Community Mental Health

Submitted to:

Prof. Dr. Iftikhar N. Hassan

Submitted by:

Sania Parveen

(MSCP-018)

Department of Clinical Psychology

Shifa Tameer-e-Millat University

Islamabad
Mental health

Mental health includes our emotional, psychological, and social well-being. It affects

how we think, feel, and act. It also helps determine how we handle stress, relate to others, and

make choices. Mental health is important at every stage of life, from childhood and adolescence

through adulthood. According to the WHO (World Health Organization), mental health is “A

state of well-being in which the individual realizes his or her own abilities, can cope with the

normal stresses of life, can work productively and fruitfully, and is able to make a contribution to

his or her community.” The WHO stresses that mental health “is not just the absence of mental

disorder. Mental health is the level of psychological well-being or an absence of mental illness. It

is the state of someone who is functioning at a satisfactory level of emotional and behavioral

adjustment. From the perspectives of positive psychology or of holism, mental health may

include an individual's ability to enjoy life and to create a balance between life activities and

efforts to achieve psychological resilience. Cultural differences, subjective assessments, and

multiple social, psychological, and biological factors determine the level of mental health of a

person at any point of time. For example, violence and persistent socio-economic pressures are

recognized risks to mental health. The clearest evidence is associated with sexual violence. Poor

mental health is also associated with rapid social change, stressful work conditions, gender

discrimination, social exclusion, unhealthy lifestyle, physical ill-health and human rights

violations.

Mental health is fundamental to our collective and individual ability as humans to think,

emote, interact with each other, earn a living and enjoy life. On this basis, the promotion,

protection and restoration of mental health can be regarded as a vital concern of individuals,

communities and societies throughout the world.

 Mental Health Services are defined as "assessment, diagnosis, treatment or counseling in

a professional relationship to assist an individual or group in alleviating mental or emotional

illness, symptoms, conditions or disorders."

It is estimated that 50% of the individuals in the developed and 85% in developing

countries have mental health problems, but are unable to receive any treatment (Pescosolido &

Lafsdottir, 2013). Globally, mental illness including schizophrenia, depression, epilepsy,

dementia, alcohol dependence and other mental, neurological and substance-use disorder

constitutes 13% of the total disease burden and there are about 450 million mental health patients

worldwide (Global and Cultural Mental Health, 2013).

Identifying the Common Mental Disorder rate in Pakistan including depression and

mental disorders, Mirza and Jenkins estimated the 34% of the overall Common Mental Disorder

prevalence (Mirza & Jenkins, 2004). Irfan (2013) estimates that 60% of those who attend

primary care clinics have diagnosable mental disorder, about 154 million suffer from depression,

25 million from schizophrenia ,91 million from alcohol use ,15 million by drug use ,50 million

from epilepsy ,24 million from Alzheimer and other dementias, and around 877,000 die by

suicide every year.

These alarming figures of mental illness in Pakistan are due to several social, cultural and

economic reasons. Since 2001, the security situation in the country is quite volatile. The

terrorism and war on terror including Taliban and Al-Qaida presence in the country, suicide

bombings, ever rising human death toll, infrastructural destruction, military operations against

terrorists, drone attacks and internally displacements are some of the reasons for higher mental

illness rates (Khalily, 2011).

 Economically there is very little investment in Pakistan on mental health care, further

aggravated by a dire shortage of skilled workers .The Pakistan government spends 0.9% of the

total gross domestic product (GDP) on health which amounts to $9.31 per person per year which

is way less than the international recommendation of $60 per person per year (Zhu, Allen,

Kearns, Caglia, & Atun, 2014). The total mental health budget merely stands at the 0.04% of the

total health budget in Pakistan (Humayun, 2016). Nationally, the 12.4% of people live below the

poverty line and country’s unemployment rate stands at the 6% (Asian Development Bank,

2016), which further aggravates the problem related to mental health services access.

As far as mental health service delivery is concerned in Pakistan, there are mainly three

formal and informal sources. Formal sources include public sector hospital based services and

community based services through public psychiatric units and through Non-Governmental

Organizations (NGOs). Informal mental health services involve religious and faith healers. As

far as hospital based mental health services are concerned, according to World Health

Organization (2011), there are only 520 certified psychiatrists and 480 psychologists in Pakistan.

For the population of 190 million there are less than 3,000 psychiatrist inpatient beds and there

are four major psychiatric hospitals in the country which are associated with mental health

outpatient facilities (Taj, 2016).

The informal, but most widely used source of mental health service delivery, is through

religious and spiritual healers due to the issues of less stigma, low cost and easy accessibility. In

Low and Middle Income Countries, especially in South East Asian countries, mental illness is

still considered due to possession or caused by evil, Jinn or other kind of supernatural forces

( Mubbashar, 2003).
Child Sexual Abuse

This world would be without love, if young children were endorsed to feel pain. Young

children are very important assets of our society and investing in children means investing in our

nation’s economic success. It is the responsibility of the whole society to take care of their

children but unfortunately, society has failed to take an approach to the health of young children.

As a result of this, children suffer from multiple problems like substance abuse, unintentional

injury, mental health problems and child abuse, which pose serious threats to the young

children’s health .

There are various types of child abuse such as physical abuse, emotional abuse and

sexual abuse. Although every type of problem is equally important but child sexual abuse (CSA)

is more serious and underreported problem as compared to others .Due to child sexual abuse, a

child not only suffers from physical but also from emotional, social and psychological problems

both in short and long term. Therefore child sexual abuse should receive appropriate medical and

public health attention.

Child sexual abuse has been described as “any sexual contact with a child through the use

of force, threat, or dishonesty to secure the child’s participation, or any sexual contact with a

child who is incapable of consenting due to age, disability or power differential”

In conservative societies like Pakistan, child sexual abuse is considered as an offensive

act. Child sexual abuse and sexual maltreatment are usually concealed in Pakistan . Due to this

conservative attitude, people do not talk about this issue in our society, including the victims

themselves. There is very limited and scarce research in Pakistan, related to child sexual abuse.

No national survey or official statistics are available in Pakistan regarding child sexual abuse,
and only limited kind of qualitative reports are published by some private organizations

.Moreover, multiple factors like izzat (honor), haya (modesty) and sharam (shame) prevent the

victims from disclosure of child sexual abuse .

In January 2018, Zainab Amin, 7 years old , was raped and killed in Kasur. Her body was

found in a trash site. Before her, 12 other child rape cases had been reported within roughly a

mile radius. In 2015, a gang of men was arrested after reports emerged that they had sexually

abused at least 200 children in a rural area of the district. The men made videos of the abuse to

either sell underground or use to extort money from victims’ families. Number of cases increases

day by day as report from one of the NGO that the child sexual abuses cases went on to add that

as many as 729 girls and 575 boys suffered sexual abuse of some kind between Jan-Jun 2019.

The report revealed that there had been 652 report cases in Punjab, 458 in Sindh, 32 in

Balochistan, whereas, 51 in Khyber Pakhtunkhwa. Meanwhile, reports of sexual abuse pertaining

to underage children amounted to 90 in Islamabad, 18 in Azad Kashmir and 3 in Gilgit-

Baltistan.The report further mentioned that as many as 50 children became victims of sexual

abuse in Lahore alone.It was also revealed that as many as 12 minor girls and boys suffered

sexual abuse in Madrassahs. This is an alarming situation for our country.

Psychologists and social scientists cite social factors as a major cause of increasing

sexual abuse of children in the country. However, child sexual abuse has never received attention

it deserves as a horrific crime in Pakistan.

Mental Health Plan for child Sexual Abuse In Pakistan

Child sexual abuse is a serious problem at individual, familial and societal level. Therefore,

prevention measures at different levels are of paramount importance.

Vision

 No child has to be victim of child sexual abuse

 Address the Taboos of the society

Objectives

 To break the silence on the issue of child sexual abuse among the communities

 To teach the children about child sexual abuse

 Identification of child sexual abuse cases and reporting

Action needs to be taken to achieve the objectives are followings

Dispelling the social taboo attached to child sexual abuse that restricts parents in reaching

out to police to register the case. Numerous prevention programs such as education of parents,

home visiting programs, public education and training sessions for teachers can be developed to

remove the social taboo attached with child sexual abuse.

Awareness can be created about child sexual abuse through school-based domestic abuse

prevention programs and prevention campaigns. In addition, community empowerment and

participation can also play an important role in removing the social Taboo.

Age-appropriate informative-text about child sexual abuse prevention in the curriculum is

now an indispensable need and should be incorporated without any ifs and buts. Short animated
videos/cartoons should be introduced in schools and aired on TV to guide children about self-

protection and self-defense through simple messages e.g. private body parts and body

boundaries, difference between good touch and bad touch, not to allow anyone to take pictures of

their body, not to keep body secrets, importance of saying no, not sitting in anyone’s lap, never

trusting strangers, to whom to talk if they are made to feel uncomfortable, how to repel if any

inappropriate advances are made and so on.

Government should make some laws and policies through which an immediate action can

be taken against the criminals and abusers. Strong political commitment and specialized

expertise on the subject, as well as special laws on child sexual abuse should be developed.

Moreover, statistics regarding child sexual abuse need to be gathered and compiled at national

and provincial levels to estimate the true burden of problem in the society so that appropriate

actions can be taken accordingly. Apart from failing to create deterrence, the painfully slow trial

procedure and deliberate procrastination of cases in courts lead to despondency and

discouragement among victims to file and plead their cases. The legislation should be done to set

the time limit for the child sexual abuse cases to be finished. Legislation should also be done that

an offence of child molestation be treated as an offence against state so that no offender can get

away by exploiting the Diyat law.

References

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complexity of how and why individuals come or do not come to mental health care. World
Psychiatry: Official Journal of the World Psychiatric Association (WPA), 12(3), 269-271.
doi:10.1002/wps.20072

Global and Cultural Mental Health. (2013). Retrieved from

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Mirza, I., & Jenkins, R. (2004). Risk factors, prevalence, and treatment of anxiety and
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Irfan, M. (2013). Integration of mental health in primary care in Pakistan. Journal of

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Zhu, N., Allen, E., Kearns, A., Caglia, J., & Atun, R. (2014). Lady health workers in
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