Op-Eds in Dawn

Mental Health Reforms
Dawn, 2018

RECENTLY, Lahore was left heartbroken when a young person died after jumping off the roof of a high-rise campus building. Sadly, this was not an isolated event. This case and the media reporting that followed highlighted many failures of mental healthcare in Pakistan even in urban and upwardly mobile segments of the population. These failures range from ignorance, stigma, a failure to recognise symptoms, inadequate psychological support services on university campuses, social and legal criminalisation of self-harm, and the inability of the media to report responsibly and accurately.

A Teenage Dream
Dawn, 2018

THIS year, World Mental Health Day, that will be observed on Oct 10, is dedicated to ‘Young people and mental health in a changing world’. Young people include adolescents aged 10 to 19 years. This is a critical period for psychological development as individuals mature towards adulthood, evolve in their identity and assume more autonomous social roles. Across Pakistan’s social classes this is also a time when life situations are in transition, from villages to cities, homes to hostels, or from giving up education to looking for livelihood. The proliferation of digital technology is an additional psychosocial challenge that can work to the detriment of traditional social networks, sense of identity, and self-esteem. With a staggering population growth rate of 2.4 per cent, Pakistan has the second-largest young population in the world.

Human Rights & Mental Health
Dawn, 2018

A DECADE ago, world-renowned psychiatrist and medical anthropologist Arthur Kleinman termed the standard of mental healthcare across the world a ‘failure of humanity’. He noted that the worse deficiencies of care lay in the ‘local conditions’ faced by the mentally ill, and not the fact that mental disorders contributed to 15 per cent of the burden of global disease; or that less than 1pc of the health budget was dedicated to mental healthcare in developing countries; or that there is a severe dearth of psychiatrists in the latter. The increased vulnerability of sufferers of mental disorders owes in part to their inability to use the full potential of their mental and emotional capacities.

Development & Mental Health
Dawn, 2018

IN the weeks leading up to, during and after this election, ‘human development’ has been a frequently invoked buzzword. The idea of ‘human development’ was explained by Pakistani economist Dr Mahbub ul Haq in the first Human Development Report (UNDP, 1990). It essentially shifted attention to human beings and their opportunities and well-being as opposed to the idea that economic development was in and of itself enough to safeguard society’s needs. Based on this approach, the Sustainable Development Goals (SDGs) 2030 were set by the UN in 2015.

Prisoners or Patients?
Dawn, 2018

A YEAR ago, this paper reported the suicide of a 45-year-old undertrial prisoner in his cell at Adiala Jail. The prisoner had been charged with his wife’s murder, and was known to suffer from mental illness for two years. Because mental illnesses are nearly always treatable, suicides, especially those that happen in jail, are preventable. His incarceration in an ostensibly secure environment should have afforded him access to basic rights including medical treatment. Like so many others with mental illness, our prison system failed him.

Supporting Seniors
Dawn, 2018

IN an editorial last year, this paper highlighted: “With the ageing population set to increase to 43 [million] by 2025, it is imperative for the state to strategise social care reform.” Healthcare, a basic right of the elderly, is an integral component of meaningful social care reform. Older adults have multiple and often overlapping healthcare needs. Above all, they need a healthcare system that offers integrated care and not just a disease-based curative model. According to Mark Gorman of HelpAge International, “The ageing process is of course a biological reality which has its own dynamic, largely beyond human control. However, it is also subject to the constructions by which each society makes sense of old age.”

Stealing Childhoods
Dawn, 2018

CHILD sexual abuse is neither a rare phenomenon nor a recent one. It is prevalent worldwide, and its occurrence is understood to be much higher than the reported rates, which vary between 10 to 30 per cent. Both girls and boys are victimised, the former at least twice as often as the latter. The most vulnerable children are those aged seven to 13, although victims are often even younger. Adolescents are particularly vulnerable to abuse by peers.

The Unholy Nexus
Dawn, 2017

24 A MEDICAL conference scheduled for early next year is expected to host at least 100 specialists from all over the country. Roughly, if the overall cost for one participant is Rs70,000, then the estimated budget of the conference is about Rs7 million. Who will pay for it? Like many other countries where healthcare is poorly regulated, the pharmaceutical industry and doctors have a well-established symbiotic relationship in Pakistan.

Attempted Suicide: Illness or Crime?
Dawn, 2017

EARLIER this month, a national daily reported that a woman in Jaranwala committed suicide after poisoning her two minor daughters. Under Section 325 of the Pakistan Penal Code (PPC), both suicide and attempted suicide are currently considered criminal offences, with the latter punishable either by a jail term of up to a year, or a fine, or both. All reported cases of suicide or any such attempts are thereby mechanically linked to law enforcement. In practice, it is rare for such FIRs to be registered with the police, but harassing and extorting money from victims of attempted suicide is not uncommon. The criminalisation of suicidal behaviour is one of the main reasons that people do not seek help for the psychological problem that may have precipitated the act.

Mental health and work
Dawn, 2017

HK heads a corporate organisation in Islamabad. After his wife suffered from a depressive disorder, he developed a better insight into the illness. At work, he noticed a team member who often looked tired, had started to miss deadlines and was avoiding social contact. As he considered a strategy to broach the subject, another colleague indicated irritability and showed signs of strained relations with others. HK recognised that his team was struggling, but wasn’t sure what he should do to help them become aware of mental health problems and see if they could find a way to prevent these. For 25 years, the world has observed World Mental Health Day on Oct 10. This year, the theme is ‘Mental Health in
the Workplace’. According to the World Health Organisation, one in five people may experience mental health problems in the workplace.

Parachinar Suicides
Dawn, 2017

PARACHINAR’S experience with terrorism is endemic and compounded by divisive sectarianism. This year, 121 people have been killed and hundreds injured as a result of militancy. Recent media reports have drawn attention to the plight of its population and, subsequently, a team of mental health professionals travelled to Parachinar to conduct a thorough assessment. Their findings are worrying. Almost half the population suffers from mental trauma and a pronounced sense of insecurity, resulting in loss of sleep, concentration and of peace of mind. The media reports high rates of post traumatic stress disorder in Parachinar. Technically, this is not entirely correct; the victims should, instead, be said to suffer from stress-related conditions that include, but are not limited to, PTSD.

Mental health priorities
Dawn, 2016

RECENTLY, a much-needed round-table conference on mainstreaming mental health and incorporating it into the public discourse was held by the Planning Commission. The deliberations focused on the need to promote positive mental health, prevent psychosocial adversity, and address the ever-growing burden of disease and disability caused by mental, neurological and substance-use disorders. A concerted national plan to address the population’s mental health needs is still non-existent, despite ad-hoc efforts that have been made over the past four decades.

Justice miscarried
Dawn, 2016

IN 2002, a little after I helped draft Pakistan’s Mental Health Ordinance, Imdad Ali was convicted under Section 302 of the Pakistan Penal Code and awarded the death sentence. A 2012 government psychiatric report concluded he suffered from paranoid schizophrenia. Based on this report, a plea of insanity was presented to the court. Subsequent appeals were rejected by the high court and Supreme Court, as was his mercy petition by the president. As Imdad Ali’s execution date drew closer, further petitions were filed by human rights organisations that repeatedly raised questions about his mental capacity.

A silent epidemic
Dawn, 2016

COMMEMORATED on Oct 10, this year’s World Mental Health Day focused on ‘psychological first aid’, with an aim to generate awareness about this theme: simple psychosocial interventions that can be learnt by anyone, including laypeople, to provide support to others in times of distress. Unfortunately, mental health issues remain poorly understood in Pakistan, and the stigma surrounding mental illness continues to hurt families. This makes it even more incumbent on the government, in collaboration with NGOs and mental health professionals, to do more to educate and train communities in psychological first aid. Broadly speaking, this is just one component of wider comprehensive mental health and psychosocial support structure, which includes appropriate training, services and referral systems at all tiers of healthcare structures.

Treating addiction
Dawn, 2016

MUSTAFA is 19 years old, recently ‘released’ from a set-up in the suburbs of Islamabad where he was kept for three months at significant expense. His father cried as he described that, following his discharge, they had to shave the hair off his entire body to get rid of the lice that clung to him. Lack of hygiene was not Mustafa’s greatest challenge. Upon his release, he narrated an account of humiliation, harassment and horror. He never once saw a doctor. What ought to have been a ‘treatment centre’ for drug abuse was, in fact, an ‘abuse centre’ for drug treatment. One of many unregulated rehabilitation facilities cropping up in urban centres, hundreds of patients suffering from drug abuse and mental disorders find themselves coerced into such set-ups because their blighted families are lost for a direction.

Violence at home
Dawn, 2016

AMIDST robust campaigning by liberal sections to activate the feminist lobby and strong criticism by clerics defending Islam’s endowment of women’s rights, there is a risk of overlooking the essence of what is a major human rights and public health issue — domestic violence.
Today, domestic violence is recognised as a ‘global’ public health issue that is prevalent in high-, middle- and low-income countries. While the presentation of domestic violence may be culture-specific, it exists in all countries, cultures and religions. The reported rates vary; generally a third of all women suffer some form of domestic violence in their lives.

Not a priority
Dawn, 2014

Each year the world observes Mental Health Day on Oct 10; this year’s theme is ‘living with schizophrenia’, a major mental disorder, which causes significant impairment of function, and disability, immeasurable distress for the family and loss of productivity. Mental disorders contribute to early mortality: suicide resulting from these disorders is a major cause of death for all ages. But, like most mental illnesses, early detection and treatment of schizophrenia is both possible and inexpensive. Mental disorders contribute 14pc of the global burden of disease. Over 70pc of this is borne by low- and middle-income countries such as Pakistan. This is because four out of five people with severe mental disorder do not receive any treatment.

IDPs mental trauma
Dawn, 2014

It has long been established that armed conflicts and the subsequent mass dislocation of population results in significant psychological and social suffering. While the impact of such a situation may be acute in the short term, it also undercuts the long-term mental health and psychosocial well-being of the affected populations. This, in turn, has serious implications for social development, governance and human rights. According to preliminary surveys on the ground, the displacement of some 800,000 people from North Waziristan Agency, where a military operation is under way, has triggered a wide range of psychosocial problems at the individual, family and community levels, by destabilising what are normal support systems.

Domestic violence - a public health issue
Express Tribune, 2013

According to the World Health Organisation, domestic violence is a global public health issue. Simply put, this verdict means that domestic violence exists in all countries, cultures and religions and stems from the social, cultural and economic fabric of communities. Further, any health issue where the basic rights of an individual are compromised, automatically, becomes a human rights concern. The net result, therefore, is that domestic violence is a complex health issue which has adverse social and humanitarian implications.
While the presentation of domestic violence may be culture-specific, it is not a “Western” malady. Politicising the mandate of domestic battery or glamourising its presentation in the media essentially helps raise awareness.

Ethics of doctor’s protest
Dawn, 2012

The question is not whether or not governance in Pakistan has failed. Maybe it has. There is plenty of evidence around us to suggest that this is the case. The health care sector, in particular, has been particularly weakened, both in terms of the provision of services and mismanagement. The rights of patients as well as doctors are violated in different ways. But as the recent strike by the Young Doctors’ Association has illustrated, the question goes far beyond the right of doctors to protest. They may have the right to do this, but the issue hinges on whether protests such as these, which resulted in the virtual shutting down of major healthcare facilities in the city for days on end, can be defended when examined through the lens of ethics.

Treatable but stigmatised
Dawn, 2012

The use of ‘depression’ in everyday nomenclature has witnessed a surge in popularity in recent times. This is probably because at a basic level, it is used to describe subjective distress in relation to socioeconomic difficulties. This is a common emotional reaction that is usually transient and does not cause any impairment of function. Medically, however, ‘depression’ is used to describe a mental illness that is ultimately very common and is in fact the fourth leading cause of disability and disease across the world. These statistics are expected to worsen and the trend is likely to see an exacerbation making depression the second leading cause of disability by the end of this decade.

The state of mental health
Dawn, 2011

The average Pakistani has been nothing more than an innocent bystander in the great power politics of an international system gone awry. For our country, already underdeveloped, struggling to form a national identity and manage a flagging economy, the events of 9/11 meant the start of a long and arduous journey, with our borders being transformed into war zones and our cities into hotbeds of socio-political instability. We’ve experienced terror firsthand. And those reserves that were left over from combating terrorism were quickly dissipated in attempting to deal with natural calamities such as the 2005 earthquake, nationwide flooding, and more recently the dengue epidemic. The equation has left us with badly damaged infrastructure, a dearth of leadership and a collapsed economy.

Psychological implication of violence
Dawn, 2011

An unarmed young man, not even found guilty yet, begging for mercy was ruthlessly shot dead by so-called ‘security forces’. The act is despicable. At an individual level, the violent act shows the callous disregard for human life in direct conflict with the norms of society. It is best described as psychopathic behaviour. But then, it has long been known that ordinary people simply doing their jobs, and without any particular hostility on their part, can become agents in a terrible destructive process. In that case, do these individuals reflect a larger system harbouring violence with absolute annihilation of human rights? The emerging pattern of public lynching reflects an adverse change in our social behaviour.

A stigmatised section
Dawn, 2010

Oct 10 is designated as World Mental Health Day. The objective is to raise public awareness about mental health issues and to promote open discussions on mental disorders and treatment. It is well recognised that people with mental disorders are stigmatised and often subjected to neglect and abuse. To mark the day this year, the World Health Organisation has released a document mhGAP (mental health Gap Action Programme) that focuses on the gap between what is needed to treat common mental disorders and what is available. It is estimated that 75 per cent of those suffering from mental disorders in low- and middle-income countries do not receive the necessary treatment.

Covering a disaster event - media and mental health
Dawn, 2008

Disasters seem to occur more often now than in the past. Any acute and sudden event which is collectively experienced as traumatic may be classified as a disaster. It can be natural (earthquakes, floods) or man-made (terrorist attacks, traffic accidents). Disasters have both short-term and long-term health consequences. These health consequences cannot be studied without focusing on the role of the mass media. The significance of the media in everyday life has increased dramatically. Last month, people all over the country watched the horrifying images of a truck exploding at the Marriott in Islamabad, guards who were struggling to extinguish the initial fire being killed a few seconds later and the petrified remains retrieved from the carnage.

Fate of the ordinance
Dawn, 2007

“Mentally ill people in the developing world are being badly neglected. Mental illness makes up about 14 per cent of global disease, more than cancer or heart disease. Up to 800,000 people commit suicide each year, mostly in poorer countries. Ninety per cent of sufferers in developing countries receive no care — and in some cases are chained to trees or kept in cages.” (BBC Sept 4) These stark facts clearly reflect the conditions of the mentally ill in Pakistan as well. Only a handful has access to medical care. They too are at the mercy of a system, which is not held accountable at all. Shocking stories of the brutal treatment meted out to the mentally ill continue to be repeated day in and day out.

To sell or not to sell an organ
Dawn, 2007

Mohammad Hussain is a 43-year-old labourer with four children. He faces a debt of Rs50,000 and sees no end to his ongoing financial constraints. Finally, he decides to sell his kidney for Rs100,000. Should he be allowed to do so? In developed countries, the use of genetically unrelated donors is restricted purely to altruistic donors who have a close and emotional relationship with the recipients. By law, commercial transplantation is illegal. The situation is alarmingly different in some third world countries, including Pakistan. In the absence of any law in the country (the Transplantation of Human Organs and Tissue Ordinance 2007 is still under consideration), 2,000 organs are transplanted every year. Of these, 1,500 transplants (carried out in the private sector) are from unrelated donors who sell their kidneys.