academic and research

endeavours, civic amenities and human rights issues. Developed countries are further ahead in utilizing

more resources and having consistent comprehensive educational and treatment policies to deal with

mental health issues effectively. In developing countries like Pakistan the number of psychiatrists and

psychiatric beds per head of population is much smaller and the majority of people having psychiatric

disorders cannot afford the treatment expenses since these must usually come from their own pocket and
where there is low average annual income. Fundamentally, there is no established model for mental health

care in most developing countries and the majority of psychiatric patients thus seek treatment from non-

professional healers using psychobabble—psychological jargon used inaccurately to talk about someone’s

personal or mental problems. In developed countries, by contrast, the availability of community-based

psychiatric services led by trained professionals and supported by specialists is the established and

effective treatment system. Access to such services rarely comes with an out-of-pocket payment since

taxation or insurance-based funding is used.

2. CURRENT SITUATION IN PAKISTAN

The prevalence of mental health problems in Pakistan is increasing rapidly due to current violent situation

in Pakistan society. Common mental health problems have been identified in both the rural and urban

population which seems to have a positive association with socio-economic adversities, relationship

problems and lack of social support. The number of people suffering from depression and anxiety

disorders is high followed by bipolar, schizophrenia, psychosomatic disorders, obsessive compulsive

disorder and post-traumatic stress disorder. Depression is also highly prevalent amongst Afghan refugees

residing in Pakistan. In addition, there is a serious problem of substance misuse and drug addiction. About

four million drug addicts have been estimated in the last national survey in Pakistan with an increasing

number of injectable drug users in the urban population creating the public health predicament. However,

the incidence among adults is under-reported due to social stigma in the context of family pride.

Nevertheless, the current wave of violence and aggression in Pakistani society is not a simple

phenomenon. There has been an increase in violence over the past five years in Pakistan, such as suicide

attacks, explosions, and even safety precautions, such as long curfew hours have caused damage on an

unprecedented scale. The local inhabitants have experienced a heavy battle between the security forces

and insurgents. In addition to the continuous violence and threat to life, there has also been a damaging
effect to the psychological health of many people. Psychological trauma as consequence of violence is on

the rise, prevailing in the whole area. As a result, individuals are manifesting a number of symptoms of

psychological trauma and anxiety, which is affecting all aspects of their lives.

3. MENTAL HEALTH POLICY IN PAKISTAN

Pakistan has come a long way since it gained its independence in 1947, when there were only three

psychiatric hospitals in the country. Today around 20 medical colleges support psychiatric wards. At the

moment, there are some 4,100 beds in the public and private sector and about 342 practicing psychiatrists,

mostly located in major cities. Behavioural sciences and psychiatric training form an essential part of

undergraduate medical training.

The National Mental Health Programme, developed in 1986, aims at achieving universal provision of

mental health and substance-abuse services by incorporating them into primary health care. Via this

programme, primary-care physicians are being trained, and training manuals are being developed for lady

health visitors (a type of health worker who provides a variety of services to urban and rural communities,

including basic nursing care, maternal and child health services, and training of community workers ). In

addition, junior psychiatrists are being trained in community mental health. The importance of including

spiritual healers in the mainstream health-care and referral system has also been recognized by the

National Mental Health Programme, as they are frequently the ones having first contact with individuals

who are mentally ill.

Mental health policy is a very important and powerful tool for the promotion of mental health in any

given population. Despite wide recognition of the importance of mental health policies, data collected by

W.H.O. reveal that only 40.5% of the countries have no mental health policy. Does Pakistan have a clear

mental health policy? Local literature search gives very less information about the policy. The national

health policy of Pakistan concentrates on poverty alleviation, priority attention to primary and secondary
sectors of health to replace the earlier concentration on tertiary care and seeing good governance as the

basis of health sector reform to achieve quality care. The mental health policy was first formulated in

1997 which addressed issues of advocacy, promotion, prevention, treatment, rehabilitation and

intersectoral collaboration. It envisaged to train primary care providers, to establish resource centers at

teaching psychiatric hospitals and detoxification centers. There was provision for crisis intervention and

counseling services, special facilities for mentally handicapped and upgradation of large mental hospitals.

The allocated mental health budget is 0.4% of total health care expenditures. As such the policy for

mental health is not comprehensive and has multiple lacunae .

3.1. Pakistani Laws and Mental illness

The law has important implications for the lives of all citizens, including those who are mentally ill. The

laws governing the treatment of mentally ill people give a clear indication of a country's attitude towards

such people. The relationship between a society's attitude and the law is a dynamic one, and a two-way

affair.

In Pakistan, until 2001, the major source of laws relating to individuals who are mentally ill was the

Lunacy Act of 1912 enacted by the colonial government, at the time, for the whole of British India. After

the partition, Pakistani law continued to be based on the relics of its colonial past, although sporadic

changes were brought about in the light of drastically changed conditions and the requirements of an

Islamic republic. The Lunacy Act of 1912, however, like most other laws, remained in effect, despite

occasional protests by the medical profession and society at large.