Expanding Mental Health in Pakistan

Khusro Elley is the director of a psychiatric hospital in Karachi, Pakistan, which provides free treatment for the mentally ill. A former vice president of Ethan Allen furniture who has devoted himself to philanthropy, Elley opened a small nonprofit rehabilitation center for psychiatric patients in summer 2010. We recently spoke with Elley about the challenges and rewards of bringing modern mental health care to disadvantaged people in this part of the world.

Brain World: What can you say about the current state of mental health in Pakistan?

Khusro Elley: The population of Pakistan is 170 million. In 2005, there were a total of 250 psychiatrists in Pakistan. Karachi had 44. We have 184 hospital beds that serve a population of 15 million people.

BW: What were your goals in founding the hospital?

KE: The purpose of the mental health hospital was to make psychiatric treatment available to the poor. An important principal established at the outset was to say that 80 percent of the beds would be reserved for charity patients, while the other 20 percent would be paying patients. Combining charity with paying patients has turned out to be a lifesaver, as paying patients are able to cover 40 percent of the costs of the charity patients.

BW: How did you come to be involved?

KE: I am the oldest of five children. My first awareness of mental illness was as a teenager, when I discovered my younger sister talking to herself. At that time I thought this is what teenage girls did. What followed was over 40 years of involvement with her condition. The discovery that my youngest brother also had mental illness led to my looking after him, also.

Over the years, from 1970 to 2010, I have consulted with doctors and visited hospitals and clinics in the U.S., England, and Pakistan in a quest to find a cure for my siblings, with varying degrees of success and failure. The failures have been greater. My sister became a chronic schizophrenic, but I was able to save my brother — to some extent. Both live currently in Pakistan, although my brother lived in the U.S. for 20 years and is a U.S. citizen. It was as a result of this personal experience that I started to think about what I could do to help other people in my situation. This resulted in my involvement in trying to establish institutions in Pakistan for the care and rehabilitation of the mentally ill.

BW: Who else was involved in making it a reality?

KE: Karwan e Hayat is a 100-bed psychiatric hospital set up five years ago in Karachi by a group of former corporate executives for the purpose of providing psychiatric treatment to the poor. Karwan was founded some 25 years back by a psychiatrist from Karachi called Zafar Qureshi, with the mission of giving free psychiatric medicine to the poor. Subsequently, Qureshi was joined by some retired executives of multinational corporations based in Karachi. These executives had fundraising abilities, concepts of good governance and a vision to set up a hospital. Prominent among them are Masroor Ahmed, former CEO of Pakistan Petroleum and currently chairman of the board of Karwan; Saeed Akhter, former CFO of Pakistan Petroleum and currently secretary of the board of Karwan; and Saleemuddin Ahmed, former deputy managing director of Shell Pakistan and currently vice president of Karwan.

BW: How long did it take to become operational? What hurdles did you face?

KE: Owning a place was a critical first step. The next, equally important, step was to raise the money to clean up the place, renovate it, equip it with beds and hire the professional staff. It took many years to find a suitable place at a subsidized rent. The renovation took three months, and then proper staffing and purchase of beds and other equipment took another six months.

Hiring a trained staff proved to be the most formidable task then, and to this day it remains the biggest challenge. Karwan today has a staff of 100 and runs round the clock, but a majority of the staff have been trained on the job. Everything revolves around the chief medical officer, who is a psychiatrist who received his training in Ireland.

BW: Has your new hospital been embraced by the government and public health officials?

KE: A hospital of this size is normally only possible in Pakistan with the assistance of the government, which has the ability to grant land for such purposes. This is a difficult process because of the red tape and corruption that exists in government departments. The sponsors were therefore fortunate when they discovered the existence of an unused hostel that belonged to the port authority of Karachi. The authority was somehow convinced that we meant to do good and entered into a 25-year lease at subsidized rates for the use of two hostels.

BW: Has it been embraced by the people?

KE: Today, Karwan has full occupancy and a waiting list of patients. Patients are not only from Karachi, but are streaming in from the villages as word gets around that there is treatment available for mental illness.

BW: Who are the patients at the hospital? Is there a typical profile, or a wide range of people being helped? What types of problems do they face?

KE: The majority of patients who are on charity come from large families and very humble backgrounds. The private patients come from middle-class, well-to-do families and include professionals like doctors. There is a separate building for women. The age of the patients ranges from teenagers to people in their 70s. A very large number of patients are diagnosed with schizophrenia or severe depression. A small percentage is violent or suicidal and is kept in isolation from others.

BW: Prior to the existence of the hospital, where would they turn for support?

KE: This is not to say that treatment for psychiatric patients is not available in Pakistan, but it is in very short supply and far too expensive to be within the reach of the common man. There are some private hospitals, which are very expensive, and there are government hospitals, which are free but which are in very short supply of trained personnel. The severe cases are sent to mental asylums. A majority would go and still go untreated or suffer at the hands of quacks.

BW: What unique challenges does a mental health facility face in Pakistan?

KE: Pakistan is not a typical third-world country. It has 170 million people, but the literacy rate is only 50 percent, which is lower than Yemen, Haiti, and Sudan. Twenty-five percent of the people live below the poverty line, which is similar to India. It’s better than Bangladesh, which is 45 percent, or Kenya and South Africa which are 50 percent.

There are serious governance and law and order issues. There is an absence of mental health awareness and laws. The main inspiration for legal definitions is the Lunacy Act of 1912. The absence of proper laws can lead to abuse of people by families, who can have people hospitalized on small pretext.