Proceedings of symposium on Developing Child Psychiatry Services in Pakistan


Asia Pacific Psychosocial Rehabilitation Conference

Proceedings of symposium on Developing
Child Psychiatry Services in Pakistan

LAHORE: Dr. Anjum Bashir Consultant Child and Adolescent Psychiatrist from UK along with Dr.Shahryar and Dr. Mujtaba chaired the special session devoted to developing Child Psychiatry Services in Pakistan during the Asia Pacific Conference on Psychosocial Rehabilitation held here from November 1-4th 2013. The speakers included Prof.Farid Minhas and Dr.Ayesha Fareed from Institute of Psychiatry Rawalpindi besides Dr.Nazish Imran, Head of the Dept.of Child and Family Psychiatry at King Edward Medical University/Mayo Hospital Lahore.
In his presentation Prof.Farid Minhas referred to the limited number of psychiatrists for the whole population in Pakistan while the number of qualified child psychiatrists were even far less. CPSP trains about ten psychiatrists every year and many of them go abroad because of poor reward and working conditions, as there are job opportunities all over the world. Psychiatrists are leaving Pakistan and no one is returning back. Institute of Psychiatry has fifty beds and we see about one hundred fifty patients per day. Almost 60% of our population is below eighteen years of age and we have no training facilities for child psychiatrists.

Dr. Anjum Bashir Consultant Child and Adolescent Neuropsychiatrist
from UK( C ) summing up the proceedings of symposium on developing
child psychiatry services in Pakistan during the Asia Pacific Conference
on Psychosocial Rehabilitation held at Lahore recently.

Dr. Ayesha Fareed stated that child psychiatry service at Institute of Psychiatry started in 2004 in collaboration with Dr.Atif Rehman and during a year we saw 821 new patients less than sixteen years of age. It consisted of 44% with depression and neuropsychiatric problems. ADHD and Autism accounted for 3%. We felt the need for training of staff in assessment and management of these children. To begin with we had a five days introductory course and then started a child mental healthcare clinic. We started preparing resource material and started working on a manual for child psychiatry. Dr. Amina Tareen visited us for a year through a scheme introduced by Royal College of Psychiatrists and saw 169 patients in one year.
Prof. Fareed Minhas stated that they also started collaborating with Dr.Waqar Azeem Consultant Child and Adolescent Psychiatrists from USA and Dr.Anjum Bashir from UK and now have a fully developed Child Psychiatry Department. We organized school teacher’s workshop and now efforts are underway to start second Fellowship in Child and Adolescent Psychiatry at the College of Physicians and Surgeons Pakistan. Hopefully it will be realized in 2014. We need to collaborate with each other, continue this mission, do need assessment, improvise our resources, never give up, learn, earn and then try to return something before going home, he remarked.


Prof. Farid Minhas (Centre) responding to the questions during the session
on Development of Child Psychiatry at the Asia Pacific Conference on
Psychosocial Rehabilitation held at Lahore. Picture also shown Dr.Nazish Imran
Head of the Dept. of Child & Family Psychiatry at KEMU/Mayo Hospital on left &
Dr. Ayesha Farid (R) from Institute of Psychiatry at Rawalpindi.

Child and Family Psychiatry Dept. at KEMU

Dr. Nazish Imran in her presentation pointed out that we have over 17% child population in Pakistan and very few centers where child psychiatry services are available. There are many barriers to development of child psychiatry in Pakistan. However it is important to identify the problem and then manage to overcome the resource constraints. Training in this sub-specialty is essential. Stigma attached to mental and emotional disorders, lack of school health service are some of the important issues. She was of the view that blind application of Western Model of child psychiatry in Pakistan could be counter productive. Neurological disorders including epilepsy should be included in child psychiatric services. Intellectual disability is seen in the West. We need child and family centered psychiatric services. She commended the pioneering work done by Prof. Khalida Tareen who established the first Department of Child Psychiatry at Mayo Hospital in Pakistan many many years ago but the tragedy was that after her retirement, this service could not be continued. When I joined KEMU/Mayo Hospital, we started with the Out Patients Service for children suffering from psychiatric and emotional disorders. Now we also have a speech therapy clinic while In-Patients service was also started last year. She was of the view that starting joint psychiatric-paediatric clinic will bring about a positive change. Exposure of pediatricians and General Practitioners to child psychiatric services will go a long way in improving the situation.
She then talked about education and training once there are more people in the department. At present the postgraduates rotate during their training and we are also involved in teaching of medical students. Academic meetings, seminars and workshops are being organized regularly to create awareness. We follow multidisciplinary approach to manage these patients with the help of clinical psychologists and speech therapists. We have Prof.Khlaida Tareen as Professor Emeritus of Child Psychiatry besides myself, two clinical psychologists, five house officers and play therapist. We saw over four thousand patients in the OPD last year and now awareness is increasing. Indoor service was started in October 2013. It is a six bed indoor unit and so far we had seventy two admissions. Mean hospital stay of these patients was 8-9 days and efforts are made to return these children back to the family as soon as possible. Almost 57% of these admissions, Dr. Nazish Imran said were female, 77.8% were self referrals while 9.7% were referred by the pediatricians.
We are collaborating with Dr.Waqar Azeem Consultant Child and Adolescent Psychiatrists in USA, we conduct combined online clinics and soon our own data will be available. We have presented our work at international child and adolescent psychiatry conferences in USA, UK and France besides presenting our data at Royal College of Psychiatrists meeting in UK. As stated earlier, there are some barriers to the development of child psychiatry but what we need is a strong political will, administrative support and involvement of Family Physicians and Primary Healthcare Professionals, get their support and improve this service.
During the discussion it was emphasized that efforts should be made to make the parents understand, have a dialogue with the parents, work with them, be good listeners. Protection from child abuse and violence needs to be highlighted as no such organized system exists in Pakistan at present. Responding to a question Dr. Nazish Imran said that no center for ADHD exists in Pakistan but there is one Autism center established at Sharif Medical City in Lahore. There is another autism center in the city as well. We do need to establish Intellectual Disability Centers. Dr. Shujat Ali Naqvi Child and Adolescent Psychiatrists from USA highlighted the problems of Child Labour, Child Sexual Abuse and punishment which are quite prevalent in Pakistan. We need to talk about these issues and find a solution, he remarked. It was also emphasized that we should master the courage, do not give up, create awareness and gather support. Education is most important for parents in Pakistan. Dr. Shahryar said that corporate punishment is also an issue. Dr. Anjum Bashir in his concluding remarks said that it is heartening to note that at last Child Psychiatric Services are developing in Pakistan and at both the places, Lahore and Rawalpindi it is a combined efforts with the better half’s.