High incidence of mental cases sans care in Afghanistan

Kabul, Dec 19: Roughly four out of every ten persons, including women and children, suffer from mental health problems in violence-ravaged Afghanistan.

Amid such a dismal scenario, reports of a resurgent Taliban and escalation of violence in some provinces leave people more depressed, traumatised and nervous, say many doctors pleading anonymity in the wake of rising number of suicide bomb attacks and repeated bids to trample the fledgling democracy.

In a country with a population of 24.1 million and a life expectancy of just 45 years for women and 47 years for men, improvement in the mental health system has been ranked fifth in the six-point high priority agenda of the Ministry of Public Health.

It has identified the "high prevalence" of mental disorders as one of the main problems.

A country cooperation strategy for WHO(World Health Organisation) and Afghanistan 2006-2009, said more than two million Afghans were estimated to be suffering from mental health problems. It said a nation-wide survey, conducted in the first year after US-led forces unseated the Taliban regime, found high levels of depression symptoms in males (59.1 per cent) and females (73.4 per cent), anxiety symptoms (male 59.3 per cent, female 83.5 per cent) and post traumatic stress disorders (male 32.1 per cent, female 48.3 per cent).

The existing conditions for highly sensitive women are more precarious as they fail to cope with the depresson. "Many of them in emotionally touch-and-go situation, immolate themselves," local people, on the basis of their own understanding, told this visiting correspondent.

Incidence of domestic violence, being attributed as prime reasons for the current spate of self immolations, were also high on the scale because of "irritations in personal behavioural patterns in a tense society," officials said.

The Health Ministry is in the process of revising its policy and formulating a new mental health programme. Financial crunch is the main stumbling block, official sources said. They said due to the high incidence of exposure to trauma symptoms of depression and anxiety are prevalent among a wide section of the people. A large number of cases often go untreated because of lack of resources and paucity of mental health care professionals.

More than two decades of conflict and three years of drought have led to widespread human sufferings and substantial population displacement. The country's infrastructure has either been destroyed or degraded and vital human resources depleted, Deputy Health Minister Dr Faizullah Kakar said.

Local people say mental health facilities in Afghanistan are non-existent or in poor condition. According to Health Ministry officials, basic reasons behind the high rates of mental health symptoms in the war weary state is due to people's exposure to trauma for years at a stretch with a round-the-clock lurking fear of untoward incidents. Many victims suffered prolonged hunger and thirst due to unavailability of drinking water. Many had also witnessed ghastly murders, loot and rape of their kith and kin.

Dr Kakar expressed concern over the large number of Post Trauma Syndrom Disorders(PTSD) patients. The Minister, quoting several studies, pointed that more than two decades of strife and three years of drought had resulted in widespread human suffering and substantial population displacement.

Scarcity of qualified personnel in the field of mental health is a big dilemma: there are hardly any medical doctors with experience in the field of mental health. According to WHO's Atlas (2002), there are only 8 psychiatrists and 20 psychologists for the whole of Afghanistan. Even this figure does not seem, officials said.

The 60-bed Mental Hospital in the capital has rudimentary facilities for drug addicts and mental patients. It is meant to be a specialised referral centre for the entire country. The hospital is linked to five community mental health centres in four localities in the city.

Some beds are allocated both for psychiatric and neurological patients in provinces like Jalalabad, Herat, Mazar-e-Sharif, Shabarghan and Kandahar.

From the studies carried out in different periods in the country, it is clear that large numbers of people have symptoms of mental disorders; especially symptoms of depression and anxiety are prevalent among women. The mean prevalence of depression among women according to the studies, is 72.08 per cent and 37.6 per cent among men. Mean prevalence of anxiety among women is 82.5 per cent and 40.6 per cent among men . Mean prevalence of PTSD among women is 40.7 per cent and 19.8 per cent among men, the Minister added.

He said these figures might be disputed due to various reasons but "mental health is a big problem in Afghanistan and without a prompt intervention, the situation can worsen." A 2006 report of assessment of the mental health system in Afghanistan using the WHO -Assessment instrument for mental health systems (WHO-AIMS) found that Schizophrenia and other disorders are most common at in patient units in the general hospitals. In the mental hospital, substance are use and schizophrenia are seen most frequently.

The report pointed out that less than one per cent of training for medical doctors is devoted to mental health in comparison to two per cent of nurses. It said there have not been major changes in the mental health systems since the collapse of the Taliban. Researchers found that that there was no financial or legislative support for people with psychiatric problems.

Almost all mental health care systems are located in major cities. In rural areas, they have either limited training in mental health are unavailable.

UNI