KARACHI 2014 South Asian Cities Conference

9-12 January

Mental Health and Urban Environment

Stress, Distress, Disease – Coping, Adaptation, Quality of Life

Sunday 12th January 2014

SOCIALSTRESS

PHYSICAL STRESS

ADAPTATION

MALADAPTATION

SICKNESS

ILLNESS

DISEASE

Society, Culture Community, Family, Life events, Faith, Religion Morality, Economic, Social, Political

CNS Organiz.

Nutrition

Infection, Toxins

Drugs, Endocrine

Vascular Degeneration

Radiation

Drug,, Crime Violence, Homicide Suicide

Apathy, Psychopathy Anxiety & Phobia Obsession Depression Psychoses

Psychosomatic Pathological statesAdaptation - Flexibility - Accommodation

Maladaptation - Rigidity - Exclusion

“Normal”

ADAPTATION, MALADAPTATION

STRESSStress is an

aversive state characterized by significant

biological, psychological

and behavioural changes which

are objects, events or

people who are perceived as

threat, danger or demand.

PHYSICAL STRESSORSNoise, crowding, mal nutrition, insufficient shelter, pollution, toxins, temperature extremes and physical dangers like threat to life, crime, traffic and disease agents

PSYCHOLOGICALSTRESSORSRole and status confusion, conflicts, (religious ethnic communal), civil strife, deprivation or denigration associated with poverty, migration acculturation, alienation and anomie. Stressors have many different descriptive qualities including frequency, intensity, duration, discriminability, controllability familiarity and complexity (Marsella and Synder, 1981)

BASIC HUMAN NEEDS OF EVERY DAY LIVING

1. Housing 2. Potable Water 3. Food 4. Clothing 5. Roads 6.

Transportation 7. Electricity

8. Occupation 9. Education 10. Health 11. Pollution 12. Social Security 13. Recreation 14. Human rights status

HUMAN RIGHTS

1. Arbitrary Arrests2. Freedom of

expression by private citizen3. Freedom of media4. Right to participate

in political activity5. Prisoners6. Sex discrimination

7. Bonded Labor8. Torture by

investigating agencies9. Religious Intolerance10. Legal System11. Rights of the child12. Protection of life,

liberty and property

KILLINGS /SUICIDE 2013

More information in Annual Report, HRCP 2013

Target Killings (Karachi) 3251

Suicide (Pakistan) 2412

CONSENSUS

In 1996 the first extended meeting was held to evaluate the quality of life in Karachi. It was attended by Psychiatrists, Psychologists, Family Physicians and other health related person ( PAMH, PPS, Karwan-e-Hayat, College of Family Medicine,)

The NGO’s participation was through Aurat Foundation, HRCP, Bazme Ilmo Danish, Forum for Peace and Development, WAF, WAR, PILER, Idare Aman-o-Insaf whose input was through their own experiences.

Since then regular updates is carried out though the participant organizations kept changing. The most recent update was carried out in 2012 (Target killing, Bhatta Mafia, Land Mafia, Kidnapping for Ransom and Taliban).

There is an increase in psychiatric morbidity in Karachi. The relapses of old cases are frequent while a greater number of new case is being reported. A majority presented with anxiety, depression, obsession, conversion and psychotic disorder.

1. Morbidity

MENTAL AND PHYSICAL STATE

MENTAL AND PHYSICAL STATE

The stress related psychological and psychosomatic disorders have also increased. A large number of patients do not relate their mental or physical state to stress in the immediate or remote environment . Focus is on physical disorders and material requirement.

2. Stress Related Disorder

Physical illness is also on the increase due to decreased body resistance and increased susceptibility. This may be related to stress and insecurity at home, on roads and at work places. Decreased mobility including lack of exercise could be other factors.

3.Decreased body Resistance

MENTAL AND PHYSICAL STATE

SOCIAL AND BEHAVIOURAL

In every day life verbal and physical violence is increasing everyday. This is because of a qualitative change in expressed emotions, attitudes and behaviour, reflected in interpersonal relationship.

1. Violence

The moral fabric has deteriorated, i.e. corruption, forgery and favour for money. Religious, ethnic and communal intolerance is unprecedented.

2. Social Behaviour

SOCIAL AND BEHAVIOURAL

SOCIAL AND BEHAVIOURAL

The social life has been restricted. The attendance at marriages, mosques, shopping centers and social get-togethers has decreased. Such limitations interfere with inter-personal relationships and rob the inherent human quality of social responsibility. This may be the beginning of a social breakdown of society.

3. Interpersonal

The economic activity in Sindh and Karachi is at standstill .Close-down of factories, a fall in attendance at work , export has decreased, informal sector’s plight is not appriciated. The shopkeepers or a mechanic, who have to close down their shops or a vendor who has to stay home are suffering much more than realized.

1. Financial Resources

SOCIO ECONOMIC

SOCIO ECONOMIC

Over-crowding, architectural flaws, commuting, air and water pollution, food adulteration and lack of other basic needs .

2. Habitation

LAW AND ORDER

There is a considerable overlap of crime and politics in our contemporary political scene. Similarly there is an overlap between ever increasing militant sects and peace loving believers of different faith & religion.

1. Politics and Crime

When crime goes unpunished, not once but again and again this re-inforces criminal behaviour and encourages potential criminals. Such elements are patronized by politicians of dubious background and the Law Enforcing Agencies use them occasionally for their political masters (harassing, killing, kidnapping) and frequently for dacoity, bank robbery and rape etc. on their own as well.

2. Governance

LAW AND ORDER

CONCLUSION

1. No Mental Health Policy.2. No Supportive Services even in urban

areas.3. No Liaison between mental health,

psychiatric, psychological and social services organizations.

4. Lopsided psychiatrists and nurses/mental health workers ratio (psychiatrist per 100,000 people is 0.2 and psychiatric nurses per 100,000 people is 0.08; Lancet 2007).

5. Research is not given importance by health providers.

Thank You