Focus on mental health care

Javed, a 22-year-old helpless young man sat in hysterics chained up under a tent in the grounds of a shrine in Tatta, some 170 km northeast of the southern Pakistani city of Karachi. "I want to leave this place but I don't know when," he told IRIN, as he lay muttering to himself. He had been brought to the Saint Shah Aqique shrine by his mother two years ago from Lahore in the Punjab Province. "We know other people who have been here and they have been cured, and I can see that he is getting better," Javed's mother, Najma, told IRIN at the shrine. "He used to roam the streets and wander off. His mind was uncontrollable and I never knew what he would do next." Mental illness is widespread in Pakistan, with some 20 percent of the population affected by depression, drug abuse, personality disorders and obsessive compulsive disorders, according to Dr Aftab Khan, a practising psychiatrist in the capital, Islamabad. Other severe forms, such as schizophrenia, are also prevalent, and there are very few resources to deal with them. "Doctors will see between 15 and 20 patients per hour, and this is not really very practical in the long run," he said, adding that he would only treat up to 10 mentally ill patients per day. Najma said both her sons were mentally ill, but that she had decided to bring only one to the shrine to start with. There is no proper care available for people who are brought to the shrine other than from devout followers of the saint, who occasionally watch over them. Food is donated by local people, but devotees have complained it is not enough. Nearby a girl stood talking to herself looking entirely lost. "Don't talk to me. I am ill," Samina cried, clinging to the windows of the shrine. "I don't know how old I am and I don't know who brought me here," she said. The 14-year-old girl had been at the shrine for the past two months. There are some 50 people living in the grounds surrounding the shrine, all in search of blessings to help cure their mental illness. Up to 300 people visit it every day, with many just offering prayers. Born in Osh Sharif in southern Punjab, near the city of Multan in 1432, Shah Aqique lived a short life and followed his brother, Sayyed Abdullah Shah Bokhari, a holy man to Tatta. The shrine was built after his death in 1465 and has become famous throughout Pakistan for spiritual healing. According to believers, the saint developed the ability to perform miracles on patients with different illnesses, and centuries later hundreds still flock there every day in search of a cure. "There are usually more people here, but it is the month of Ramazan," one devotee, told IRIN at the shrine. Followers of the saint believe that if a person is under the influence of black magic or evil spirits, he or she can be cured by sitting in the shrine's passage or gripping the railings. Most of those in search of a cure were sitting or lying outside the shrine, with a few chained up in tents in the grounds, allegedly for their own safety. Inside the building others could be seen clinging to the barriers surrounding the saint's tomb. Occasionally, believers run up and down in the grounds in an effort to rid their bodies of bad spirits. "People receive a message in their dreams from the saint and that is how they are cured," Rehana, a devotee at the shrine, told IRIN. Commenting on the general state of mental health care in Pakistan, Khan said hardly any resources were available for dealing with the problem, and "no more than 300 psychiatrists are treating a population of 140 million people." He compared this to the US where there are around 40,000 psychiatrists for a population of 240 million. "Resources are stretched to the absolute limit, so there is marginal care". He also echoed concerns over the myths surrounding such illnesses in this deeply traditional Islamic society, adding that the best form of treatment for patients would be a combination of medical care in familiar settings, preferably with the family. He agreed that the social fabric in Asian countries was better suited to supporting mentally ill patients due to the extended family network. "In the West people don't have this additional support, and it is very difficult for them to look after their relatives." He maintained that love, care and attention were crucial for the recovery process. "It has been proven that if you treat a patient and send them back to a strong support network they will not relapse," he said, adding that the fact that people at the shrine were in contact with their families and other people was healthy, unlike in some mental institutions in the West. "People don't have the time or resources to care for the mentally ill, that is why they are institutionalised," he said, but went on to stress that the fact that they were receiving no medical help could serve to worsen their situation. Although the shrine offers peace of mind in a country which has poor facilities for mental health care, there has been criticism of the way some people are left there, particularly those chained up. But local authorities claim they have no knowledge of this. "I am not aware of this shrine, but if we hear that people are being treated badly or are being tortured we will release them immediately," the district coordination officer for Tatta, Mahmud Ahmad Khan, told IRIN in Tatta. He added that he acknowledged that it was a serious human rights issue. Local religious leaders also frown on these practices. "People should not be chained. This is against human dignity, and there is no need for this," religious scholar, Muhammad Tufayl Thattvi, told IRIN in Tatta. He added that in most cases relatives brought their loved ones in chains because they thought them to be a danger. "There is a tradition of bringing them with chains or handcuffs," he explained. In an effort to put an end to malpractice after complaints that shrines were just money spinners because believers often donate cash to them, the Pakistani government took control of most of the major shrines in the country during the early 1990s. However, Khan said this one was not one of them. "If there are complaints, we will follow them up straight away," he stated. Khan explained that Pakistan was a society which strongly believed in traditions and mythology. "These customs have developed due to poverty. These people do need financial help. They can't afford to take their loved ones to the doctor, so many are left with no choice but to go for spiritual healing." Acknowledging that cases of mental illness required continuous treatment and education, he agreed that there were limited resources. "There are hospitals and institutions caring for the mentally ill, and we are trying to do as much as we can in offering these services to the poor, but our resources are stretched," he warned. Critics of the spiritual healing process say parts of the community are clinging to ancient beliefs which have no place in today's society. But for believers, this shrine of Shah Aqique offers hope in a country where services for the mentally ill are very poor. "I feel at peace here and I know God will help me," 13-year-old Rafiq, told IRIN, after having been at the shrine for just over six months. See further photos