Mental Health & the Urban Environment
Presentation by
Dr. Saadia Quraishy,
CEO AMAN Mental Health
70 % of the World’s population will be living in an urban environment
by 2050
600 cities in the world hold 60 % of the GDP and one fifth of the worlds population
828 million people live in informal settlements around cities in the developing world
By 2020 mental disorders likely to account for 15% of life years lost to illness
Depression will become the second leading contributor t o Gobal Burden of Disease by 2020
• Health receives 1% of its Pakistan’s budget of which mental health 1 % of that even
though there are about 29 million people who suffer from some form of common
mental disorder
• The prevalence rate of mental illness is about 34%.
• Of these 0.5-2% have serious mental illnesses
• Mental health services in Karachi is are mainly provided at government
hospitals and clinics and in facilities in the private sector
• There is a serious shortage of mental health professionals including doctors,
nurses’ psychologists, social workers and occupational therapists.
• Only 25 % are able to receive treatment with little opportunities for follow up
care in the community
Suicide and Deliberate self harm
Significant rise in the number of suicides from
1996 to 2006 from 153 to over 5000
The current rate is estimated between 5000
and 7000
Under reported ,mostly indirect information
from media,hospital and postmortem records
Mostly males under 30 years .
The common themes Depressive illness (79%)
in a background of poor socioeconomic
conditions, unemployment , low literacy and
social isolation.
Karachi is Pakistan’s Largest City and Business Hub
Karachi’s population continues to grow above 5 %
per annum due to Migration and High birth rate
Karachi’s Population Growth
Population has multiplied by 5 since 1971
Over crowding
Transport problems
Crime and violence
Economic and
Living and
Family; Education;
Social Network
Mental Health Problems
Individual factors
• Genetic
• Brain chemistry
• Birth trauma and injuries
• Health and nutrition
• Physical illnesses
• Medications/sideeffects
• Lifestyle choices
Childhood development
• Quality of parenting
• Attachment figures /family
• Educational attainment
• Losses/separation
• Trauma/abuse neglect
Socialisation and inclusion
Employment/ working conditions
Housing/living conditions
,Wider Environment
Water supply
Energy supply
Wider Economic issues/political stability
• Social and economic inequity
• Conflict
• Migration
Urban Stress
• With rise in urban living stress levels also increase
• Stress is the response to a perceived threat to an individual ‘s
physical mental or social integrity .
• It escalates when there are worries or uncertainty around
employment and finances, housing, environmental issues and a fear
of not being able to have control over ones life circumstances.
• It is a protective evolutionary response to help people deal with
threats and adapt to their environments
• However if persistent it can be harmful in the longer term
• We respond to threats via our autonomic nervous system releasing
hormones which prepare us for an immediate reaction
• Our heart increases, airways open up as our body prepares to fight or
• There is also a slower system that operates via our hypothalamuspituitary gland and causes release of other hormones which operate
when stress is prolonged and can result in a metabolic imbalance
and restructuring of body fat causing obes ity and its complications
• Prolonged stress brings with it irritabilty and inability to cope, sleep
and appetite disturbances,fatigue and lowered immunity
• People respond to stress in different ways depending on different coping
skills and lifestyles
In some this leads to reliance on smoking, illicit drugs and alcohol and
changes in behavior
Urban environments are associated with higher levels of stress ,social stress,
lack of control fear of losing ones social status, noise, pollution overcrowding
in vulnerable people may precipitate mental illnesses.
Urban dwellers can also have an advantage of access to resources and health
services educational and cultural activities
Stress vulnerability is a complex multifaceted issue and requires a multi sectoral approach to deal with it
Mental Health Awareness
“A state of complete
physical, mental and
social well being, and
not merely the
absence of disease”.
WHO definition
• Aman Foundation commissioned a Report on the Status
of Mental Health in Karachi with a focus on low income
communities to facilitate the development of a Mental
Health strategy for Karachi The document produced
through the work, of Aga khan university would be broad
based and collaborative with the relevant stakeholders
in the city.
• Earlier in 2013, Aman Foundation also hosted a Stakeholder’s Round
Table to bring pressing issues as well as opportunities in the Mental
Health paradigm of the city.
1. Integration of Aman Initiatives
Aman Foundation has a number of initiatives that
provide mental health support within programs as
well as independent business units. Aman Mental
Health Company could capitalize on the existing
institutional presence of Aman to create an
integrated strategy for Aman Mental Health
• Basic Needs established a Community Mental Health and
Development programme in Pakistan in 2011 funded by the Aman
Foundation and the British Asian Trust.
• As an international organisation the community programme is able
to influence mental health work, practices and policy. HANDS (Health
and Nutrition Development Society) providing community outreach
workers (trained by Pakistan Association of Mental Health and
Medical camps in the community run by Karawan-e-Hayat.
• Services were commissioned and began to function in Korangi in a
pilot scheme covering a population of 300,000
• Community workers called Marwi workers recruited and trained who
identified people with mental health issues visiting them at home
• Community awareness and mobilsation workshops held
• 70 new patients in the first 4 months and 500 follow up patients
• Numbers continued to grow with regular input
• Record keeping and statistics generated regularly
Health Promotion
Community Healing
• Agha Khan University, study 2013
• Men’s Health Initiative. http://menshealthinitiative.files.wordpress.com/2013/10/mental-health1.jpg.
Retrieved 1/7/2014
• Karachi Battles. http://beenasarwar.files.wordpress.com/2013/03/karachi-muhammad-arshad-ips.jpg.
Retrieved 1/6/2014
• Mental Hospital. http://www.dostpakistan.pk/wp-content/uploads/2013/05/mental_hospital1024x1024.jpg. Retrieved 1/6/2014
• Urban stress and mental health,Adli,Mazda November 2011,LSE cities