Development of mental health services in Pakistan.

The development of mental health services is described here. Some of the activities undertaken are outlined including intersectoral collaborations to further mental health services.

Mental health: the missing link in primary care? Health for All by the Year 2000 revisited.

The effects on the uptake of services offered in primary health care of a demonstration community mental health project in Pakistan were assessed. A subdistrict with the project was compared with a matched area without the project over 7 years. Routinely collected information on service use was used, including the detection and treatment of mental disorders. Compared with the comparison subdistrict, the index subdistrict showed an increase in use of primary care by men, reduction in pregnancy rate, increased use of antenatal care, reduced maternal mortality, increased immunization coverage, and increased detection and treatment of mental disorders.

Mental health: the missing link in primary care? Health for All by the Year 2000 revisited

The effects on the uptake of services offered in primary health care of a demonstration community mental health project in Pakistan were assessed. A subdistrict with the project was compared with a matched area without the project over 7 years. Routinely collected information on service use was used, including the detection and treatment of mental disorders. Compared with the comparison subdistrict, the index subdistrict showed an increase in use of primary care by men, reduction in pregnancy rate, increased use of antenatal care, reduced maternal mortality, increased immunization coverage, and increased detection and treatment of mental disorders

Development of mental health services in Pakistan

The development of mental health services is described here. Some of the activities undertaken are outlined including intersectoral collaborations to further mental health services

Stress and psychiatric disorder in urban Rawalpindi. Community survey.

BACKGROUND: Recent studies in rural areas of Pakistan have yielded high prevalence rates of common mental disorders, especially among women. AIMS: To investigate emotional distress and common mental disorders in a poor urban district using the same survey method. METHOD: First-stage screening of a slum district of Rawalpindi used the Bradford Somatic Inventory. Psychiatric interviews were conducted with stratified samples using the ICD-10 research diagnostic criteria. RESULTS: On a conservative estimate, 25% of women and 10% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both men and women. Women living in joint households reported more distress than those living in unitary families. Higher levels of education were associated with lower risk of common mental disorders, especially in younger women. Emotional distress was negatively correlated with socio-economic variables among women. CONCLUSIONS: This study found levels of emotional distress and psychiatric morbidity in a poor district of Rawalpindi to be less than half those in a nearby rural village in the Punjab, although rates in women were still double those in men. Possible explanations are that more healthy people migrate to the cities or that urban living is more conducive to good mental health in Pakistan.

Detection of disabilities by schoolchildren: a pilot study in rural Pakistan.

An important consideration in planning services for disabled children is to establish the need, including the size of the potential beneficiary group. However, surveys are expensive and time consuming (especially surveys of disability, which has a low prevalence within the population), and can raise expectations of service for patients who are often very unsure about how to cope with their disabled child. The World Health Organization (WHO) has produced a series of survey tools which have been used to identify disabled children in settings where a service is planned. Zaman et al, produced the '10 Question Screen', a simple screening tool for use by community health staff to identify disabilities among children in the community. Both the WHO survey tools and the 10 Question Screen rely on trained primary health care (PHC) or community-based rehabilitation (CBR) staff. The small study reported here shows that schoolchildren are effective identifiers of disabled children within their home communities and may be a useful resource when there are no trained CBR or PHC workers to conduct surveys. Furthermore, the children's ability to identify within the five major disability groups was relatively robust when compared with medical diagnosis.

Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan.

BACKGROUND: A school mental-health programme has been developed as a component of the community mental-health programme in Rawalpindi, Pakistan. It has the objective of improving the understanding of disorders of mental health in the rural community. We aimed to assess the impact of a school mental-health programme on the awareness of schoolchildren, their parents, friends who were not attending school, and neighbours. METHODS: We chose two secondary schools for boys and two for girls that were similar in terms of size, staff-pupil ratio, and drop-out rates. 100 children aged 12-16 years (25 girls and 25 boys in each of the study and control groups), 100 parents (one for each child), 100 friends who did not attend school (one for each child), and 100 neighbours (one for each child) were given a 19-item questionnaire before and after the study group had had a 4-month programme of mental-health education. The maximum score for the questionnaire was 16 points. FINDINGS: Before the school mental-health programme the awareness of mental-health issues was poor (mean score 5.7-7.6) in the four groups of participants. In the study group there was a significant improvement in the mean scores after the school programme in the schoolchildren (mean improvement 7.6 [95% CI 6.7-8.5], p<0.01), their parents (5.3 [4.5-6.1], p<0.01), friends (5.1 [4.1-6.1], p<0.01), and neighbours (3.4 [2.6-4.2], p<0.01). In the control group the difference in awareness was significant only in schoolchildren (1.5 [0.5-2.3], p=0.01) and their friends (0.8 [0.3-1.3], p<0.01). INTERPRETATION: The school programme succeeded in improving awareness of mental health in schoolchildren and the community. The schoolchildren were receptive to the programme, and shared their new understanding with family, friends, and neighbours. Mental-health planners who wish to improve community awareness of mental health, particularly in areas with low literacy rates, should consider setting up school mental-health programmes.

Stress and psychiatric disorder in rural Punjab. A community survey.

BACKGROUND: The prevalence of psychiatric disorders in rural Punjab is unknown. Previous studies in rural areas elsewhere in the Indian subcontinent have yielded widely differing estimates. METHOD: First-stage screening of a village near Gujar Khan used the Bradford Somatic Inventory and Self Reporting Questionnaire. Psychiatric interviews were conducted with stratified samples using the ICD-10 Diagnostic Criteria for Research. RESULTS: It is estimated that 66% of women and 25% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both genders. Women living in unitary households reported more distress than those living in extended or joint families. With younger men and women, lower levels of education were associated with greater risk of psychiatric disorders. Social disadvantage was associated with more emotional distress. CONCLUSIONS: This study in rural Punjab confirms that findings of a previous study in Chitral, northern Pakistan, of high levels of emotional distress and psychiatric morbidity among women in rural areas of Pakistan.

Risk factors for drug abuse in Pakistan: a replication.

While a number of risk factors have been identified for drug abuse in the United States, little evidence is available about such factors in some other counties. Among these latter is Pakistan, a nation in which heroin addiction is a major problem. The present study was done to examine those psychosocial characteristics which differentiated 60 heroin addicts from 60 nondrug-using controls in Pakistan. Most of the drug-abuse factors identified earlier were significant in Pakistan as well. Applying cut-off scores previously established for each of 9 variables, the relationship between drug status and number of factors at risk was also examined. Over 98% of the addicts were at risk for five or more factors; only 15% of controls were at risk for 5 variables and none exceeded 5. Precursors for abuse appear to cut across cultural lines. The high-risk individual in Pakistan, as in the United States, is one with ready access to drugs and the social inducements to use them while lacking bonds with societal institutions or value systems which might mitigate against drug use. Because several of the risk factors represent deep and long-standing aspects of the addict's personality, both prevention and treatment confront formidable difficulties.