It is the Mental Health Awareness month, and the importance of the discussion on mental health cannot be stressed enough. As the stigma surrounding the month gets challenged all around the world, it must also be understood that the access to the treatment of mental health issues, can be a luxury for many people due to their socio-economic class, the rural-urban divide and other factors.
According to the WHO, mental health issues cannot be considered in isolation, which also brings forward the question about people living in abject poverty being more exposed to situations which will lead to mental health issues like parental negligence or bearing the responsibility to support household financially at a younger age among others. It is necessary to understand this aspect in Pakistan because majority of the population does not have access to basic necessities in lives.
Zaufishan Qureshi, who is a psychotherapist based in Islamabad said that whilst it was true that people belonging to lower-income groups are more vulnerable to mental health issues due to their upbringing and other situations, people from privileged groups also face consequences of mental health issues albeit in a different way.
“With less privileged groups, there are different situations which can lead to PTSD, complex trauma which may make one more vulnerable. That said, we don’t have a definite research through which we can make a relation between the two because on the opposite end, we do find severe cases of mental health issues. However, poverty paves ways for different triggers especially in cases of schizophrenia,” she said.
Qureshi felt that there wasn’t adequate awareness regarding the subject because it was often discussed on Internet or at institutions, with both spheres not always accessible to those who belong to lower-income groups.
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Access to resources to get treatment
The brochures distributed do not always reach lower-income groups, and Qureshi thinks we need to build setups which would inform the communities. “Media must also play a role, especially the national television and channels of local languages,” she said.
While there is a constant question about qualified therapists charging amounts that cannot be afforded by the less privileged, there are also therapists who voluntarily want to provide services for nominal fee to those who need it.
The fees of therapists vary with areas, experience and other factors. Those who can afford therapy are expected to pay between Rs2,200 to Rs5,000. But on the other hand, there are therapists who charge between Rs200 to Rs1,000, and sometimes Rs50 if the patient is unable to pay any other sum.
While there is no dismissal of the pain faced by those who are privileged, we need to admit that the group has at least some accessibility to tools and resources creating awareness about mental health through internet and other means. But those at the other spectrum may not even have terms for it in the vernacular, and language is perhaps the most basic of tool to identify a problem, especially if it is stigmatized.
Reaching out to the less-privileged
“We often reach out to communities to discuss mental health issue by taking in confidence any person who has empathy and can also reach out to other members. We train them so they can at least identify those in need of counseling so they can be brought to the right people. In cases where we know the patient cannot comprehend, we ensure that they talk to someone who can understand their language because in therapy, communication is key,” Qureshi explained.
Discussing the treatment for such people, she said that joint sessions with a trustworthy family member goes a long way because it is important to identify triggers and build a support system for the patient.
Poverty and stress
One often wonders about the correlation of stress and mental health issues and thinking aloud it won’t be news that people who belong to impoverished or oppressed communities through economic or social means, grow up in an environment where stress doesn’t really leave their side.
While stress can be healthy in some situations, constant stress which also counts the stress to survive can have lasting effects on the personality of a person.
“When you are in constant stress, and if you grow up with it, the hormone Cortisol doesn’t really go back. Cortisol, a hormone released during stressful situations has a function to help humans counter their stress and are a result of a fight or flight response. However, when the stress is constant, it doesn’t cease to release and doesn’t inhibit. The person then remains in an alert state which leads to severe anxiety. Furthermore, they are unable to develop their coping skills,” she said.
Many a time, the coping mechanism can be seen in the form of anger which can also lead to harmful behaviors.
“Basically, the priorities of privileged and less privileged groups are not similar. Both face issues albeit in different forms with former often dealing with self-related one while the latter deals with problems which have to do with the external conditions like worry about basic necessities. But the lines between both groups are so blurred that we cannot put them in boxes,” she said.
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Role of patriarchy
Sharing an interesting insight, Zaufishan said that one common aspect which she saw in almost all her cases irrespective of class was the influence of patriarchy and toxic masculinity, be it cases of depression or anxiety.
“One of my patients, a student, who came to me owing to complaint of body ache for quite some time, after doctors deduced that it was unreal and she was having psychological issues, abandoned her therapy because her uncle, at whose place she was living, forbade her from seeing a therapist.
She was living with him and the reason that place was a trigger to her was the fact that she was sexually abused at the same house when she was younger by someone of the family. But because her uncle had the last word, she discontinued the treatment. So, such norms also affect the entire realm of mental health,” she said.
Unfortunately, the role of patriarchy is dominant in both social classes in Pakistan. What a woman should or should not do, is mostly decided by the men in their lives.
However, if you or someone you know is struggling from a mental illness, here are a few organizations that offer affordable counselling services:
- Forum for Dignity Initiatives, Islamabad
- Institute of Clinical Psychology, Karachi
- Soch Psychological Services, Rawalpindi
- Rozan telephonic counselling
- Transformation International Society, Karachi and Islamabad