A chained, mentally ill Afghan patient sits at the Mia Ali Baba shrine in Samar Khel on the outskirts of Jalalabad, May 2, 2017. (Noorullah Shizada/AFP via Getty Images)

Afghanistan’s Mental Illness Emergency

After 40 years of war, most in country suffer from psychological disorder

Decades of conflict in Afghanistan have taken a human toll on the population. Human Rights Watch says that over half the population has a mental illness, and the World Health Organization, citing the 2018 Afghanistan National Mental Health Survey, found that over two-thirds of Afghans had gone through one or more traumatic experiences.

“After four decades of war, I don’t think you can find any family who hasn’t had a loved one killed,” Muslim Shirzad, a university lecturer at several Afghanistan universities, including Mashal University in Kabul, told The Media Line.

Although the World Health Organization cautions that the real numbers are most likely greater, at least a million Afghans have depression and a little more than a million are dealing with anxiety.

At the same time, the 2018 national survey found that there are roughly 300 psychologists serving the entire population of some 32 million.

The lack of mental health professionals and services is a major problem fueling Afghanistan’s mental health crisis, and it is especially felt in rural areas.

“We have some in urban areas, like Kabul, which is a big city, but in rural areas and in smaller cities, it’s [harder to find help],” Fatima Jafari, a psycho-social officer (someone who does psychology and social work together) at Peace of Mind Afghanistan (PoMA), a national mental health awareness campaign in Afghanistan, told The Media Line. “We have difficult referring people to professionals because [in certain areas], we don’t have any.”

However, even in cities, the services offered are limited.

“There are very few hospitals, but they’re for severely mentally ill people. They don’t provide counseling; it’s just psychiatrists who give medicine,” Jafari said.

“I only know of three counseling centers in Kabul,” she added, “and I work in psychology. People [outside the field] might know that these services exist.”

And those lucky enough to access these services do not always have the means to pay for it.

“It’s expensive, and that’s why it should be a governmental service,” Jafari said.

The Afghan government has put together a mental health strategy for 2019-2023, which includes training and certification of more mental health specialists.

While the state has started to institute small changes, Jafari has not been satisfied with its response so far.

“Mental health is something that has been completely ignored and forgotten.”

She said that to improve the situation on the ground, the government needed to include students graduating from psychology programs today in the certification process, something that does happen today. Jafari is unsure why, but she suspects that such a function does not exist in the Afghan bureaucracy.

“They might not even have a section. They just lack this,” she said.

The government has introduced some training already which allows anyone interested to work in the field, but the short-term nature of the program and lack of selectiveness might create more problems in the future.

“Even a person who studied through just ninth grade can go through that training and become a certified counselor in two months,” Jafari said.

Jafari advocated for more extensive education for people in these programs.

“I’m sure the students who studied at universities know more than the people who go to the training for two months,” she said. “They should have more training.”

Jafari argued that ignorance about mental health fueled the mental illness epidemic.

“People don’t know what mental illness is. … The majority of our people didn’t go to school and don’t know how to read and write. It’s really hard for them to understand what a psychologist is,” she said.

Dr. Ayesha Ahmad, lecturer in global health at St. Georges University of London and honorary lecturer at the Institute for Global Health, University College London, argues that addressing the mental health crisis in Afghanistan must include reducing stigma and ensuring lasting peace.

“There needs to be greater recognition of stories of suffering, rather than marginalizing voices and portraying victims as perpetrators,” Ahmad, who conducts trauma therapeutic intervention using traditional storytelling, told The Media Line. “Furthermore, we must understand suffering from a health perspective and learn how to respond to mental health needs, and ensuring peace and stability is a first-step process to engaging in good mental (and physical) well-being.”

Paktyawal, a researcher on the Middle East and North Africa region and human rights activist from Afghanistan who declined to give his last name, agreed that the government needed to pursue peace to address the proliferation of mental illness in the country.

“The peace process has brought people back to life and made them hopeful for a better future, for peace. A US-Taliban deal could bring forth a time of peace and prosperity. That’s probably the best thing for all of Afghanistan,” he told The Media Line.

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