Background
Pakistan has one of the highest reported rates of childhood intellectual disabilities in the world. Prevalence estimates vary from 19.1/1000 for serious intellectual disability to 65/1000 for mild intellectual disability
Methods
We surveyed carers of persons with intellectual disabilities (n=100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers (n=16) and key primary health providers (n=10). We also carried out focus groups (n=7). Data was triangulated and interpreted in light of peer reviewed literature
Results
There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean SRQ score 8.4; 95%CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with intellectual disability contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for intellectual disabilities.
Conclusions
Our findings suggest that there is significant delay in detection of intellectual disabilities especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost effective, community level interventions, which can be integrated into existing healthcare systems.
Differing symptom profiles for anorexia nervosa need to be taken into account when assessing patients from different cultures. South Asian adolescents may present with a non-fat-phobic form of anorexia nervosa. This has clinical and epidemiologic implications. Further investigation is warranted to assess the nosologic status of this group.
Continued efforts to produce appropriate mental health legislation in Pakistan led to the Mental Health Ordinance of 2001. However, with the 18th amendment to the constitution and devolution of health responsibilities to the provincial governments, it became the task of the provinces to pass appropriate mental health legislation through their respective assemblies. Currently the mental health legislative picture is fragmented and unsatisfactory. Only the provinces of Sindh and Punjab have a mental health act in place and there is an urgent need for similar legislative frameworks in other provinces to protect the rights of those with mental illness.
Aims and MethodTo develop a child and adolescent mental health service in a low-income country. This was a collaborative effort involving governmental and non-governmental organisations in the UK and Pakistan, where a training clinic was established.ResultsWe assessed and treated 169 children and adolescents. A team of mental health professionals was trained, including one consultant psychiatrist; the consultant psychiatrist is now leading the clinic. Links were further developed with healthcare, social care and educational organisations, as well as efforts made to engage the public in relation to child and adolescent mental health.Clinical ImplicationsOur development highlights a model of research collaboration and service development which may be sustainable in low-income settings. Such initiatives need support from a variety of organisations. There is a need to consider whether there should be a formal funding mechanism to support the Royal College of Psychiatrists Senior Volunteer Programme.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.