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The United Nations – UN – defines people between 15 and 24 years as youth. Youth is a period of transition from the dependence of childhood to independence of adulthood. WHO defines adolescence as the phase of life between childhood and adulthood, from ages 10 to 19. Adolescents experience rapid physical, cognitive, and psychosocial growth.
Pakistan already has a major problem with mental health issues in children, adolescents and youth which is growing rapidly due to fast deteriorating socio-economic situation. I shall quote from several research article to shed light on the nature and extent of the problem. The links are given at the end.
Anxiety and depression are leading causes of morbidity in children, adolescent, and youth, because too many young ones are exposed to chronic adversities such as violence, social and economic inequalities, domestic abuse, child labor and its associated problems, and a generally unsafe environment for both male and female children and young adults. Breakdown of social and moral values is causing friction, class struggle, and open display of bad behavior.
Zubeida Mustafa writes in Truthdig that changing social norms are a powerful cause of friction, especially for youth who tend to be impatient. Various kinds of inequalities and polarizations are creating stress which may become too much to handle. There is no consensus on the incidence rates of mental disorders. It is estimated that 10% of children and 15-20% of adults have some form of mental disorder. WHO statistics put suicide and para-suicide figures in Pakistan at 130,000 to 270,000 every year.
Another important issue is the availability of treatment for these patients. Even if they take courage against stigma and seek medical treatment, the facilities are highly inadequate. The legal framework governing mental healthcare system leaves much to be desired. Until 2001, the main law regulating mental healthcare was the Lunacy Act of 1912 introduced by the British, then it was replaced by Mental Health Act. The state of implementation of the new Act is unsatisfactory.
Yet another issue is work towards better treatment. Most such researches are funded by pharmaceutical companies and therefore, the research revolves around drug treatment only, not on non-pharmacological measures.
The economic burden of mental health illness is Pakistan was calculated in 2020 to be 3.69 billion US Dollars – over one trillion Pak Rupees, which is huge for an impoverished country like ours. For treatment, only 2.4 billion rupees were allocated for mental health out of the 617 billion rupees health budget. 11% of the mental health budget Is utilized in hospital-based psychiatry units, the remaining 89% is for other mental health facilities.
PILL – Pakistan Institute of Living and Learning identifies several risk factors in three domains: individual, family, and school/neighborhood/community.
Individual Domain – Risk Factors
- Early puberty
- Low self-esteem, shyness
- Anxiety, depressive symptoms
- Difficult temperament, low mood, withdrawal
- Poor social and communication skills
- Extreme need for approval and social support
- Emotional problems, anti-social behavior
Family Domain – Risk Factors
- Parents with depression and anxiety
- Parent-child conflict, family conflicts
- Poor parenting, poor attachment with parents
- Negative family environment, substance abuse among parents
- Single parent family, broken home, marital conflicts
- Child abuse/ maltreatment/ sexual abuse
School, Neighborhood, Community
- Peer pressure, peer rejection
- Stressful, traumatic events around – terrorism, crimes, violence
- Poor academic achievement
- Associating with deviant peers, substance use
- Poverty all around, poor living conditions
First, we need effective utilization of mental health budget, whatever it is. Some of the government mental health institutes are notorious for buying low quality drugs at exorbitant prices because there is a common saying there that how would the insane patients know what they were getting. This is callous and should be liable to harder punishments.
Mental health budget allocation must also be revised.
It is also necessary that clinicians and academia conduct research to find treatment which would be low cost and effective.
The psychiatrists do not have the time for counseling. They only prescribe drugs which alone may not be sufficient. More clinical psychologists are urgently needed to offer counseling even when the patient is on medication. Presently, most clinical psychologists are female; some of whom do not work, and the others may not get male patients as they may feel uncomfortable opening up to a female. More male clinical psychologists are urgently needed.
Mental health services are also included in the Sehat Sahulat Program which offers some relief. At present though, the program itself is in doldrums.
Given the steep rise in the mental health problems, it should be treated with the public health approach. An editorial in the World Social Psychiatry suggests that just like successful public health campaigns were mounted against non-communicable diseases like cardiovascular diseases, similar campaigns should be launched for Public Mental Health. The authors argue that there is a reasonable confidence now that Public Mental Health interventions exist to prevent mental disorders from arising, prevent the associated impacts of mental disorders, and promote mental well-being and resilience. This is a very important point. Rather than just treating the mental health disorders, and helplessly looking at the constant increase in the number of patients along with the suffering of patients and their relatives, the effort should also be directed towards stemming the tide of ever-increasing incidence.
Unfortunately, despite the demonstrated efficacy and cost-effectiveness of several PMH interventions, their large-scale adaptation has been extremely inadequate. The PMH implementation gap is due to several factors, from lack of awareness at individual level to government apathy.
A highly valuable suggestion put forward is to use social media to create awareness. As on April 2023, there are 5.18 billion users of social media, such as Facebook, YouTube, X (formerly Twitter), Instagram, Telegram, WeChat and so on. The reach of social media is enormous, and it can be leveraged to campaign for mental health.
Coming back to the youth, a report compiled for Pakistan Mental Health Coalition says that there is no progress at present. Prevalence studies for under 25 are not being prioritized and that this age group is fully represented in policy decisions. The report recommends working holistically in all areas, legislation, policy, implementation, research, and adequate financing.
The conclusion is that the mental disorders in our children, adolescents, and young adults are an emergency. Our governments are mired in the lowest depths of inefficiency, corruption, directionlessness, and political polarization. Even then, the government must be assailed to provide resources and reach because only they can do it. Youth is our asset, our biggest and most important asset; we cannot afford to waste it for any reason.
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