Dr. Manizha Ashna
Dr Manizha Ashna is the co-founder of the Women’s Health and Welfare Organization. She is co-leading the non-profit organization’s advocacy and training projects on promoting the health and welfare of Afghan women and girls. She has also worked with World Health Organization on Gender Mainstreaming in Health and Emergency Settings. Dr. Ashna is a Global Goodwill Ambassador working on the Afghan Women’s Physical & Mental Health Advocacy initiative.
Afghanistan has been impacted in many ways by conflict, and its effect on the mental health of the country’s civilians is one of its most destructive consequences. Insecurity, widespread poverty, migration, unemployment, breakdown of community support services, violence, oppression, and the experience of witnessing loved ones dying or being separated from family members inevitably have a significant impact on mental health. Depression, anxiety disorders, and post-traumatic stress disorder are very common among Afghans. About 66% of the Afghan population suffers from mental disorders. The findings of a survey undertaken in 2004 showed that 44% of Afghans had experienced more than four traumatic events and emotional stresses, 72% had anxiety disorders, and 68% were suffering from different forms of depression. In addition, 42% suffered from post-traumatic stress disorder (PTSD).
Depression and anxiety disorders are prevalent among Afghan women. Traumas of war, early and forced marriages, domestic violence, sexual abuse, traditional harmful practices, and cultural restrictions imposed on social activities are all factors that increase the rate of mental health problems among Afghan women. In Afghanistan, mental illness is often misunderstood. The misconceptions tied to mental disorders result in the fact that people consider mental illness a weakness, a defect, and a sign of disability. Some people are not even aware of their illnesses; they simply carry on. Unfortunately, people suffering tend to hide the maladaptive behavior, emotional illness, or psychological distress that requires treatment. Social taboos constitute one of the main barriers preventing sufferers’ access to mental health services in Afghanistan. The widespread stigma tied to mental disorders jeopardizes the development and implementation of mental health policy. Stigmas and discrimination are barriers that make intervention for treatment difficult, especially in rural areas of Afghanistan.
Mental disorders can bring significant changes in thinking, emotions, and behavior, causing either suffering or poor ability to function in daily life. Anxiety and depressive disorders are the most common mental disorders observed in Afghanistan. Everyone experiences anxiety, sadness and fear. These emotions are just a part of life, but a mental illness is present when these feelings become so disquieting or overwhelming that people have great difficulty coping with the activities of daily life. One of the most serious consequence of mental illness is when the sufferer goes as far as attempting or committing suicide. Unfortunately, many Afghan women attempt suicide, mainly due to mental disorders, domestic violence, or social and economic hardship. More than 90% of suicides committed by women in Afghanistan are directly attributed to untreated mental illness.
Mental health services are almost non-existent and there is little domestic capacity to prevent or treat mental illness in Afghanistan; this is a remarkable weakness in the health policy of the Ministry of Public Health in Afghanistan. On the other hand, mental disorders are one of the most misunderstood afflictions in Afghan society as they are exclusively tied to traditional medicine practices and irrational beliefs. In most cases, people who are mentally ill are treated by mullahs and, in severe cases, they are brought to traditional healing centers. There is a famous shrine called Mia Ali in Jalalabad city, located in eastern Afghanistan. People take family members who are not mentally well there as they believe that mental health problems can be cured by stern ordeal at the shrine. These traditional healing centers do not have facilities—not even the very basic requirements for defecating. Ill individuals are chained within these shrines for days, and even months.
There are some cultural and social barriers that deny most victims access to mental health services, such as inability to pay for treatment, lack of support from family members and friends, and self-stigmatization due to people’s negative and inaccurate believes about mental illnesses. One of the main barriers to the provision of effective mental health services is the lack of psychiatric hospitals and mental health care professionals equipped to handle and manage mentally ill patients. There are very few mental health facilities, and these facilities are scattered across the country with limited capacity and low levels of coverage. There is considerable neglect of mental health issues in Afghanistan; mental health problems are not given the attention of other physical diseases. There are few non-governmental organizations that provide mental health services; however, the few services that do exist are largely confined to urban areas. For example, Medica Afghanistan provides professional psychological counseling services to women and girls affected by war and violence. Additionally, PARSA (Physiotherapy and Rehabilitation Support for Afghanistan) has worked for many years to assist war victims, with a focus on women. This non-governmental organization provides counseling services to a women’s mental health facility in Kabul, also offering help to children with mental health issues.
An adaptive strategy with emphasis on prevention is needed to address mental health problems at all levels. The government should improve community awareness levels by using organizations with community links, such as governmental and non-governmental organizations, mass media, schools, campaigns, community groups, magazines, and newspapers to reduce stigma and discrimination associated with mental disorders. The mass media can play a significant role, with the ability to change popular belief within society related to mental health disorders. MoPH should support and encourage practices that integrate mental health into primary health care. It could help people to get fast and easy mental health services, especially in rural areas. Primary health providers can play an important role in identifying and treating mental disorders. However, this process requires the training of primary care staff in the identification and treatment of mental disorders, which many primary health care workers lack the knowledge to recognize and treat. Therefore, there is an urgent need to improve health providers’ capabilities regarding mental health problems to meet the future needs of the mental health system.
Government and health policy-makers must give to all Afghans who are suffering from mental illness the chance and necessary support to rebuild their lives, and lift their hope for the future through the encouragement of healthy minds and healthy bodies.
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