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A population at risk: poor mental health of
males in Chitral
Dear editor,
I want to share the findings of a research study with the public
through your reputed news paper. This study was conducted in
subdivision Chitral to explore the prevalence, and to determine the
associated factors of anxiety and depression among the male
population. This study was very precisely designed and well
organized, and supervised by one of the top -ranked university of
the Muslim world. The findings of this study show some alarming
signs of vulnerability of male population in Chitral for the
future.
Mental health is a major aspect of life. It reflects on physical,
social, economical and spiritual well being of the people. Any
element distracting physical, social or spiritual part of an
individual will result in mental disturbance. Anxiety and
depression is a devastating mental illness, and is a major health
problem both in the developed and developing countries. In
Pakistan, it is the main burden-some health problem. The scope of
mental health is not up-to the mark in Pakistan, especially in
Chitral due to shortage of resources and awareness.
Chitral is the largest district (area-wise) of the North West
Frontier Province (NWFP), situated at the extreme north and west of
Pakistan. It is a remote and isolated area. Being an
underprivileged area, the opportunities and the resources available
for education, recreation, and earning income are very limited. A
majority of the females are house wives and males are the sources
of earning income for their families. Due to the cultural and
religious influence, the families are extended. Moreover, there are
seven to ten children in each of the families. This puts relatively
more socio-economic pressure on the male members of a family.
There are a very meagre number of mental health professionals,
including family physicians, general practitioners, and social
workers; however, there is not a single psychiatrist or a mental
health nurse in this region. In addition, the existing
hospital-based psychiatric services are also poorly utilised
because of the social stigma attached to the psychiatric patients
and popular misconceptions about mental illnesses, that is, mental
illnesses are caused due to 'possession' by supernatural evil
forces, called ‘Jin’. Many individuals with mental disorders report
not using health services for treatment of mental illnesses.
In the Chitral district, people with psychiatric problems are often
treated by general practitioners, as there is not a single
psychiatrist and psychiatric nurse in Chitral. According to a
report, anxiety and depression was included in the top ten diseases
of the year in Chitral district. However, only those patients
sought treatment for mental illnesses who had somatic problems.
Many psychiatric patients are misunderstood and mistreated at home,
and are often stigmatized as “Pagal” (mad). These stigmatized
patients are ignored and avoided by the society. Eventually, they
become drug addicts and disabled, or misused by others.
Recently we conducted a research study in Chitral to explore the
prevalence of anxiety and depression among males, and to identify
the causes of anxiety and depression. This study was funded and
supervised by the Aga Khan University. This research showed that
34% of the male population was suffering from anxiety and
depression. Main causes of anxiety and depression were less income,
social conflicts (emotional violence), social injustice, and less
education. We explored many other imperative facts in this
research. The literacy rate among the males in Chitral was 54%, out
of which, 14% males had primary education, 20% matriculation, 7%
intermediate, 8% graduate, and 5% males were post-graduate. The
average monthly income of males in Chitral was about Rs.. 5000.
About 80% of the males were married. The mean age of the males was
40 years. About 40% of the males were substance abuser; these
included, cigarette smoking, Niswar, Charas, opium and wine. Nearly
21 % were employed in government organization and NGOs. About 12%
were unemployed, and 67% males were self employed; including
shopkeeper, farmer, carpenter, and so on. Nearly 16% of males had
social conflicts with others, or they had been subjected to
violence.
The findings of this study suggested a high burden of anxiety and
depression among the adult male population in Chitral, Pakistan.
Mental health is not the problem of only Chitral, indeed this is
the problem of whole Pakistan and developing countries. The major
drive-factors behind terrorism, violence and suicidal attack, is
mainly the social injustice and deprivation, which lead to poor
mental health of the males; and mentally disturbed males become
rebellious (Baghi), and are usually committed to such kinds of
offensives. A report witnessed that the prevalence of anxiety and
depression among males in FATAs (agencies) of NWFP was 49%. To-day
we see, the majority of the criminals belongs to these areas. A
large number of males in Chitral, Pakistan, experienced
anxiety/depression, which suggest that anxiety/depression is a
focal health problem in Chitral, and there is a need for proper
interventions, in terms of launching awareness programs at the
community level, availability of services, development of research
work, and making of policies for the improvement of mental health.
Community programs, aiming at educating males for adopting healthy
coping techniques and making constructive use of free time are
suggested. Males should be provided proper information and
techniques about managing their stress, and strategies about using
their free time productively. Community health professionals, such
as Community Heath Nurses [CHNs] and Lady Health Visitors [LHVs]
could be trained and facilitated to run these kinds of awareness
programs under the supervision of the local government health
authorities, or/and with the sponsorship of non government
organizations[NGOs] health programs.
A mental health unit comprising of a few psychiatrists and
psychiatric nurses, along with the necessary diagnostic and
therapeutic facilities should be established in the Chitral town,
making it a proper routine diagnosis and monitoring of
anxiety/depression possible. For the screening purpose, psychiatric
nurses should be appointed in the civil hospitals of each tehsil,
so that they can screen the individuals for anxiety/depression and
refer them to the town mental health unit for diagnosis and
treatment. LHVs and CHNs should be provided with proper training to
monitor anxiety/depression at the community level.
The results of our study recommend that the existing policy
regarding mental health should be improved, and new policy
implications are that there would be an increased staff and
resource facilities, and awareness programs at the community level,
regarding mental health care. Mental health related professions and
professionals should be provided with proper recognition and
priority, thus improving the image of mental health in Pakistan,
particularly in Chitral.
Hakim Shah,
Karachi |
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