Need to address mental health issues

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Need to address mental health issues

Prof. Dr. Muhammad Iqbal Afridi is currently the Dean of JPMC (Jinnah Postgraduate Medical Centre), the Dean of Faculty of Medicine, JSMU (Jinnah Sindh Medical University), Chairman of Faculty of Psychiatry, JSMU, Head, Dept. of Psychiatry & Behavioral Sciences, JPMC, Member of Sindh Mental Health Authority as well as a Member of the Sindh Health Care Commission. He is also the President Elect, PPS (Pakistan Psychiatric Society), the representative body of Psychiatry in the country.

During his professional career, he has received numerous awards including Life Achievement Award by PPS, Legends of Matli Award, Sir Shah Sulaiman Peace Award, Zikerya Award in the field of Medical Science, Pride of Performance Award by St. John Homeopathic Medical College, DAYTOP Graduate Award by USA Embassy, & ANF (PNCB) Islamabad, Avicenna Research Award in International Psychiatric Conference. Recently he was awarded by DG, NAB (National Accountability Bauru), Brain Trust Gold Medal Award at the RSM(Royal Society Of Medicine, London), Avicenna Science and Innovation Award, President Brain Trust, UK. He has 84 research papers/articles published and presented in National & International conferences related to general Psychiatry, Psychosomatic Medicine (CLP) and Addictionology.

Recently, Muhammad Fareed, Editor of Medical Review interviewed him in his office. Following are the excerpt of his interview.

Q – Please tell us something about yourself?

Ans – My name is Prof. Dr. Muhammad Iqbal Afridi. Presently, I am the Dean of Jinnah Postgraduate Medical Centre (JPMC), Karachi as well as Dean of Faculty of Medicine at Jinnah Sindh Medical University (JSMU), Karachi. Furthermore, I also have two additional responsibilities i.e. the Chairman of Faculty of Psychiatry, JSMU and Head of Department of Psychiatry, JPMC. Beside this, I am also representing the society of psychiatrists i.e. Pakistan Psychiatry Society as the President-elect. I am working in this specialty since last 31 years. Primarily, I am clinician, teacher and as well as a researcher. My early education was in Govt. schools with inadequate facilities that can be imagined from the fact that there was only one teacher in the whole primary school. I was the only student who became doctor from that school.

Q – How can you explain psychiatrist attitude towards genetic counseling?

Ans – First of all, Psychiatric disorders are multi-factorial. Genetics is one of the most important components of causation of mental illnesses. Many diseases like Bipolar Affective Disorder, Schizophrenia and Mental Retardations are linked to the genes. Like other physical illness, most of the mental illnesses have a multifactorial origin, but some aspect of hereditary is also involved, such as in depressive disorder around 35 percent genetic attribution is established. So, therefore besides balance lifestyle there should be genetic counseling regarding the prevention of diseases. Many autosomal recessive and dominant disorder can be prevented by proper counseling. People having inter-marriages should be given proper information regarding genetic penetration in order to control some of the psychiatric disorders.

Q – How mental disorders affect men and women?

Ans – Mental disorder disturbs the personal life of both men and women by disturbing sleep, appetite, sexual activity as well as their daily performance. If a person is in a school or any other organization, his performance will be disturbed. Similarly, his social connection will also be lost. If the female is suffering from mental disorder that can lead to disturbed family life with serious impact on other members of the family especially children. The person with mental disorder can have marital disharmony as well as relationship problems with children, friend and colleagues at workplace as well as in the community, therefore addressing mental health can be useful at all levels since it is a social capital and the cornerstone of eHealth.

Q – What are the religious impacts on mental health status?

Ans – Primarily, religious impact can be a mode of prevention in mental disorder. Optimal religious activity can prevent some illness but over indulgence in religion may be cause of mental illness. Because anything in excess is pathology.

Q – What is the prevalence of mental health illness in Pakistan?

Ans – Regarding epidemiology of mental disorders, there is lack of proper research data in Pakistan which truly represent all the communities, various age groups and ethnic groups. However, one meta-analysis research revealed that 34% (i.e. 1 in 3 persons) of the Pakistani population is suffering from anxiety and depressive disorder. Other disorder such as schizophrenia is 1%, addiction is around 3% and mental retardation is around 2.5%. Worldwide 26% of the global burden of the disease occurs as result of mental illnesses. In our population, every third person needs psychiatric help.

Q-What are the causes of mental illnesses and how they can be prevented?

Ans — The causes of mental illnesses are biopsychosocial. The biological component includes genetic vulnerability as well as disturbance of neurotransmitters in the brain. Similarly problem with the nutrition and balanced lifestyle is also the main cause. If lifestyle is not proper, person will be disturbed. There should be good ratio between sleep, work, exercise and social activities in order to prevent these illnesses. The psychological component is also important i.e. parents and teachers should encourage their students and children in order to prevent many illnesses. Bullying among students and family members is also one of the causes that can lead to psychiatric disorder. We should encourage social activities, pleasant behaviours and good relationships with others to prevent mental illness.

Q – What is the role of media (electronic and print media) or social website – internet?

Ans – Nowadays, the role of media is very important in every aspect because it creates awareness amongst various segments and walk of life. Secondly, it is also related to mental illness. Previously, the role of media was not upto the mark, People used to laugh on psychiatric patients and therapists but now with the advancements in the media especially social media, it can be utilized for rational awareness for psychiatric disorder, prevention, treatment and rehabilitation. If we have good stories, movies, article on prevention and treatment, role of healthy lifestyle, we can prevent alot of mental health problems and diseases.

On the other hand, responsible reporting is very essential nowadays. We often see in the western culture that, they have control system on media, they don’t depict such stories or pictures which are horrible and create fear amongst peoples specially youngsters. Therefore, responsible reporting is utmost important and we should try to encourage and enhance good things that are happening in the community rather than just the bad things which are focused.

Q – What are the most important psychosocial risk factors for mental health disorder in men and women (gender base violence)?

Ans – The most important social factor that women should be given is due respect and it is also important for every human being. We should treat all the people equally. We often see that, people are not giving importance to their daughters. In this way, if due respect is given by the society to the female, we can prevent many mental health illnesses. For example, if the mother-in-law consider their daughter-in-law as her own daughter, she will realize her importance and therefore the interpersonal relationship amongst them will be improved which can be good sign for the whole family and society.

Q – What is the role of parents in growing children (emotionally supportive)?

Ans – Parents must be role model for their kids in term of their gesture, their talk and their lifestyle because young children usually follow their parents. Therefore, they should encourage them and address their simple innocent questions in such a way that enhance their confidence. There should be harmony amongst their relationship. Social and emotional component is very important for all the children.

Q – Any significant life event that happened in childhood or adolescence (effect on brain)?

Ans – Yes. During development stage, the brain and mind of children requires proper nutrition and sleep because sleep enhance the growth amongst the whole vitality of brain and body. Youngster requires around 16 hours of sleep while adult requires 8 to 9 hours in 24 hours. Instead of wasting time on social media and WhatsApp, people should have proper focus on their sleep, meal and exercise. Previously, the exercise is said to be extra-curricular activity but nowadays it is said to be para or co-curricular activity. Prevention of trauma, infection, head injuries all lead to good brain. Generally, we often see that people are wasting so much of their money on wedding and other function but they are not giving importance on pregnancy and delivery. Giving importance to pregnancy and delivery will result to have healthy baby birth.

Q – Being as President-Elect of your association, what is your future plan?

Ans – My future plan is huge. First of all, I will develop my own vision for upcoming 2 years which include patient’s care, teaching and training, research and development. We will try to destigmatize psychiatry at all levels. We will focus on 109 districts of Pakistan and will develop special research groups for working on different mental illnesses like addiction, OCD, depression, schizophrenia and mental retardation. We will try to publicize psychiatry by developing consensus on various terminologies in Urdu and local languages so that it could be understandable to all. We have planned to develop a magazine for common illnesses. Furthermore, we would also arrange 1 hour program in which every disease will be discussed, regarding prevention and treatment. We have also planned to collaborate with overseas Pakistanis and reach the government to establish mental health facilities in every district of Pakistan. We will also assess to find psychiatric friendly medical colleges having adequate mental health serviced besides PMCD criteria. We will try to translate mental health act in Urdu and local languages.

We have planned to form an area of research i.e. research on prevalence, research on intervention, research on treatment and rehabilitation. Furthermore, we will do situation analysis, national survey, disease registry, availability of medicine, oversea group formation, formation of different care givers group, establish first aid treatment of psychiatric disorder. Our theme is “Look, listen and link”.

Let me share a list of tasks that I have in my agenda and we will strive to achieve it collectively

  • PPS Vision & Mission
  • Own place for PPS Head office
  • Anthem
  • Agenda for months and years
  • Calendar to show important WHO world days WMHD
  • Situation analysis
  • Nation survey
  • Special disease groups
  • JPPS impact factor
  • Disease registry
  • Urdu Magazine Zahni sehat/ Nafsiat ur zindgi
  • Psychiatric services at 109 districts
  • Availability of medicine
  • Books & Assessment tools
  • Focal person in each zone/district
  • Various tasks group
  • Subspecialties
  • Nonmembers list in Urdu and other local languages
  • Membership drive
  • Overseas groups
  • Wings for overseas, associate members Clinical Psychologist Social Workers, Occupational
  • therapist psychiatric nurse caregivers / self-help groups n media, judiciary
  • 3 L for PFA Look listen link Volunteers for PFA at A & E
  • Medical college status for psychiatry n Behavioural Sciences
  • Community psychiatry
  • Training Ladies health worker
  • Research dessert on website
  • Guidelines
  • Groups Ethical, Research, CME/CPRD, Publication, Public Awareness
  • Psychiatry facilities in proposed 39 federal model hospitals
  • Letter to be Bureau of statistics for inducting questions on mental morbidity n disabilities
  • Research themes for dissertation
  • Sister Medical college with good standing
  • Responsibility of recognize dept to facilitate new dept to be recognized at deficient dept
  • Ethical relationships with pharma
  • Translation of MHA in local languages
  • Implementation of MHA through home dept/ beurocrate /police
  • Chapter in books at middle schools
  • Research areas for grants involving epidemiologists n statisticians
  • Categorize and standardize psychiatry depts as Class I to III
  • Benzodiazepines No more OTC availability
  • Developing Question Banks BCQ
  • Liaison with International OrganizationS WPA/APA/EPA
  • Holding a Thematic conference with WPA

Q – Anything you wish to add?

Ans – Mental health is beyond the absence of psychiatric disorders. It is state in which individual realizes his or her potentials, can cope with daily stresses, can work fruitfully and productively and contribute to his or her community and country. We have to promote positive mental health as mental health professionals not only tell about the prevention, detection, treatment and rehabilitation but can help the ways to maintain healthy lifestyle, can help how to communicate, sleep, study, work, play sports and develop good relationship with others. Psychiatric problems are same as other diseases. We have to treat patients holistically so that they can be become earning members of their family and useful members of the society. Let us join hand for the prevention, treatment and rehabilitation of psychiatric problem at all levels and means.