Mental health treatment practices in Pakistan are still not ethically sound. As the education system surrounding mental health is still a work in progress, it is not surprising that there is a lack of skilled and capable professionals. In Pakistan, there are limited universities which offer majors in psychology, counselling and sociology.
There are even fewer higher education programs that are specialized to meet the needs of the diverse population of the nation. There are significant younger people who require special need, therapy and other aid in their lives, and yet their requirements are not met. While there has been an increase in the demand for mental health practitioners due to awareness programs and the social media boom, it has been detrimental to the country’s population at large.
There is a lack of state regulated, licensed professionals, and patients often do not get the help they need from viable practitioners. Why is this the case? And how can we prevent these unlicensed practices from taking place?
There is a despairing gap between the demand and supply of licensed mental health professionals provided by the state or other private bodies. Rather than investing in legitimate practices, profit making institutions have marketed their positions in the field. They have little to no regard for ethical and professional standards set by international rules and guidelines, and their practices have no professional backing.
Even if there is a considerable increase in mental health services from the early 2000s, it is simply not enough to meet our rising demands and concerns. With the spread of the coronavirus pandemic, there are many services being offered over the internet, thus increasing our accessibility to professional help. Skype and Zoom consultations, chats, emails and other forms of communication are acting as brand new forms of mental health services and their provision. The problem here lies within the authenticity of these professionals and the scrutiny surrounding their ‘practices’.
With the popularity of online therapy and its many benefits to the Pakistani population, there also comes the issue of a lack of credibility. Uncredited professionals are taking on patients, preying on their vulnerabilities, and essentially taking advantage of their desperation in order to make money. Individuals with mental health problems are struggling to have their needs met, and these uncredited therapists are only exacerbating their issues.
Such a high level of exploitation borderlines on unethical conduct by both international and national standards, and private websites are well aware of these consequences. Subsequently, these businesses and their hired personnel charge large sums of money for sessions, mostly through online meetings. These services lack credentials, accountability, doctor patient confidentiality, and have often incited religious and spiritual beliefs as part of a larger propaganda.
There are growing concerns surrounding these websites, operating in and out of the country to target its citizens. The counsellors being used are not medical professionals, nor do they possess the skills to deal with mentally ill patients. Furthermore, there is a minimum standard of training that needs to be met, which is not being checked at all. In cases of serious mental illnesses, patients often find themselves in a worse position than before they acquired therapy services.
To protect themselves from potential liability and legal action, these websites and counsellors are working with loopholes in their terminologies. They may be providing services such as “psychotherapy” and “counseling”, but since they usually work outside the law, the name for those services will be different.
Most times, a term is regulated and so they use words that do not fall under such a category. For examples, someone could be providing services under the words “hypnotherapy”, “life couching” and even “mental health counselling” as umbrella terms to avoid any potential lawsuits. Regardless of what kind of title they use for their services, it is still likely that they are in violation of national and international laws regarding medical practices. Without an issued license, a professional cannot treat depression, schizophrenia, DID or any other illness present in the DSM.
There is also a common complaint amongst patients in Pakistan about the lack of empathy these professionals show. Clients often accuse psychiatrists of not listening to their issues and writing a prescription immediately. Psychologists often breach doctor-patient confidentiality agreements and get family members involved, especially in cases regarding sexuality and suicidal tendencies among younger patients. A lot of people are thus discouraged by such behaviors and seldom get the help they need.
Besides regulatory training ethics and experiences of Pakistani patients, the future of these practices is as bleak as their present. The right factors are not taken into account to assess the quality of mental health services and their counsellors, whether online or in a real life facility. Furthermore, there is a strong lack of empathy amongst people coming into the field of mental health service provisions, from psychologists to psychiatrists alike.
These people, despite their studies, do not understand the technicalities or ethics surrounding the needs of their profession. They do not understand confidentiality, impartial reasoning, freedom of beliefs and speech and so on. While it is common for every person to have their biases, it is not an appropriate way of dealing with sensitive professional matters.
The current mental health paradigm for the public is still focused on conventional psychiatry and clinical psychology, and there is no room for expansion of other means of treatment. There is a drastic need for innovation, balance and check of license information and more tolerance amongst our mental health care providers.
Therapists, whether online or in person, should have their qualifications and credentials ready for patients to view and assess. If this is not the case, there is a likely chance that they are not licensed and cannot give you the help you need. Thus, keeping an eye out and reporting such issues will not only benefit you, but also those around you.
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