HISTORY OF MENTAL HEALTH IN Khyber Pakhtunkhwa KPK, former (North West Frontier Province)
editBeginings
editAt the time of independence (1947) Pakistan with a population of 40 million had three asylum-like hospitals with a total of less than 2000 beds. The hospitals were prison-like and they provided custody with little care. Patients were mostly brought in chains. Detention and reception orders were used for admission as provided in law and the law was continues to be the Lunacy Act of 1912. The common men referred to them as pagal-khanas (mad houses) or jail hospitals. The doctors appointed were mostly general duty doctors with no training and often no interest in psychiatry and their average stay was two to three years. In place of nurses there was a cadre of attendant staff, most of them illiterate, untrained and acting more like police sepoy or jail warder than nurse. Public attitudes were steeped in ignorance and superstition, ranging from fear, contempt and indifference at one extreme to veneration at the other. At this stage, psychiatry had little to offer beyond barbiturates and bromides and a crude ECT machine. With the newly created state of Pakistan facing gigantic problems and its very survival at stake, psychiatry could not find its place even at the bottom of the list of national priorities of that period. The first five or six national 'five years' plans' did not contain even an oblique reference to Mental Health.
After partition Lady Reading Hospital Peshawar was the Premier Medical Institution of this region and with the establishment of One Unit (administrative) Professor Muhammad Shafique has joined Mental Hospital Dhodial he came from Mental Hospital Punjab after abolishment of one unit Professor Muhammad Shafique joined as an Assistant Professor of Psychiatry Khyber Medical College. He has started OPD at LRH uder the tree, later on he has been allocated four beds in medical ward and department was established.
Regarding the selection of Dr Shafique as Assistant Professor, brig shoaib from Military Hospital Rawalpindi came as subject specialist and Professor S A Raza Ali was the principal of Khyber Medical College at that time. Other Pioneers were Dr Ahmed Ali (he established the first private psychiatric hospital and was a regular contributor to Frontier Post), Dr Aziz Afridi (MS Govt Mental Hospital Peshawar), Dr Haider Ali a(District Specialist Central Hsoital Saidu Shareef Swat) and Dr Muhammad Irfan (MS Govt Hospital Dhodial) Professor Zia ur Rehman duke (established Forensic Psychiatric Services) and Dr Farooq (Mardan). They were the holder of DPM the highest degree in psychiatry from Royal College of Psychiatrists UK at that time.
Professor Khalid-A-Mufti was the first MRC Psych from UK. He has joined Lady Reading Hospital as Consultant and later on became Assistant Professor. He has established Department of Psychiatry at LRH and also laid the foundation of MD Program in psychiatry. Apart from other achievements he established services for substance use disorder with the help of NGO Horizon and initiated ``Green December´´ movement.he later on joined Department of Psychiatry Khyber Medical College and retired as Principal of the said institution.
When training in MCPS was started by College of Physician and Surgeons the notible holder of this diploma were Dr Basharat, Dr Aziz ur Rehman Yusafzai (he was poineer and established Department of Psychiatry at Ayub Teaching Hospital Abbottabad), professor Idrees (he has established Psychiatric services at OPD level at Hayatabad Medical Complex), Dr shahid khattak (fisrt District Specialist from D.I.kHAN), Dr Subtain (District Specialist of Mardan), Dr Tariq, Dr Mian Iqbal, Dr Tabassum Nafees, Dr Sameena Saeed, Dr Azra (were the first female specialist in Psychiatry) and Dr Fayyaz. Professor Saeed Farooq and Dr Shifa Muneer were the first FCPS in Psychiatry from this Province.
In late 80s Dr Anees ur Rehman has joined as Medical Superintendent and Consultant Psychiatrist Govt Mental Hospital Peshawar. He has redically altered the structure and function of institutions and service delivery.he was also the holder of Mphil in psychiatry. His contribution to provide quality Mental Health Services, Medical Education, Medical Journalism, continuous professional development CPD were exemplary. Prof Said Muhammad Sultan has a very illustrious career he has done DPM; FCPS, MRC psych in UK: his hallmark is his leadership qualities in Pakistan Psychiatric Society. The notible FCPS in Psychiatry were Professor Zahid Nazar, Professor Naveed Irfan, Professor Muhammad Younas Khawaja, Prof Wajid Ali, Prof Bashir Ahmed, Prof Muhammad Javed Akhtar, Prof Muhammad Idrees. Prof Dr Munir Ahmed Dawar (established Department of Psychiatry at Gomal Medical College D.I Khan) and Dr Kaleem have done MS in Psychiaty from Saint-Petersburg Russia. Dr Mian Iftikhar Hussain, Dr Bashir, Dr Jahanzaib (Hangu), Dr Abdul Malik (Mardan), Dr Bahdur Khan (District Specialist and headed Department of Psychiatry Saidu Medical College) have done DPM from Lahore Punjab. Notable contributions came from Medical Officer with special interest in Mental Health for example late Dr Mansoor, Dr Shoukat (GMH-PES), Dr Jaffar, Dr Javed Iqbal and Dr Saeed Anwar. Prominent family physicians with certification and experiance in Mental Health are Dr Younas (umarzai charsadda),Dr Jahanzaib (Hangu) Lt.Col (Retd) Dr Hamid (Thall) and other notable professionals after retiring from Armed forces offer their services at their respective community levels.
During the tenure of Professor Muhammad Shafique diploma in Psychitric nursing has beed started at Khyber Medical College in collaboration with respective School of Nursing. Then Diploma in Clinical Psychology has been started by Department of Psychology Shaheed Benazir Bhutto University in collaboration with Department of Psychiatry Lady Reading Hospital. The founders were Prof Farhana Jahangir Vice Chanselor of the University and Prof Zahid Nazar from LRH.
During Earthquick 2005 was the momentous event for flourishing of the field of Clinicsl Psychology. Then later on flooding in nowshahra and charsadda further strengthen the service of clinical psychologists (concept like post traumatic growth emerged). During Covid-19 the need for Talymedicine was widely fel. Department of psychaitry LRH with the help of IT department provided mental health consultation and services during the said period. Now telimedicine is prominant technology in delivering services.
FUTURE DIRECTIONS
With the emergence of tely medicine on the clinical horizon a quick action should be initiated to take the help of artificial intelligence. We hope that in coming years institute of behavioral sciences at khyber medical university will take a lead to consolidate and strengthen it. Also as this region is located at geological fault line of earthquakes tribal enemities i.e injuries due to fire arm and road traffic accidents services for neuro cognitive rehabilitation are warranted. To add more because of the wider prevalence for substance abuse, social workers should be trained in occupational rehabilitation in general and substance abuse in particular. So that they can manage rehab center effectively. We need further sub specialization of social worker as occupational and recreational therapists. We appreciate that department of social work has taken multiple initiative to promote health in general and mental health in particular i.e running child protection beauro, rehab center, rehabilitation of street drug addicts, services for adolescents, old age etc.
REFERENCES
editPsychiatry in pakistan (1947/1994): The Balance Sheet. Psychiatric Bulletin (1995), 19, 567-570
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Afridi.pdf