Mental health problems affect people throughout the world. In low-income countries, improved treatment and prevention strategies are needed. To be effective, these must be informed by knowledge of who is providing mental health care and how clients view the different forms of care available.

In Pakistan, there is relatively little evidence available on mental health provision and use perceptions. A team of researchers from the Department of Psychiatry and Behavioural Sciences, Fatima Jinnah Medical College, Lahore (Pakistan) and the Institute of Psychiatry, London (UK) was invited to conduct a study in the small town of Choti in the Punjab, in order to describe the types of mental health care providers that are available, and clients’ perceptions of the effectiveness of the different types of treatments offered.

The study involved a mental health consultation day, in April 2004. A total of 462 people attended the consultation day, of which 322 consented to participate in the study. 157 were 18 years or older. Questionnaires were used to gather information from clients while they were waiting to be seen by the psychiatrist. The questionnaires were in English and conducted by trainee clinical psychologists.

Five different types of health care provider were identified: general practitioner, religious healer, Hakim (traditional medicine), homeopathic doctor and faith healer. The general practitioner was the most commonly consulted. Clients considered general practitioner treatments to be the most effective.

The study team report the following findings:

• The most common condition was depression (107 people).
• Most conditions were chronic, but the duration was shorter for depression than for other illnesses.
• Almost all patients thought their condition was treatable, but some stigma was associated with mental disorders: 22 percent said they hide their illnesses from others.
• A majority (52 percent) believed that mental disorders were due to problems in the mind, while 25.3 percent thought they were physical and 11.3 percent said they were a combination of both. A small number (6.7 percent) said they were due to magic.
• 56 percent of those who sought treatment for depression from a general practitioner considered their treatment effective. For other mental illnesses this figure rose to 78.4 percent.

The results point to a difference between peoples’ beliefs and knowledge about available treatments. Lack of information makes it difficult to assess the effectiveness of the different treatments. The following recommendations are made for further investigation to help formulate mental health treatment and prevention strategies:

• The variety of different types of health provider demonstrates a need to broaden the focus of research into primary mental health care in Pakistan.
• Further work is needed to map the similarities and differences in practitioners’ knowledge of mental health issues.
• Drug treatments given by general practitioners need to be compared with the standardised treatments offered by homeopaths and Hakims.
• There is a need to further describe and standardise the mental health treatments offered by primary care providers, including both physical treatments and spiritual and psychotherapeutic techniques.
• Improving patients’ knowledge about primary mental health treatments would help set standards for treatment and may prevent conditions from becoming chronic.

Source(s):
‘Primary mental health care in rural Punjab, Pakistan: providers and user perspectives of the effectiveness of treatments’, Social Science and Medicine 63(3), pages 593-597, by Ilyas Mirza, Muhammad Mujtaba, Haroon Chaudhry and Rachel Jenkins, 2006 Full document.
'Eliciting explanatory models of common mental disorders using the Short Explanatory Model Interview (SEMI) Urdu adaptation - a pilot study', Journal of Pakistan Medical Association 56, pages 161 to 162, by Ilyas Mirza, R. Hassan, Haroon Chaudhry and Rachel Jenkins, 2006
'Knowledge and practice of help seeking for treatment of mental disorders in Pemba Island, Zanzibar', Tropical Doctor 36, pages 140-144, by Ilyas Mirza, M. Okitapoy and Rachel Jenkins, 2006

id21 Research Highlight: 22 February 2007

Further Information:
Ilyas Mirza
HEC Foreign Professor of Psychiatry
Institute of Psychiatry and WHO Collaborating Centre for Mental Health
Rawalpindi Medical College
Murree Road
Rawalpindi
Pakistan

Tel: +92 302 450 1584
Contact the contributor: iqmirza@gmail.com

Institute of Psychiatry, King's College London, UK

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