Mental Health, Policies and Inclusion of Neurodivergent People

Of all the crises our world is currently facing, the increasing ratio of mental health disorders combined with attached stigmas, lack of resources, and lack of treatment is a significant challenge for mankind today. Mental health disorders exist on a wide spectrum ranging from neurodevelopmental disorders to eating disorders to more severe personality disorders. These disorders bring along several emotional, physical, cognitive, and behavioral symptoms each with their own interventions. According to the World Health Organization, one in four people is affected by some mental or neurological disorder at some point in their lives. They estimate that globally, around 264 million people are affected by depression (which has recently been categorized as the world’s number 1 leading killer, passing cardiovascular diseases), 45 million by bipolar disorder, 20 million by schizophrenia and other psychoses and a whopping 50 million by dementia. This is not what the statistics are limited to as many go unchecked, underdiagnosed, or worse, misdiagnosed. All these conditions lead to an increase in the rate of suicide, the number grows each year. (WHO 2013) (WHO 2019) Mental health disorders also bring many associated challenges such as economic burdens, lack of educational and employment opportunities, infrastructure-related concerns, bullying, and so on.
Relevant and beneficial interventions are available across the board for almost all disorders yet around two-thirds of people go without treatment their whole life. According to WHO, in low to middle-income countries, more than 76% of people with any such disorder are never able to seek treatment. There are many reasons for this, namely financial concerns, lack of competent professionals, attached stigmas, and so on. The numbers get disturbingly worse as we move on to underdeveloped and conflict-ridden areas. According to WHO, a considerable number of countries also exist without any legislation, policies, or programs for mental health interventions. Furthermore, it is significant to note that psychological help is not the only kind needed for recovery, social support, accommodating and specific infrastructure, housing, employment, and educational opportunities are also highly necessary and play an important role, yet many countries, unfortunately, do not have such procedures in place.
Regrettably, the state of affairs is not much better in our own country. According to a 2015 report, more than 14 million people in Pakistan suffer from some form of mental disorders, the ratio being higher in the female population. The majority of these 14 million people suffer from depression, which is common everywhere in the world. The report also goes on to touch upon the considerable lack of resources with around 4 major psychiatric hospitals and one psychiatrist for around 10,000 people, the ratio improves a little with psychologists. There is a lack of professionals with specializations in specific fields and interventions such as specializations in child psychology, relationship psychology, psychotherapy for cancer patients or patients with other illnesses, behavioral therapy, and so on. There are a number of special schools scattered throughout the country but often they do not have a faculty that is trained and equipped with adequate facilities that enable them to provide the most conducive environment for a child with any disorder. (Ansari 2015)
The rising number of mental health concerns is attributed to various factors. If we take our own country into consideration, poverty is one of the leading causes of people falling into the pitfalls of illnesses like depression. Other factors include but are not limited to, genetic predispositions, violence, unemployment, presence of other illnesses (mental or physical), stressful working and educational conditions, gender discrimination, harassment, and many other social, emotional and psychological conditions. The factors can be personal to a certain person such as loss of a loved one or they can be widespread over a large area such as war-related trauma, terrorism, unstable economic conditions, unstable political scenario, etc.
By going through the aforementioned paragraph, it is evident that to curb the increase of mental health disorders is not a one-night job. It requires significant changes in different areas, the government has succeeded in passing certain legislation for mental healthcare. Some provinces also have a mental health act in place. Our mental health policy contains but is not limited to pointers such as the development of mental health hospitals and community services, the development of mental health services in primary healthcare, access, advocacy, the involvement of families, etc. An emergency mental health plan is also in place. There are organizations in the private sector as well as working for counseling, advocacy, availability of treatment, and other pertinent cause. The list includes big names such as Edhi homes, karwaan e hayat, Pakistan Association for Mental Health, and Rozan Pakistan. The challenge that exists here is that majority of the population is not aware that such structures are in place and for the ones who are, huge amounts of stigma prevent them from availing these services.
One of the biggest obstacles in our society between patients and therapy is the prevalence of stigma. A major part of our population still does not believe in the existence of mental disorders and attributes all symptoms to the person’s own faults such as laziness, oversensitivity, overreacting, etc and yet there’s a whole other portion of the population that actively pits black magic, evil eye and the presence of jinns as the causes behind anyone’s deteriorating condition. Talking about therapy, let alone going to it yourself, is considered a taboo. Anyone dealing with a mental disorder is labeled ‘crazy’ and even ‘dangerous’ in some cases and treated as an outcast. The entire family of any such person is looked down upon which is why many times people face backlash from their own family if they express their will of pursuing therapy. The whole idea of ‘what will people say’ plagues many, which often leads to instances where people do send their family members to therapy but would not accept it in front of anyone and would tell their children to hide it as well. People seeking therapy are considered shameful and hence are hidden behind curtains. People also have to face a lot of bullying growing up which causes significant damage to their self-image and self-esteem.
People battling any mental health concerns are commonly lead to believe that it is due to the lacking of their own personality that they face all this. They are often told that none of this would be happening to them had they had a strong connection with God. People are pushed to pray, to divert their minds, and just not ‘think about it’. A commonly heard phrase is ‘there was no depression in our time’ oftentimes coming from the older population because the toxic cycle of denying therapy has been continuing for many generations. There are instances where the mental health concerns of an individual are turned around and used against them in abusing ways such as portraying as if they are incapable of thinking soundly, making informed decisions, and will always overreact because they have a certain health concern. Their issues are constantly used to discredit their feelings and experiences by statements like ‘you are thinking/feeling this too much’. All of this comes from the lack of knowledge and awareness, people believe whatever they hear and see, to which the media leaves no stone unturned in often putting up horribly inaccurate representations of mental health disorders. Characters with any mental health concerns are constantly portrayed in a criminal light where they are capable of heinous crimes and have no social skills whatsoever, the humanizing element of their personality is often locked away. There is next to no information that people can use to build upon their knowledge of people with mental health disorders. There are severe misunderstandings and myths surrounding mental health that need to be extracted.
In a nutshell, our society is not the best place for a person with mental health concerns to exist. There is no denying that wider steps need to be taken from the government and authorities’ side to ensure the provision of fundamental rights and necessary facilities to people with any disorder, but all of that accounts to nothing if we as a community do not take it upon ourselves to educate our own self and others around us. We cannot choose to stay ignorant in the age of information, that too at the expense of others. There are relevant resources all around us which we can use to get more knowledge about symptoms, treatments, and experiences related to certain disorders. The fight belongs to all of us and the first step in this course is to dispel myths, misunderstandings, and stigmas and let everyone feel like they have a safe space to exist, be it someone who is neurodivergent or not. We have a long way to go but the first step needs to be taken today by our own foot.
References
Ansari, Inamullah. 2015. Mental Health Pakistan: Optimizing Brains. https://www.omicsonline.org/open-access/mental-health-pakistan-optimizing-brains-1522-4821-17-160.pdf.
Gadit, A. A. 2001. JPMA. July. https://jpma.org.pk/article-details/2680.
Kamal, Daanika. 2018. Mental health and stigma. September 15. https://dailytimes.com.pk/298034/mental-health-and-stigma/.
n.d. Mental Health NGOs in Pakistan. http://www.ngo.com.pk/health/mental_health_pakistan.htm.
Minhas, Fareed Aslam, Asad Tamizuddin Nizami, Ghulam Fatima, and Mehmood Ali Jafri. 2009. WHO-AIMS REPORT ON MENTAL HEALTH SYSTEM IN PAKISTAN. https://www.who.int/mental_health/pakistan_who_aims_report.pdf?ua=1.
Tareen, Amina, and Khalida Ijaz Tareen. 2016. Mental health law in Pakistan. August 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618880/.
WHO. 2019. Mental disorders. November 28. https://www.who.int/news-room/fact-sheets/detail/mental-disorders.
WHO. 2013. Mental Illness Affect 1 in 4 People. July 29. https://www.who.int/whr/2001/media_centre/press_release/en/.