Mental Health & the Urban Environment

Dr. Saadia Quraishy,CEO AMAN Mental Health

Presentation by

70 % of the World’s population will be living in an urban environment by 2050

600 cities in the world hold 60 % of the GDP and one fifth of the worlds population

828 million people live in informal settlements around cities in the developing world

By 2020 mental disorders likely to account for 15% of life years lost to illness

Depression will become the second leading contributor t o Gobal Burden of Disease by 2020

• Health receives 1% of its Pakistan’s budget of which mental health 1 % of that even though there are about 29 million people who suffer from some form of common mental disorder

• The prevalence rate of mental illness is about 34%.• Of these 0.5-2% have serious mental illnesses• Mental health services in Karachi is are mainly provided at government

hospitals and clinics and in facilities in the private sector • There is a serious shortage of mental health professionals including doctors,

nurses’ psychologists, social workers and occupational therapists. • Only 25 % are able to receive treatment with little opportunities for follow up

care in the community

Suicide and Deliberate self harm

Significant rise in the number of suicides from 1996 to 2006 from 153 to over 5000

The current rate is estimated between 5000 and 7000

Under reported ,mostly indirect information from media,hospital and postmortem records

Mostly males under 30 years .The common themes Depressive illness (79%) in a background of poor socioeconomic conditions, unemployment , low literacy and social isolation.

Karachi is Pakistan’s Largest City and Business Hub

Karachi’s population continues to grow above 5 % per annum due to Migration and High birth rate

Karachi’s Population Growth

Population has multiplied by 5 since 1971

Over crowding

Transport problems

Crime and violence

Terrorism

H

Economic and Political

environment

Family; Education; Social Network

Living and Working Conditions

Mental Health Problems

Individual factors• Genetic• Brain chemistry• Birth trauma and injuries• Health and nutrition• Physical illnesses • Medications/sideeffects• Lifestyle choices

Childhood development

• Quality of parenting• Attachment figures /family • Educational attainment• Losses/separation• Trauma/abuse neglect

Socialisation and inclusionRelationshipsEmployment/ working conditionsHousing/living conditionsEnvironment

,Wider Environment

Water supplySanitationEnergy supplyCongestionTransportNoiseViolence/conflict/safety

Wider Economic issues/political stability• Social and economic inequity• Conflict• Migration

Urban Stress

• With rise in urban living stress levels also increase• Stress is the response to a perceived threat to an individual ‘s physical

mental or social integrity .• It escalates when there are worries or uncertainty around

employment and finances, housing, environmental issues and a fear of not being able to have control over ones life circumstances.• It is a protective evolutionary response to help people deal with

threats and adapt to their environments• However if persistent it can be harmful in the longer term

• We respond to threats via our autonomic nervous system releasing hormones which prepare us for an immediate reaction • Our heart increases, airways open up as our body prepares to fight or

flight • There is also a slower system that operates via our hypothalamus-

pituitary gland and causes release of other hormones which operate when stress is prolonged and can result in a metabolic imbalance and restructuring of body fat causing obes ity and its complications• Prolonged stress brings with it irritabilty and inability to cope, sleep

and appetite disturbances,fatigue and lowered immunity

• People respond to stress in different ways depending on different coping skills and lifestyles

In some this leads to reliance on smoking, illicit drugs and alcohol and changes in behaviorUrban environments are associated with higher levels of stress ,social stress, lack of control fear of losing ones social status, noise, pollution overcrowding in vulnerable people may precipitate mental illnesses.Urban dwellers can also have an advantage of access to resources and health services educational and cultural activities Stress vulnerability is a complex multifaceted issue and requires a multi -sectoral approach to deal with it

Mental Health Awareness

“A state of complete physical, mental and social well being, and not merely the absence of disease”. WHO definition

• Aman Foundation commissioned a Report on the Status of Mental Health in Karachi with a focus on low income communities to facilitate the development of a Mental Health strategy for Karachi The document produced through the work, of Aga khan university would be broad based and collaborative with the relevant stakeholders in the city. • Earlier in 2013, Aman Foundation also hosted a Stakeholder’s Round

Table to bring pressing issues as well as opportunities in the Mental Health paradigm of the city.

1. Integration of Aman Initiatives

Aman Foundation has a number of initiatives that provide mental health support within programs as

well as independent business units. Aman Mental Health Company could capitalize on the existing institutional presence of Aman to create an integrated strategy for Aman Mental Health Company

• Basic Needs established a Community Mental Health and Development programme in Pakistan in 2011 funded by the Aman Foundation and the British Asian Trust.• As an international organisation the community programme is able

to influence mental health work, practices and policy. HANDS (Health and Nutrition Development Society) providing community outreach workers (trained by Pakistan Association of Mental Health and Medical camps in the community run by Karawan-e-Hayat.

• Services were commissioned and began to function in Korangi in a pilot scheme covering a population of 300,000 • Community workers called Marwi workers recruited and trained who

identified people with mental health issues visiting them at home • Community awareness and mobilsation workshops held• 70 new patients in the first 4 months and 500 follow up patients• Numbers continued to grow with regular input• Record keeping and statistics generated regularly

Health Promotion

Community Healing

Bibliography:

•

• Agha Khan University, study 2013

• Men’s Health Initiative. http://menshealthinitiative.files.wordpress.com/2013/10/mental-health1.jpg. Retrieved 1/7/2014

• Karachi Battles. http://beenasarwar.files.wordpress.com/2013/03/karachi-muhammad-arshad-ips.jpg. Retrieved 1/6/2014

• Mental Hospital. http://www.dostpakistan.pk/wp-content/uploads/2013/05/mental_hospital-1024x1024.jpg. Retrieved 1/6/2014

• Urban stress and mental health,Adli,Mazda November 2011,LSE cities