Journal Article

Offering Mental Health Services in a Conflict Affected Region of Pakistan: Who Comes, and Why?

van Griensven, Johan, Schneider, Serge, Shah, Safieh, Sadiq, Sana, Zachariah, Rony, Van den Bergh, Rafael, Guillergan, Erwin Lloyd D., Severy, Nathalie, Van Bellinghen, Benedicte, Saleem-ur-Rehman, Akhtar, Asma, Van Overloop, Catherine, Saeed-ur-Rehman, Khilji, Tahir Bashir-ud-Din, Dazzi, Francesca, Afridi, Sher Ali, Bosman, Philippe, Maïkére, Jacob

2014

Overview

North West Pakistan is an area ravaged by conflict and population displacement for over three decades. Recently, drone attacks and military operations have aggravated underlying mental disorders, while access to care is limited. Among patients attending a mental health clinic integrated in district hospital conducted by psychologists; we describe service utilization, patient characteristics, presenting complaints, morbidity patterns, and follow-up details. A retrospective study using routinely collected programme data was conducted from February to December 2012. A total of 1545 consultations were conducted for 928 patients (86% females). There were 71(8%) children and adolescents. An increase was observed from February to July, followed by a decline. 163 new patients (18%) were on psychotropic medication at presentation. The most common morbidity in females (36%) were symptoms of adjustment disorders and acute reactions. Depression and anxiety were common in both genders while post traumatic disorder was frequent in males (21%). Out of the 928 new patients, 639(69%) had a follow up visit planned with their psychologist, but only 220(34%) new patients returned for a follow up visit. In a district hospital, mental health services managed by psychologists were well attended. There is a need to consider widening the current package of care to cater to the diversity of mental health disorders, gender difference, children and adolescents. Standardized diagnostic and monitoring tools would also need to be adapted accordingly and to assess patient progress. Innovative approaches to tackle the problem of the low return rate are needed.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adjustment disorder / Adolescent / Adolescents / Adult / Ambulatory care facilities / Anxiety / Anxiety - epidemiology / Anxiety - therapy / Armed forces / Biology and Life Sciences / Child / Children / Childrens health / Complaints / Conflict / Depression - epidemiology / Depression - therapy / Developing countries / Diagnostic software / Diagnostic systems / Disorders / Displaced persons / Domestic violence / Drugs / Ethics / Female / Females / Gender differences / Health care access / Health services / Health Services Accessibility / Hospitals / Humans / LDCs / Male / Males / Medicine and Health Sciences / Mental depression / Mental disorders / Mental health / Mental health care / Mental health services / Mental Health Services - statistics & numerical data / Military aspects / Military operations / Morbidity / Pakistan - epidemiology / Patients / Psychiatry / Psychologists / Psychotropic drugs / Research and Analysis Methods / Retrospective Studies / Stress Disorders, Post-Traumatic - epidemiology / Stress Disorders, Post-Traumatic - therapy / Systematic review / Trauma / Widening