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KARACHI 2014 South Asian Cities Conference
9-12 January
Mental Health and Urban Environment
Stress, Distress, Disease – Coping, Adaptation, Quality of Life
Sunday 12th January 2014
SOCIALSTRESS
PHYSICAL STRESS
ADAPTATION
MALADAPTATION
SICKNESS
ILLNESS
DISEASE
Society, Culture Community, Family, Life events, Faith, Religion Morality, Economic, Social, Political
CNS Organiz.
Nutrition
Infection, Toxins
Drugs, Endocrine
Vascular Degeneration
Radiation
Drug,, Crime Violence, Homicide Suicide
Apathy, Psychopathy Anxiety & Phobia Obsession Depression Psychoses
Psychosomatic Pathological statesAdaptation - Flexibility - Accommodation
Maladaptation - Rigidity - Exclusion
“Normal”
ADAPTATION, MALADAPTATION
STRESSStress is an
aversive state characterized by significant
biological, psychological
and behavioural changes which
are objects, events or
people who are perceived as
threat, danger or demand.
PHYSICAL STRESSORSNoise, crowding, mal nutrition, insufficient shelter, pollution, toxins, temperature extremes and physical dangers like threat to life, crime, traffic and disease agents
PSYCHOLOGICALSTRESSORSRole and status confusion, conflicts, (religious ethnic communal), civil strife, deprivation or denigration associated with poverty, migration acculturation, alienation and anomie. Stressors have many different descriptive qualities including frequency, intensity, duration, discriminability, controllability familiarity and complexity (Marsella and Synder, 1981)
BASIC HUMAN NEEDS OF EVERY DAY LIVING
1. Housing 2. Potable Water 3. Food 4. Clothing 5. Roads 6.
Transportation 7. Electricity
8. Occupation 9. Education 10. Health 11. Pollution 12. Social Security 13. Recreation 14. Human rights status
HUMAN RIGHTS
1. Arbitrary Arrests2. Freedom of
expression by private citizen3. Freedom of media4. Right to participate
in political activity5. Prisoners6. Sex discrimination
7. Bonded Labor8. Torture by
investigating agencies9. Religious Intolerance10. Legal System11. Rights of the child12. Protection of life,
liberty and property
KILLINGS /SUICIDE 2013
More information in Annual Report, HRCP 2013
Target Killings (Karachi) 3251
Suicide (Pakistan) 2412
CONSENSUS
In 1996 the first extended meeting was held to evaluate the quality of life in Karachi. It was attended by Psychiatrists, Psychologists, Family Physicians and other health related person ( PAMH, PPS, Karwan-e-Hayat, College of Family Medicine,)
The NGO’s participation was through Aurat Foundation, HRCP, Bazme Ilmo Danish, Forum for Peace and Development, WAF, WAR, PILER, Idare Aman-o-Insaf whose input was through their own experiences.
Since then regular updates is carried out though the participant organizations kept changing. The most recent update was carried out in 2012 (Target killing, Bhatta Mafia, Land Mafia, Kidnapping for Ransom and Taliban).
There is an increase in psychiatric morbidity in Karachi. The relapses of old cases are frequent while a greater number of new case is being reported. A majority presented with anxiety, depression, obsession, conversion and psychotic disorder.
1. Morbidity
MENTAL AND PHYSICAL STATE
MENTAL AND PHYSICAL STATE
The stress related psychological and psychosomatic disorders have also increased. A large number of patients do not relate their mental or physical state to stress in the immediate or remote environment . Focus is on physical disorders and material requirement.
2. Stress Related Disorder
Physical illness is also on the increase due to decreased body resistance and increased susceptibility. This may be related to stress and insecurity at home, on roads and at work places. Decreased mobility including lack of exercise could be other factors.
3.Decreased body Resistance
MENTAL AND PHYSICAL STATE
SOCIAL AND BEHAVIOURAL
In every day life verbal and physical violence is increasing everyday. This is because of a qualitative change in expressed emotions, attitudes and behaviour, reflected in interpersonal relationship.
1. Violence
The moral fabric has deteriorated, i.e. corruption, forgery and favour for money. Religious, ethnic and communal intolerance is unprecedented.
2. Social Behaviour
SOCIAL AND BEHAVIOURAL
SOCIAL AND BEHAVIOURAL
The social life has been restricted. The attendance at marriages, mosques, shopping centers and social get-togethers has decreased. Such limitations interfere with inter-personal relationships and rob the inherent human quality of social responsibility. This may be the beginning of a social breakdown of society.
3. Interpersonal
The economic activity in Sindh and Karachi is at standstill .Close-down of factories, a fall in attendance at work , export has decreased, informal sector’s plight is not appriciated. The shopkeepers or a mechanic, who have to close down their shops or a vendor who has to stay home are suffering much more than realized.
1. Financial Resources
SOCIO ECONOMIC
SOCIO ECONOMIC
Over-crowding, architectural flaws, commuting, air and water pollution, food adulteration and lack of other basic needs .
2. Habitation
LAW AND ORDER
There is a considerable overlap of crime and politics in our contemporary political scene. Similarly there is an overlap between ever increasing militant sects and peace loving believers of different faith & religion.
1. Politics and Crime
When crime goes unpunished, not once but again and again this re-inforces criminal behaviour and encourages potential criminals. Such elements are patronized by politicians of dubious background and the Law Enforcing Agencies use them occasionally for their political masters (harassing, killing, kidnapping) and frequently for dacoity, bank robbery and rape etc. on their own as well.
2. Governance
LAW AND ORDER
CONCLUSION
1. No Mental Health Policy.2. No Supportive Services even in urban
areas.3. No Liaison between mental health,
psychiatric, psychological and social services organizations.
4. Lopsided psychiatrists and nurses/mental health workers ratio (psychiatrist per 100,000 people is 0.2 and psychiatric nurses per 100,000 people is 0.08; Lancet 2007).
5. Research is not given importance by health providers.