Mental Illness: the Unseen Epidemic

20 November 2011

by Bruce Clark

Tearfund's Bruce Clark on how thirty years of war has damaged Afghans' mental health

Depression, anxiety and post-traumatic stress disorder are not conditions you would associate with the average youngster.

But Afghanistan is not an average country to grow up in.

A UNICEF study of 300 children in Kabul in 1997 found that 67 per cent had seen dead body parts and 90 per cent believed they would be killed in war. Eighty per cent of those interviewed felt frightened, sad and unable to cope with life.

That survey was published four years before the Taliban were toppled. Since then billions of dollars in international aid has been pumped into Afghanistan.

But mental illness remains an unseen, misunderstood, and largely untreated, epidemic.

In 2010, Afghanistan’s acting public health minister, Suraya Dalil, said at least 60 per cent of the Afghan population suffered from stress disorders and mental health problems.

That’s far higher than the international average - the World Health Organisation suggests that globally, only one in four people will suffer from mental illness at some point in their lives.  

This hidden crisis is a result of thirty years of war, insecurity and poverty.

Women, who often suffer violence or intimidation within the home as well as outside, are especially affected.

In 2009, a Durham University survey also found that one in five Afghan children suffered from psychiatric disorders, including extreme anxiety, depression and post-traumatic stress disorder.  It concluded that while their mental health was affected by war, other factors also played a part. These included violence in the family or community, inadequate housing, poor quality education and having to work to earn money for their families.

Lack of information about mental health issues, and a dearth of trained mental health professionals means patients are often abandoned by their families. The stigma attached to mental illness, along with the fact that some people believe sufferers are possessed by demons, has led to patients being confined to their rooms, sometimes in chains. Few Afghans know about, or have access to, psychotherapy or counselling.

Tearfund is supporting work to change this. We’re working with a partner agency in Western Afghanistan to provide basic mental health care to people in four provinces - Herat, Badghis, Ghor and Farah.

Our partner’s Primary Mental Health Programme is groundbreaking. Established in 1995 in response to a high rate of self immolation by Afghan girls and women, it has since developed into a national leader in mental health support.

It provides training to doctors, nurses and community health workers, trying to ensure that some basic mental health care is available even in remote areas. It is trying to reduce the stigmatisation of mental illness by integrating such services into existing, accessible, local health structures.

The programme also seeks to draw in community figures who have traditionally been families’ first port of call for mental health advice, including local healers, mullahs and sheikhs. They are being given a basic education in priority mental health disorders and are being taught how to pass that knowledge on to the community.

Health workers are also being taught about family conflict issues, counselling, and how to refer patients on for further treatment. 

To a Western audience, such services might seem unremarkable. But in Afghanistan, they are nothing short of revolutionary. Indeed, they are so rare that one patient, an Afghan refugee in Pakistan, travelled across the whole of Afghanistan to visit our partner’s clinic.

Last, but not least, the project is changing attitudes by building awareness of mental illness among decision makers, teachers and legal professionals.

Such an approach is finally beginning to pay off.  When I visited Herat recently, I was thrilled to see key government officials, foreign dignitaries and six Afghan TV crews turn up to a ceremony to mark World Mental Health Day.

Mental health issues in Afghanistan are finally starting to come out of the shadows.

Bruce Clark is Afghanistan Country Representative, Tearfund.