People with mental health conditions often face severe human right violation, discrimination, and stigma particularly in developing countries. Lack of acceptance makes it difficult for such individuals to share their mental health issues with their family or friends out of the fear of being judged or worse disowned. For this reason, most of the people experiencing psychological stresses never receive the treatment they should, negatively impacting their quality of life and of those around them.
The COVID-19 pandemic created a global crisis for mental health, exacerbating both short- and long-term depression. Anxiety and depressive disorders rose by more than 25% during the first year of the pandemic, per recent World Health Organisation estimates, the developing countries were the worst affected as already limited healthcare resources were allocated to treat COVID-19 patients. In Pakistan, mental health disorders account for more than 4% of the total disease burden, with the mental health burden being higher among women. It is estimated that 24 million people in Pakistan are in need of psychiatric assistance. However, allocated resources for the screening and treatment of mental health disorders are not enough to cater to these patients.
The Foundations for Health and Empowerment (F4HE) programme, an initiative of the Aga Khan Development Network (AKDN), is designed to ensure professional healthcare for the mental illnesses by creating awareness and building capacity of the healthcare workers in Pakistan, Kyrgyzstan, and Tajikistan. The Aga Khan University’s School of Nursing and Midwifery (AKU-SONAM), Brain and Mind Institute (BMI) and Department of Psychiatry collaborated with Aga Khan Health Services, Pakistan (AKHS, P) to conduct research, develop the training modules and roll out the programme. In Gilgit, Baltistan and Chitral (GBC) region of Pakistan, the stepped care model is being implemented by AKHSP and AKU-SONAM to help develop positive narrative around and awareness of key mental health issues and create pathways for early identification and management of depression and anxiety and other mental health issues.
AKDN partners will adapt and integrate evidence-based interventions including the WHO Mental Health Action Gap Program (mhGAP), the WHO-endorsed Thinking Healthy Program (THP) for Perinatal Depression, and the Healthy Activity Program (HAP) for preparation of mental health counsellors – along a stepped care design that will offer patients the needs-based options following a continuum of low intensity task shiftable support mechanisms to more intensive treatment options offered by specialized healthcare providers. The need assessment and first phase of training has been conducted in GBC region. In Kyrgyzstan and Tajikistan, F4HE programme is being managed by AKU-SONAM and the need assessment has been completed successfully.
In GBC region, the need assessment was conducted from August to October 2021 by arranging focus groups with the target audience comprising female adolescents, male adolescents, young mothers, elderly, and regional local council members. The focus groups revealed multiple mental health issues faced by each of the target groups due to varying factors like hostile and conservative family environment, lack of communication and trust, peer and academic pressure, lack of job opportunities, generational gap, and misperception among others.
The healthcare workers confirmed that schizophrenia is the most prevalent mental health issue followed by depression and anxiety, they also observed higher rates of mental health problems among women; majority of the patients resort to drug abuse in the absence of proper treatment. Health workers also cited lack of trust, referral pathways and resistance to payment as key impediments in administering treatment to the patients.
As a first step towards the solution, AKU organised capacity building trainings for the health care workers to address perinatal mental health needs in GBC region under F4HE project. The six-day training was conducted from March 27 to April 1, 2022, based on Health Activity Program designed for lay counsellors to provide a culturally appropriate and flexible psychological support and treatment for depression and Anxiety in primary care settings. The workshop was attended by 29 participants including psychologists, nurses, student counsellors and health representatives from Aga Khan Health Services, Aga Khan Education Services and Government of Gilgit, Baltistan and Chitral.
The workshop sessions facilitated participants to learn the assessment of patients using designated tools and basic counselling skills to manage moderate to severe Depression and Anxiety in primary care settings. Through practice sessions, participants were trained to utilize ethical principles while dealing with the mental health needs of clients and patients. Developing an understanding of scope of practice and related pathways for healthcare providers under F4HE project were also considered during the training. The facilitators imparted theoretical knowledge and clinical experiences to enhance peer-support across disciplines, in adjunct to the training aim, and to promote best possible mental health care to patients in the region at primary care level.
The second phase of the training will focus on developing the skillset of nurses, student counselors and health representatives in order to improve their counseling skills specifically to manage mental health patients using cognitive-behavioural techniques.
The lead facilitators for the workshop were Ambreen Tharani, Assistant Professor and Head Mental Health Clinical Stream, AKU-SONAM and Syeda Humera Qutb, Instructor AKU-SONAM, (certified NLP and hypnotherapy practitioner, NGH, ABNLP, USA). The co-facilitators were Dr. Nargis Asad, Associate Professor and Chair, Department of Psychiatry, AKU, Falak Madhani, Head of Programs, AKHSP, Farida Bibi Mughal, Instructor, AKU-SONAM, Perin Avari, AKHSP and Jasmit Shah, Brain and Mind Institute, AKU.
