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When mountains weep: psychological care for those affected by the earthquake in northern Pakistan

  • Murad M. Khan (a1)
Extract

Fate, it seems, conjures up all sorts of ways for us to be in a certain place at a certain time. In 1982 as a trainee psychiatrist in the UK, I found myself co-facilitating a group at the Castlewood Day Hospital, then part of the Bexley psychiatric rotation scheme, in the south-east of London. Group psychotherapy was part of our training. Held thrice a week the groups were open-ended and patients ranged from those with interpersonal relationship and personality problems to those with anxiety and substance misuse problems. At the time the experience was somewhat baffling. Not only was I from a different country and culture, my exposure to psychiatry was limited to about 12 months. More often than not I felt lost as I tried to come to terms with ‘group dynamics', ‘reality testing’, ‘transference’, ‘multiple transference’, ‘group cohesion’, ‘group pressure’, etc.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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When mountains weep: psychological care for those affected by the earthquake in northern Pakistan

  • Murad M. Khan (a1)
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eLetters

Neglect of mental health care in India and Pakistan

Murad M Khan, Professor of Psychiatry
26 February 2007

I fully endorse the views of Dr. Sambhi re. mental health services inIndian and Pakistan. Both India and Pakistan are nuclear powers and spend billions of dollars every year in maintaining large standing armies, fuelled by the 60-year old unresolved Kashmir dispute. For over 20 years both countries have been fighting a costly and senseless war in the Siachen glacier, where just an hour of a helicopter flight costs hundreds of thousands of dollars.

On the other hand health indicators of both countries make sorry reading. Studies show that prevalence rates of depression in Pakistan are 30%, making it one of the hightest in the developing world. More than 100,000 people in India and over 5000 people in Pakistan commit suicide every year, the vast majority of them are depressed and have no access to mental health facilities. Deliberate self-harm figures are 10-20 times forevery suicide. More than a third of people of both countries live below the poverty line, devoid of any health facility. Pakistan spends less than1% of its GDP on health. Mental health does not have a separate budget.

It is a sad indictment of our times that in this 21st century, while many developing countries of South Asia are investing in health and education of their population, focusing on health promotion and prevention, India and Pakistan continue to criminally neglect the urgent health needs of their population.

Leaders of both countries need to wake up to this reality and take urgent corrective measures.
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Conflict of interest: None Declared

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Mental health needs of India

Rajvinder S Sambhi, SHO Psychiatry
16 February 2007

I read with interest the special article by Murad M Khan. Although itwas a great effort on the part of Dr Khan and his team for providing counselling services to the distressed population but, in a way, it highlights the state of mental health care systems in that part of the world.

Having worked as a qualified psychiatrist in the Indian State of Punjab, i think it is very reasonable to comment that despite the growth of psychiatric services in the private sector, the number of mental healthprofessionals remains abysmally low. There are just about 4000 psychiatrists for a population of more than a billion in India resulting in 0.25 psychiatric beds/10,000 population and 0.4 psychiatrists/100,000 population. The number of Institutes providing training for clinical psychology in the whole of India is less than five.Although oppurtunities for studying psychology exist at the undergraduate and postgraduate levels, most courses are taught with noplacements for practical training. Mental health nursing courses are very few in number.

A busy outpatient clinic of a privately practicing psychiatrist can have as many as one hundred patients to be seen in a day, much to the surprise of western psychiatrists. All this leads to emphasis on a pharmacological model of treatment and the psychological needs of the clients are not met with.

These kind of disaster situations expose the lack of preparedness of the system to deal with psychological issues by mental health professionals. References

THARA R, PADMAVATI R, SRINIVASAN TN.(2004) Focus on psychiatry in India.The British Journal of Psychiatry 184 : 366-373

KHANDELWAL SK,JHINGAN HP,RAMESH S,GUPTA RK,SRIVASTAVA VK(2004)India mental health country profile. Int Rev Psychiatry Feb.-May;16(1-2):126-41
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