AKU National Health Sciences Research Symposium on Mental Health

Assalam-o-Alaikum

On behalf of Aga Khan University and the Organising Committee, I would like to welcome you to the National Health Sciences Research Symposium, 2003. As you know the theme of this year's symposium is 'Mental Health - Understanding the Challenges'.

The choice of this year's symposium theme is an important one. Mental health problems not only afflict more than 450 million people world wide, they are on the rise. The World Health Organization estimates that if the present trend continues then by the year 2020, globally, depression would become the second most common disorder causing disability and distress, exacting a toll in human suffering that will be difficult to meet with the resources available - currently or in the future.

For developing countries like Pakistan these estimates have serious implications. Studies have shown that the prevalence of depression is staggeringly high in Pakistan - higher even than other developing countries with similar socio-economic indicators. Even if we take the most conservative estimate, then almost 10% of our men and more than a quarter of women suffer from depression. Add to this the 1-2% suffering from serious mental illness like schizophrenia, 3-4 million from drug addiction, 1-2% children suffering from mental retardation, and countless others from various psychosomatic disorders and we have, literally, millions of our people suffering from mental health related problems.

Where are these millions ending up? What is being done to address these problems and relieve them of their suffering? The sad but true answer is - nothing much. With a pitiable low health budget of around 1% and a fraction of that - if that at all - for mental health, a psychiatrist-population ratio of around 1 psychiatrist to a million people, discrimination, stigma, ignorance and an acute lack of treatment facilities - all indicate that we are living in, what I would call a 'mental health time bomb'.

And this 'bomb' is already ticking and taking a heavy toll on our population. The alarming rise in suicide rates over the last few years, from previously of a few hundred to now in thousands, the more than 3 million drug addicts in the country (the vast majority young men), the increasing levels of violence and intolerance in the society and the aggressive behaviour we come across in our daily lives are all indications that the mental health of the people of this country is seriously compromised.

What can we do about this state of affairs? It is obvious we cannot remain silent observers as this terrible tragedy unfolds in front of us. For where there are problems, there are also solutions. Solutions we have to come up with. But to be effective these solutions have to be culturally relevant, cost effective, replicable and sustainable. Given the fact that we have extremely limited resources - and what little we have is squandered by massive corruption, poor governance and mismanagement, this is no easy task. The challenge for all of us - the government, policy makers, aid donors and health professional is therefore a formidable one.

This University with its commitment, as enshrined in its mission statement, of improving health of the people of this country is strategically placed to take up the challenge. It has already led the way in many other areas - child health; community health, family medicine, nursing and teacher training are only some of the examples. There is no reason to believe that it cannot do the same in the area of mental health in Pakistan. And it must. Seen against this background the significance of this symposium is much more than that of an annual event. It is, in fact a landmark event. It is Aga Khan University's way of acknowledging that mental health not only matters, but that is has become a priority issue with us.

This symposium brings together a number of eminent experts, scholars, academicians and health policy makers, who will be sharing their experiences as well as challenges they faced in their own settings and in their own countries. We look forward to hearing their experiences and learning from them. We are grateful to all our foreign speakers, not only to have taken the time out but also to have had the courage to come to our shore in these troubled times. We truly appreciate this and thank you for your presence.

The two day symposium is immediately followed by two contrasting but equally important workshops. On Wednesday 24^th we have a one day workshop for Training of lay counsellors for counselling depressed and anxious women in the communities. This is a new and innovative project - result of collaborative research between the Department of Family Medicine, Community Health Sciences, and Psychiatry, which suggests this method of treating depression in women in the community is not only effective clinically but may also be feasible economically. If this kind of translational research is adopted in other settings then it has the potential of making a major impact on the management of depression, not only in Pakistan but in other developing countries as well.

The second is a four-day laboratory based workshop on molecular and analytical techniques for researchers involved in the field of mental health, who wish to familiarise themselves with basic, analytical and clinical research methods.

These two workshops are in addition to the four concurrent workshops on Mental Health Promotion in different settings i.e. schools, workplace, families and communities, scheduled for tomorrow Tuesday 23^rd September in the afternoon. We hope that some of you will take time out to participate in these workshops and share your experience with us.

I would like to conclude by saying that the challenges facing us in mental health in Pakistan today are enormous. And the road that we have to travel is not only long and winding but littered with innumerable obstacles. It is up to us to understand these challenges, rise to meet them and finally to overcome them.

I sincerely hope this symposium would help us towards that goal.

Thank you.