The Noor Mukadam case and mental health regulation in Pakistan
https://arab.news/62va5
The gut-churning murder of Noor Mukadam not only left Pakistan reeling in shock, anger, and grief, but the multi-faceted case also stirred a discussion about mental health which reflects Pakistan’s lack of mental health awareness. Mental health, being a taboo in Pakistan, has always been the elephant in the room we are socially constructed not to register. In the country, the budget allocation on health is painfully low, so the cost of limited fiscal space is borne by mental health. Statistics say that over 15 million people in Pakistan are suffering from some form of mental illness, yet the lack of mental health prioritization for the state can well be demonstrated by the fact that there is no regulatory or licensing body for counselling and psychotherapy in Pakistan.
In a local talk show, the parliamentary secretary of the Ministry of National Health Services, Dr. Nosheen Hamid disclosed how the ‘Islamabad health care regulatory authority’ whose job it is to address malpractices, regulate and create accountability is not functional ‘like that’. More shockingly, the Pakistan Medical and Dental Council regulates medical professionals but not mental health professionals.
Psychotherapy is not recognized formally in Pakistan and there is no local body that trains psychotherapists. All of them are internationally qualified with qualifications that legitimize them to work independently, following international ethics of psychotherapy but because of the lack of a regulating body in Pakistan, they are not discredited or held for malpractices.
Some malpractices include breach of confidentiality which is the foundation of therapy. Practitioners are never supposed to disclose the content of their sessions. This is a boundary drawn and exceptions are explained to the client beforehand. However, many practitioners disclose the client’s confidential information to their parents, for business and other motives. Having dual relationships, asking for favors, or having ulterior motives with clients is unethical. A therapist cannot offer sessions to, nor have any relationship with anyone their client is related to or even she herself knows.
Pakistan, while struggling with a mental health epidemic, is picking pace with psychotherapy as people are in therapy more so than ever.
Farwa Naqvi
Many practitioners who are not emotionally processed and have not worked on themselves first — as is the case when the degrees are handed out solely based on academic qualification – bring into the session their own biases and judgments. There are many cases where clients have reported being shamed and blamed for their mental distress given religious biases, sexual and other projections of the practitioner. Many clients also report that psychiatrists see them for two minutes and prescribe medication without even listening to them. Moreover, psychologists, psychotherapists and counselors who are not even academically qualified and professionally trained to see clients have not only been seeing them but have also been prescribing medication. Psychologists who have degrees in school, organizational and industrial psychology etc and not clinical or applied psychology have also been calling themselves therapists and are seeing clients while lying about their credentials. Internationally qualified trainee counselors and psychotherapists have been seeing clients without permission from their center and even before all the academic requirements of their accrediting bodies have been cleared or even submitted, independently hence unethically.
Such derelictions of duty along with cases of severe abuse occurring under the nose of the government bring us to how other countries prevent malpractice creating accountability. Regulatory bodies that exist almost all over the world are deemed so imperative that certain states have their own.
A registered psychotherapist in Canada retails to me that when she moved there from Pakistan, she applied for a license as it was illegal to practice without one and a practitioner could go to jail if practicing while not being registered with a regulatory body. She narrated how in the applicant form, excessive details were inquired about credentials, qualifications, professional experience, work population, trainings to support, supervisory details, nature, frequency, and details of supervisor, physical conditions, learning abilities, handicap, mental distress, the psychological condition of the past, depression/anxiety/addiction history, any visits to the psychiatrist in the past, criminal records, client complaints, any visit to court, physical, emotional and mental self-care regime, evidence of continuing education to refresh, support and update practice and much more, stringently. Her peers back in Pakistan were also contacted.
Once registered, the names of registered therapists are put up on the website of the body where clients can check the legality of therapists. These bodies have an option where clients can complain about a practitioner. Bodies support complainants at every step of the complaint, send someone along for support in case of a hearing, bear the responsibility of funding for therapy a client may require if a registered practitioner sexually abused them, and assist in other ways.
The non-existence of a regulating body in Pakistan facilitates all sorts of ethical breaches in the field of mental health. Because there is no check and balance or a system that can create some punishment and reward mechanism, fake as well as trained practitioners have no sense of accountability in the sacred relationship between a mental health practitioner and the client.
Pakistan, while struggling with a mental health epidemic, is picking pace with psychotherapy as people are in therapy more so than ever. As an aftermath of the Mukadam case, rather than discouraging people from therapy or stigmatizing mental illness and help, we must regard this as a cause to gain awareness and address our concerns.
No matter how unethical some practitioners may have been, therapy remains essential and a regulatory body therefore necessary.
- Farwa Naqvi is a London School of Economics and Political Sciences (University of London) degree-holder and a CPCAB– UK qualified integrative mental health counselor & psychotherapist. Twitter @farwanaqvi_
