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Psychiatric rehabilitation: A wellness model

There are hardly two or three psychiatrists per million people in Pakistan, reports the 2008 Journal of Pakistan Medical Association. To make matters worse, there are only 3,729 outpatient mental health facilities across the country, one percent of which are for children and adolescents states the 2008 World Health Organization report. Hence, facilities like The Recovery House (TRH), a psychiatric rehabilitation centre in Karachi, play a crucial role in empowering psychiatric patients and helping them reintegrate into society.

Shaheen Ahmed, the founder and president of the first rehabilitation institution for mental illnesses, Caravan of Life Pakistan Trust, and a pioneer in psychological rehabilitation in Pakistan, and her brother, Khusro Karamat Elley, have played a key role in changing the way mental healthcare is dealt within the country. The duo realised the lack of awareness about mental illnesses in Pakistan when two of their siblings were diagnosed with serious mental health disorders in the early ’60s. After the diagnosis in Britain, the family looked into treatment options in Pakistan but discovered that the limited options, which involved medication and electroconvulsive or electroshock therapy, were less than satisfactory. As a result, they came up with the idea of setting up Caravan of Life Pakistan Trust.

Previously, the Caravan of Life USA —  a sister organisation based in the United States — also trained Karawan-e-Hayat, which is a free-of-cost mental health facility in Pakistan, says Ahmed. But after they started inducting patients with substance abuse, Ahmad felt it was important to revert to the original plan of a centre purely for psychiatric patients which led to the formation of TRH in 2009.

In Pakistan, the focus is solely on medication, which is only one part of the treatment. For patients suffering from severe psychiatric disorders, whose daily lives are also impacted due to impaired functionality, rehabilitation is the only solution, says Ahmed. Based in the United States for the last 47 years, Ahmed has been actively involved in the field of mental health as a volunteer and has developed a comprehensive understanding of the different models of care, especially psychiatric rehabilitation. She has served as a member of several health boards and is also a member of the international committee of Psychiatric Rehabilitation Association. It is through these connections that Ahmad imported the necessary expertise and assembled a team of experts to help her set up TRH in Pakistan. Experts are also invited regularly to the facility, including Dr Veronica Carey, an assistant clinical professor and associate director of the Saturday Scholars Programme at the Behavioral Health Counseling Department at Drexel University, United States, who visited the facility earlier this month. “It has been an opportunity to continue the dialogue, introduce new concepts, assist with the correct language and work towards incorporating rehabilitation as part of the behavioural health framework,” she says adding that rehabilitation is not meant to substitute psychiatrists and medication, but complement it.

The Recovery House has a client-centered approach to rehabilitation which aims at empowering patients (referred to as clients at the facility) in a safe and secure environment and focusing on their wellness, independence and mobility, explains Dr Carey. The facility can accommodate 15 patients in the ‘residential programme’ and 15 more in the ‘day treatment programme’, which includes activities such as sound therapy, theatre, cooking, gardening, money management, memory enhancement exercises, yoga and meditation, personal grooming, nutrition and visual art. Plans to introduce a ‘visiting home services programme’ are also in the pipeline, says psychologist and director of TRH, Naheed Khan. “We want people to benefit, recover and live a healthy and successful life. Recovery is a journey. It is not an end in itself,” she adds.

Forty-one-year-old Faizan* who suffers from schizoaffective disorder — a psychiatric disorder characterised by abnormal thought processes and deregulated emotions — has come a long way since he came to TRH three years ago. “I suffered from severe aggression and was violent. I had been extremely disturbed for almost five years due to hallucinations and delusions. I [would] smash items at home as I could not control my anger,” he shares, adding that it took a while for his family to realise that he was suffering from a psychiatric disorder. Even though Faizan has spent a few years at rehabilitation units in hospitals in Islamabad, he did not find any of them as accommodating as TRH. “When I came here initially, I was not comfortable but gradually I made friends and it became my second home,” he says. Today, not only is Faizan interning at a Karachi-based firm but is also planning to get married.

We want people to benefit, recover and live a healthy and successful life. Recovery is a journey. It is not an end in itself.

Psychologist and Director of TRH Naheed Khan

People with severe psychiatric disorders can have a relapse since their journey is not linear. “When they understand this and realise that they have an illness that can be treated, they are ready to enroll in a psychiatric rehabilitation programme and begin their journey to recovery,” says Khan. Some can recover within three months while others may take either a year or more. Around 50 to 60 percent patients with serious psychiatric disorders can recover and lead a normal life if there is more awareness about rehabilitation in the country, says Dr Uzma Ambreen, a psychiatrist and clinical director at TRH. Although there are rehabilitation units in many psychiatric hospitals, they mainly facilitate people with substance abuse, she explains. The situation can improve if inpatient rehabilitation units are set up purely for patients with psychiatric disorders.

TRH has also been recognised by the United States Psychiatric Rehabilitation Association. “We want TRH to be [a facility that can also train others] in South Asia. People from the region [should] come here for education and training,” says Dr Carey.

The facility can accommodate 15 patients in the ‘residential programme’ and 15 more in the ‘day treatment programme’, which includes activities such as sound therapy, theatre, cooking, gardening, money management, memory enhancement exercises, yoga and meditation, personal grooming, nutrition and visual art.

Dr Veronica Carey – Drexel University, PA, United States

*Name of the patient has been changed to protect privacy.

With additional input by Amna R Ali.

Facilities across Pakistan that offer psychiatric treatment:

Karachi

Karachi Psychiatric Hospital:
92-21-111760760

Karawan-e-Hayat:
92-21-3586 3060

The Recovery House:
92-21-3454 6364 – 66

Islamabad

Pakistan Institute of Medical Science:
92-51-9261170 – 89

Shifa International Hospital:
92- 51- 8464646

National Engineering and Scientific Commission:
92-51-90742466

Peshawar

Khyber Teaching Hospital:
92-91-9216340 – 47

Lady Reading Hospital:
92-91-9211430 – 9

Hayatabad Medical Complex:
92-91- 9217188

Lahore

Centre for Advanced Medicine:
92-42-35790123

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