International Models of Emergency Psychiatric Care: Pakistan
Pakistan is the sixth most populous country in the world. Rapid population growth, limited resources, and political and social instability have created a tremendous need for mental health services, including emergency psychiatric care. Currently, there ar
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Muhammad Aslam, Ali M. Hashmi, and Ali A. Ali
Contents 24.1 Country Demographics and Information 24.2 Emergency Psychiatry Service Structure 24.3 Emergency Psychiatry Service Systems Flow 24.4 Patient and Staff Safety Concerns 24.5 Personnel and Staffing: The Psychiatric Emergency Services Team 24.6 Considerations for Coordination of Care 24.7 Health Care Funding and Resources 24.8 Mental Health Legislation 24.9 Education 24.10 Quality Initiatives and Quality Assurance 24.11 Summary References
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Abstract
Pakistan is the sixth most populous country in the world. Rapid population growth, limited resources, and political and social instability have created a tremendous need for mental health services, including emergency psychiatric care. Currently, there are almost no emergency psychiatric services in Pakistan due to a limited mental health budget, a limited number of qualified mental health M. Aslam (*) Geriatric Psychiatry, University of Cincinnati, Veterans Administration Medical Center, Cincinnati, OH, USA e-mail: [email protected] A. M. Hashmi Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan A. A. Ali Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY, USA © Springer Nature Switzerland AG 2020 M. J. Fitz-Gerald, J. Takeshita (eds.), Models of Emergency Psychiatric Services That Work, Integrating Psychiatry and Primary Care, https://doi.org/10.1007/978-3-030-50808-1_24
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p rofessionals for such a large population, and no specialized emergency psychiatric care providers. In response to this need, the World Health Organization (WHO) has recently started a pilot program called the Mental Health Gap Action Program (MHGAP) to improve services for mental, neurological, and substance use disorders in Pakistan.
24.1 Country Demographics and Information As the world’s sixth most populous nation, the estimated population of Pakistan is over 200 million [1]. Almost one-third of the population lives below the poverty line [2]. The main languages spoken in Pakistan are Urdu, English, Punjabi, Sindhi, Saraiki, Pashto, and Balochi. There are numerous regional languages and dialects [3]. Punjabis are the largest ethnic group, followed by Pashtuns, Sindhis, Saraikis, and other minority groups [4]. The country is overwhelmingly Muslim (96%), with Christians, Hindus, and other religions comprising the remaining 4% [5]. The World Bank has categorized Pakistan as a “Low- and Middle-Income (LMIC)” country [6]. Thirty-four percent (34%) of the population is under the age of 15, and 7% is above the age of 60. Sixty-eight percent (68%) of the population lives in rural communities. The life expectancy at birth for both males and females is approximately 65 years. Literacy estimates note that 62% of men and 37% of women are literate. Medically speaking, it is estimated that there are only 85 general practitioners and one hospital bed per 100,000
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