Decades ago, when I was doing my Masters in Psychology, people used to say, only ‘mental’ people study psychology or that people who study psychology are not ‘normal’. It used to break my heart and I used to explain that it was not like that. Both my parents, being psychologists, would just smile and say it is stigmatized and people will understand how important it is to be mentally healthy and that this is going to change with time when there is more awareness.
Now, after three decades or so, when I sit and write this, I have the same feelings; nothing has changed in decades and this brings pangs of anguish, sadness and pessimism: How much more time? After all, when is it going to change?
Mental health in Pakistan has always been neglected or sidelined; people still struggle with their mental health, refraining from seeking help due to the fear of being judged or labelled. Even the students of psychology and counselling have to face this wrath. This is very disturbing as not seeking help, when it is needed, deeply affects the entire life. In spite of significant developments around the world in creating awareness and tackling the stigma attached to seeking mental help, Pakistan still lags far behind in making it socially acceptable to seek therapy. We, as a nation, have been living in denial about mental health issues.
The pandemic has affected mental health all over the world and has posed serious implications on the quality of life; there is so much suffering and seeing the near and dear ones suffer has created mental health issues. There is fear, depression, insecurity, anxiety and so much more. Now there is a dire need to address these issues, instead of brushing them under the carpet. The first step to deal with these is awareness of the importance of mental health. Going to a counsellor or therapist when you are feeling sad, grieving or overwhelmed should be as normal as going to the doctor when you have flu or fever.
We all know that we need to end the stigma about mental health and, in this regards, awareness is the key step. Different study programmes, local and international, have been out, trying to create this awareness. Pakistan offers amazing study programmes in psychology: general psychology, clinical psychology, organisational psychology etc. and also in psychiatry; these are awarded by recognized universities of Pakistan and a lot of valuable research is being done in these fields. I did my masters in psychology from a Pakistani university and it set a solid foundation for my future psychology studies; however, my pursuits of exploring more in the field took me to a couple of international universities and institutions that actually opened new avenues throughout my journey.
It was through these international platforms I learned that mental health does not refer to people with psychotic problems only; it also refers to people who are in conflict and are stuck in dealing with them ·
Latest developments in mental health have brought the person needing help out of the hospital clinic to a beautiful therapy room with fresh flowers and a relaxing environment. Gone are the days when therapies were done only in hospitals or clinics. I learnt that we need to bring this out of the hospital clinics, into more refreshing and brighter places. It has brought the person out of the counselling couch used in Freudian times, where the psychologist sits on a side, taking notes, to a relaxing chair where the client sits and talks about his feelings not always from the past, but also in the here-and-now, where he can sit comfortably and unwind. These talking therapies are in a more relaxed and collaborative environment. A psychologist comes from a position of power, as is a doctor, but a therapist collaborates with the person and steers him to regulate his life. This is the beauty of therapy, where you yourself are the decision maker; you accept responsibility for your life and are not pressured to change.
Mental health studies are more diverse now, with latest theories and therapies cropping up each year. Apart from the studies of psychology, we need to open new avenues of counselling and psychotherapy studies that are so vast and even they have sub-categories to be explored e.g. humanistic, CBT, existential, EMDR, group therapy etc. And all these have proven to be very effective. The international courses have basically widened our horizons and updated our knowledge. I feel after studying psychology my studies of counselling and psychotherapy were like a breath of fresh air. There is so much to it that I feel I cannot do justice by writing a couple of lines on it here.
I am not saying that the study of psychology is not effective; my point is that Pakistan offers only the studies of Psychology and no institution in Pakistan offers Counselling and Psychotherapy as a local separate study programme to pursue a degree. Some local institutes have tried to fill up the gap and have brought international courses to Pakistan, which is encouraging as this has taken us to new and beautiful horizons where a lot of experiential learning is being done.
If these study programmes are different from what is already being taught, does it make them less credible? If the therapist puts in years of effort and hard work to become a therapist, does it make him stand nowhere just because some people think it was done in two years? How much time do you require to be a psychologist? Two years after graduation. People, who are criticizing these Certificates and Diplomas as being done as short courses, please note that these are done in almost two and a half or three years (that is obviously a longer duration than the masters in Psychology). We still do not have many practising psychologists as we need to have; however, the number of counsellors is even less. This is the time we need to shift gear and explore the field of counselling as well.
These are sad times for mental health professionals in Pakistan because all these professionals’ credibility is at stake because of the negligence or malpractice of a handful of people. There are brilliant people with outstanding credentials being doubted and questioned on their credibility. The international awarding body, one of the most prestigious awarding bodies in the UK and Europe, is being labelled as fake. This is being done by people who, probably, have the knowledge of how these mental health studies have advanced and what are the latest researches heading towards but neither accept change nor are ready to change.
Freud is the pioneer of psychology and psycho-analysis,, but the world has gone much ahead, there is so much to be explored; these studies are much more than the research proposals, vivas and clinical settings. I have worked with these international bodies, and believe me, the way they go into the depth of each and everything related to these studies is commendable. This has been a rich learning experience for me. The current scenario of joining the blame game, by putting everything on the international awarding body is not correct. This awarding body is most popular in the UK and Europe, with over 300 centres in the UK, Europe and overseas and over 13,000 students enrolling each year. Their Certificates and Diplomas provide experiential learning opportunities to the learners.
This, and some other similar awarding bodies, have played a crucial part in creating awareness of mental health, breaking the stigmas attached, bringing it to people’s daily lives and, as they claim, changing lives. Now a person seeks therapy whenever he feels discomfort, or emotional pressure; it is NOT the mentally sick only now. These international awarding bodies have proper course developing systems and if their criteria are not met, they revoke the licenses; thus having a proper accountability system. I agree that some people have done relentless damage to the mental health profession by being involved in malpractice, but then that is the case in every field.
All the efforts to get rid of the stigmatism and to seek help when required stand failed today. If these international awarding bodies are delivering outstandingly in the UK, Europe and other countries, why are they considered fake in Pakistan? Is it more on their system or our system? We really need to think about it.
Counselling is a healing profession and aims at changing lives for the better. Where the gruesome and cold-blooded murder has shaken the entire nation; it has also raised many questions on the credibility of mental health professionals. Please do not let these recent developments and cases of malpractice, or criminal negligence, damage this noble profession. Instead, try to find solutions so that such a disservice is not repeated.
Early this year, I messaged the health department pointing out the irregularities in the mental health profession, the mushroom growth of self-proclaimed therapists, the exorbitant amount of money charged as the fee per hour, the quality of service being dished out, no regulatory body, no checks or balances and no accountability. I volunteered to assist in forming the system. However, unfortunately, the handling of pandemics, and justifiably so, took most of the time of our health department and this could not be paid heed to.
Now is the time to regulate the system. Mental health studies, local or international, to be encouraged to spread mental health awareness. Licenses to be issued to all centres imparting mental health studies and licenses to be issued to mental health professionals that should be reviewed yearly based on their performance. Professional bodies need to be made to ensure quality assurance of the performance of mental health professionals and hold them accountable where any harm is being done. Cap the fees of a mental health professional to a reasonable amount. Counselling should not be for the elite and affluent families only. It should be affordable and accessible to everyone who needs help.