Editor in Chief: Moh. Reza Huwaida Tuesday, January 23rd, 2018

The Communicable Mental Disorders Pave the Bed for Social Violence

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The Communicable Mental Disorders Pave the Bed for Social Violence

Whenever we think about the challenges caused by insecurity, a lot of images come immediately in our minds: sever poverty, destruction, casualties, addiction, collapsed infrastructure, devastated cities and communities, broken families and pain. But we tend to pay less attention to other invisible wounds that last for years and cause deep scars on people and on development such as mental health. To be better understood, mental health is a term used to describe either a level of cognitive or emotional well-being or an absence of a mental disorder. Mental health is an expression of one’s emotions and signifies a successful adaptation to a range of demands. The World Health Organization (WHO) defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can properly cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
For the period of the last several decades, Afghanistan has been impacted in many ways by conflict and still is much in the middle of a conflict -- though some people classify it as post-conflict—in this context, one can hardly find an Afghan family which has not lost one or more members in this period due to insecurity crisis. Millions of people have been killed, addicted, windowed, orphaned, about one million are disabled and millions either migrated abroad or are internally displaced. Insecurity crisis and other factors such as unemployment, general poverty, breakdown of community support services, and inadequate access to health services have not only damaged the social infrastructure of the nation, but also caused mental health disorders mostly in vulnerable groups like women and disabled people.
Regrettably, half of the Afghan population aged 15 years or older is affected by a communicable and invisible disease called mental disorders which include several types akin to: depression, anxiety, hyperactivities, aggressions and post traumatic stress disorder. These disorders contribute to community and domestic violence and to the high levels of malnutrition in the country as they adversely affect maternal care giving in diverse ways. In addition, existing superstitions and social restrictions are big challenges for women’s access to mental health services in Afghanistan.
Due to a combination of high prevalence, early onset, persistence and disability, mental health disorders constitute a major part of the total burden of disease globally and even more so in conflict and post-conflict settings. There is no disagreement, amongst experts, about the very high burden of mental health disorders in Afghanistan, much of which can be attributed to deep social trauma, over 30 years of armed conflict and the continuous social insecurities, unemployment, acute poverty, dissolution of social capital, and inadequate access or lack of access to mental health services.
In fact, Mental health disorders is one the major factors contributing to violence at community and household level. The violence is not only husbands against wives, but also brothers against sisters, mother-in-laws towards daughter-in-laws and always against children. Due to socio-traditional and uneducated context, mental illness is higher among women, which is a likely contributor to the high levels of malnutrition among children in the country. It has been globally documented that mental health problems adversely affect maternal care giving, e.g., breastfeeding, responsive complementary feeding, thereby affecting child motor and cognitive development, and increased prevalence of stunting (chronic malnutrition), which could be a causative factor in the high levels of stunting in Afghanistan (more than 50 percent among children under five). In the meantime, due to social superstitions, low literacy level and lack of female health professionals delivering services to female patients remains an important challenge.
Consequently, Investments in mental health services will not only contribute to reducing individual suffering, but will also contribute to reduction of the burden of domestic violence, alleviating societal fragility and tribal conflicts, and hence help the nation to move towards sustainable peace and development. In addition, improved mental health of mothers is likely to contribute to improved child care and may well improve the nutritional status of young children, thus resulting in overall reduction of child mortality. The Disease Control Priorities in Developing Countries elaborates that the main challenge to deal with mental health problems is enhancing systems of care by developing effective local models and disseminating them throughout a country.  It also points out those basic psychological therapies can be effective and can be easily put to use at the primary level. There is recent evidence on anti-depressants, which suggest that the pharmacological interventions for mild to moderate depression had no greater impact than a placebo. However, there is good evidence that anti-depressants are helpful for patients with severe depression. Therefore, in line with the intervention guide, the prescription of anti-depressant medication should be restricted to the more severe forms. In Afghanistan, as in many other Asian countries, many patients visiting health facilities expect to be prescribed some kind of medicine. In the training of health staff an important element is to assist patients in a satisfactory way, while preventing iatrogenic harm due to unnecessary prescription of psychotropic drugs. Alternatives for anti-depressant prescription can include psychosocial interventions and short-term prescription of symptomatic medication to restore sleep or reduce anxiety.
In summary, there is ample global evidence which indicates that a psychosocial approach at local level through Primary Health Care (PHC) is the best choice to manage wide-spread mental health problems in Afghanistan. Also, from a programmatic perspective, it could be readily implemented through strengthening the Basic Package of Health Services (BPHS) or Essential Package Hospital Services (EPHS) in Afghanistan in terms of its capacity to provide basic psychosocial counseling coupled with provision of the right medication.

Mohammad Zahir Akbari is the newly emerging writer of the Daily Outlook Afghanistan. He can be reached at mohammadzahirakbari@ gmail.com

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