The cost of coping | Political economics


home to a quarter of the world’s population, the countries of South Asia (that’s to say, Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) have a high prevalence of common mental health conditions. 150-200 million people here suffer from anxiety, depression, bipolar disorder, suicidal behavior, phobias and tobacco/drug/alcohol abuse. The World Health Organization’s Mental Health Gap Action Program (mhGAP) identifies depression, bipolar affective disorder, schizophrenia and other psychotic disorders, dementia, intellectual disabilities and development such as autism as priority mental and neurological disorders. Of the eight countries in this region, Pakistan has the highest prevalence of common mental disorders (NCBI, Frontiers in Psychiatry 2020).

From aristocrats to everyday people, there are a plethora of common mental health issues. The disease burden is high and no support is available for patients due to poor health infrastructure and the lack of a well-organized primary care system. There is also a shortage of psychiatrists and other mental health professionals and resources. Mental health problems therefore remain unanswered and the vulnerable population without care.

Many women are at risk of developing depression due to marriage-related issues, in-law attitudes, and domestic violence. An article in PubMed (2013) reported that postpartum depression in Pakistan was another overlooked problem and has a prevalence rate of 28-63%.

Among men, admitting to a mental health problem is often seen as a sign of weakness. Work and home stress, illicit drug and alcohol use, childhood trauma, and a family history of mental health issues are some of the factors that contribute to depression in men. Poverty, illiteracy and unemployment are good predictors of mental health problems. There is an association 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 young and old alike. A systematic review in 2020 showed that 42.6% of college students had depressive symptoms. A cross-sectional study based on the population of Karachi showed a high prevalence (40.6%) of depression among the elderly population (BMC 2013).

The benefits of integrating mental health into primary care are manifold. Placing psychologists in primary care centers will provide a cost effective method for early stage mental health wellness and support. This will not only improve access to the population as a whole, but also reduce morbidity and mortality from chronic diseases..

An increase in mental health problems during and after the era of Covid-19 infection has been noted. Social isolation in a lockdown situation, restrictions on international travel and economic repercussions have led to the emergence of new cases or the exacerbation of existing conditions of anxiety and depression. The unprecedented Covid-19 pandemic has significantly affected healthcare personnel, through increased work demands, fear of illness, loss of patients/colleagues and loved ones etc.

Stress can greatly affect our mental health. Sometimes its management is beyond our control. Sometimes we think we can handle it on our own, but sometimes it’s not easy. In terms of managing stress, it’s important to recognize it and seek help. Help may be needed from sources such as community family physicians, therapists, counsellors, etc, to learn coping skills. Some strategies like learning new skills, having a hobby, and staying active can help build resilience and positive thinking, increase 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 a sense of belonging and self-esteem. Sharing your positive experiences provides emotional support for you and others.

Primary care is the first point of contact for people with mental health issues. Improve access to psychological therapies like cognitive behavioral therapy, holistic therapy etc helps people improve their mental health, manage negative thoughts and get back to normal life. Mental health issues co-exist with long-term conditions such as diabetes, ischemic heart disease and chronic obstructive pulmonary disease. Conversely, people with mental health conditions are at high risk of developing a wide range of chronic physical conditions. Improving the mental health of these patients has been shown to improve outcomes in people with chronic/long-term illnesses.

The benefits of integrating mental health into primary care are manifold. Placing psychologists in primary care centers will provide a cost effective method for early stage mental health wellness and support. This will not only improve access to the population as a whole, but also reduce morbidity and mortality from chronic diseases. This helps to improve patient health outcomes and reduce the workload for hospitals and emergency care. This holistic approach can also help patients self-manage their long-term conditions. Common mental health issues such as anxiety or depression can also be diagnosed and treated early.

Mental disorders are treatable. Prevention, early identification and initial treatment should be given priority. The population must have access to treatment and care.


Dr Hina Jawaid is Assistant Professor of Family Medicine at Lahore University of Health Sciences

Dr Abdul Jalil Khan is Assistant Professor of Family Medicine at Khyber Medical University, Peshawar

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