What do people think about mental health care in Pakistan?

Mental health problems affect people throughout the world. In low-income countries, improved treatment and prevention strategies are needed. To be effective, these must be informed by knowledge of who is providing mental health care and how clients view the different forms of care available.

In Pakistan, there isrelatively little evidence available on mental health provision and useperceptions. A team of researchers from the Department of Psychiatry andBehavioural Sciences, Fatima Jinnah Medical College,Lahore (Pakistan) and the Institute of Psychiatry, London (UK) was invited toconduct a study in the small town of Choti in thePunjab, in order to describe the types of mental health care providers that areavailable, and clients’ perceptions of the effectiveness of the different typesof treatments offered.

The study involved a mentalhealth consultation day, in April 2004. A total of 462 people attended theconsultation day, of which 322 consented to participate in the study. 157 were18 years or older. Questionnaires were used to gather information from clientswhile they were waiting to be seen by the psychiatrist. The questionnaires werein English and conducted by trainee clinical psychologists.

Five different types ofhealth care provider were identified: generalpractitioner, religious healer, Hakim (traditional medicine), homeopathicdoctor and faith healer. The general practitioner was the most commonlyconsulted. Clients considered general practitioner treatments to be the mosteffective.

The study team report thefollowing findings:

• The most common condition was depression (107people).
• Most conditions were chronic, but the durationwas shorter for depression than for other illnesses.
• Almost all patients thought their condition wastreatable, but some stigma was associated with mental disorders: 22percent said they hide their illnesses from others.
• A majority (52 percent) believed that mentaldisorders were due to problems in the mind, while 25.3 percent thoughtthey were physical and 11.3 percent said they were a combination of both.A small number (6.7 percent) said they were due to magic.
• 56 percent of those who sought treatment fordepression from a general practitioner considered their treatmenteffective. For other mental illnesses this figure rose to 78.4 percent.

The results point to a differencebetween peoples’ beliefs and knowledge about available treatments. Lack ofinformation makes it difficult to assess the effectiveness of the differenttreatments. The following recommendations are made for further investigation tohelp formulate mental health treatment and prevention strategies:

• The variety of different types of health providerdemonstrates a need to broaden the focus of research into primary mentalhealth care in Pakistan.
• Further work is needed to map the similaritiesand differences in practitioners’ knowledge of mental health issues.
• Drug treatments given by general practitioners needto be compared with the standardised treatments offered by homeopaths andHakims.
• There is a need to further describe andstandardise the mental health treatments offered by primary careproviders, including both physical treatments and spiritual andpsychotherapeutic techniques.
• Improving patients’ knowledge about primarymental health treatments would help set standards for treatment and mayprevent conditions from becoming chronic.