Maria Bukhari, a psychologist and therapist by profession,boasts of significant experience in the mental health industry, with her patients ranging from young kids, to middle-aged adults. She completed her MS Psychology from the University of Karachi, and returned as an MPhil scholar in 2019. To stay abreast with the constantly-evolving and developing health industry, she regularly expands her knowledge by gaining certifications, some of which include Cognitive Behavioral Therapy (CBT), Assessment, Counseling and Psychotherapy and Healing Practitioner. Depression treatment, stress and anger management, relationship coaching, and family conflict resolutionis her forte.

BR Research recently sat down with her to understand mental health, current situation of the population, and the ripple impact poor mental health creates for an individual and the economy. Following are the edited excerpts from the interview:

BR Research: Let us begin with your venture iSupport. What led to the idea of having your own practice?

Maria Bukhari: iSupport is my first brain child. The purpose was to serve mental health and normalize seeking support for mental health issues.

BRR: What kind of economic impact do you see with growing mental illnesses, particularly in the youth that are supposed to be the most productive elements of the society and economy?

MB: Statistics reveal that 3 to 4 percent of population that have reached adulthood have lost productivity due to mental illnesses faced during adolescence that were left unresolved. And productivity is directly proportional to economic stability. It is as simple as that.

There is diversity within the umbrella term “mental health illnesses”. While short-term illnesses can be addressed through counselling, more pressing issues require therapy. For instance, with psychosis, an individual’s everyday life becomes more problematic and unmanageable.

BRR: Which type of mental health illness is more prevalent in in our country, and where do you think it is stemming from?

MB: Based on my experience and practice, depression and anxiety stand at alarming levels. Why? The exposure through different sources of information have involved people in insecurities and social comparisons that is playing a major role. Moreover, personality disorders are also on a rise.

However, instead of placing them in certain categories, it is more important to manage the cognitive disorders. Scientifically speaking, the illness stems from an imbalance of neurotransmitters. But how we address the problem is the ultimate goal. The way to address cognitive disorders naturally varies with how the disorder is affecting an individual.

BRR: Why are personality disorders on a rise?

MB: Speaking from the perspective of therapy, personality disorders are rising at a rather fast pace because of the kind of patriarchal society we have, and the conventional mindsets that we have been brought up with. But at the same time, it is always easy to project things on to the other person rather than working on oneself. We never want to know about our own flaws, and work on them. I believe every person should be aware of the fact that we are all carrying personalities that are imperfect. It can have flaws and that is okay too. But what is not okay is to leave it unaddressed. As a therapist, I want to say that half the work is done if a person is willing and starts working on themselves, be it overthinking, anxiety, depression, aggression, frustration, etc. If you find yourself unable to do so, always seek professional help. It is okay if one is not comfortable with revealing it to their families or friends, but do work on yourselves or seek help if need be.

BRR: Speaking of awareness, there seems to be considerable work happening on the urban side of the country. What is awareness and accessibility like for the mass population that resides in the rural areas?

MB: There are lots of mental health platforms that have registered therapists and psychiatrists. Internet and smartphone penetration has also made reaching out to mental health practitioners fairly easy compared to the situation ten years from now.

As you mentioned, there is considerable work happening in the urban side of the country.There is also significant work regarding awareness happening in rural areas as well. In fact, conducting awareness sessions is part of the regular education at colleges and hospitals since psychologists have research-based work, so students have to bring community sessions to their credit.

In addition to all of the above, agencies like WHO and UNICEF are also working on national levels regarding this. They are linked with universities and renowned professors of the same are also associated with it- to conduct webinars that are accessible to anybody with an internet connection.

BRR: How do we ensure consistency and practical application after awareness has been conducted? For example, climate change activists have been warning for several years, but it is only now that we have come to a realization as Pakistan is going through devastating floods.

MB: Unfortunately, currently the mental health legislative picture is very fragmented and unsatisfactory if you look at it from a legal perspective. It exists in Sindh and Punjab but there is an urgent need to have similar legislation and frameworks in other provinces too- to provide rights of those who are mentally ill/sick. When things begin to change at a legal level and is then applied at a national level, there will be a prominent change.

BRR: But given the crippling state of the existent healthcare system, how does one advocate for mental health? A study reveals that there is one psychiatrist for 10,000 people and majority are located in urban centers, implying that the mass population residing in rural areas are deprived of even this small ratio. And already a very small portion of the budget is allocated to health, of which less than 1 percent is directed towards mental health.

MB: The change needs to happen at legal level. And the size of the budget allocated to this definitely needs to increase, especially considering the mammoth size of the issue this will unveil to be. This needs to be advocated and highlighted in provincial assemblies, and amendments in ordinances. It must be understood that physical health is directly related to mental health. It creates a snowball effect that will eventually have a positive impact for the society and economy as a whole when we have mentally sound and productive individuals. WHO and ILO claim that approximately 12 billion workdays are lost due to depression and anxiety, while the impact on global economy in monetary terms stands at $1 trillion. That alone should be reason enough to give this aspect of life the much-needed focus.

BRR: Are there any local bodies that mental health practitioners have to be a part of/affiliated with to ensure credibility/maintain industry standard, from a patient’s perspective?Or are there any licensing exams to appear for before dealing with patients?

MB: We do not have licensing exams, per se, but our certifications are licensed to practice. We follow American Psychological Association (APA). In addition, one must have a minimum of 18 years of education to become a licensed professional.

BRR: Talking about the education, there is often a misconception that getting a degree in psychology equates to being a therapist. Can you clarify this, and what kind of laws are in place to avoid malpractice, which, unfortunately is quite common?

MB: Understandably, this is a very sensitive profession. Abroad, as per the mental health act and law, one needs to acquire minimum 18 years of education, gain a certain number of years’ experience, in addition to gaining other credentials to become a therapist or counsellor.There is no such law in place in Pakistan at the moment, although renowned professors of the field are working towards it. Resultantly, malpractices are also common in the absence of law. Developing law and its implementation is the way to eliminate malpractice.

I would also like to mention here that this is also the basic right of the client or patient to inquire about a psychologist’s or therapist’s credentials.

BRR: There has been a rise in the existence of counsellors and psychologists in academic institutions and workplaces which was nonexistent a decade ago.

MB: I have been in this field for over a decade now, and I can say that awareness of these issues has picked up. More and more people are recognizing the problems and the need to address them. A lot of the mental health issues take root in childhood. I am a counselor at a school, and I believe that when issues are resolved with children at the appropriate age, they grow up to be emotionally and mentally sound individuals. The psychotherapy that we implement yields significant results at school level.

At the same time, I do advocate for every company and academic institution to have an in-house counselor as well as make mental health a part of the employee’s health insurance because mental illnesses are as important as any other physical health issue.

BRR: As more and more students are now choosing psychology as a career choice, what trends do you see in the future for this industry?

MB: Demand for professionals is certainly increasing, so these students are making a wise decision. But again, I want to reiterate that getting a bachelors and masters in psychology does not equate to being a therapist. Tremendous research is required when dealing with clients because they can come with anything and everything, so the professional needs to be adequately equipped with the necessary knowledge and tools to deal with the situation and problems. This also brings me to the point that when one is studying about mental disorders as part of their education, one often recognizes similar symptoms in themselves too. There is nothing wrong with it, but they need to learn to emotionally detach and think logically. Hence, I say again, this is a very sensitive profession to be in.

BRR: I believe before you can deal with patients directly, part of the training also requires the professionals themselves to undergo healing?

MB: Yes, you have raised a very good point. As I said, I have been in this field for more than a decade, but I am still under the supervision of a senior psychiatrist and psychologist. But I do this by choice. Although I believe this needs to be a law. The discussion with professionals that are senior and have rich experience, can provide a fresh perspective, and breeds a healthy discussion.

BRR: TV penetration in our country is noteworthy, and is a good medium to send out messages to the mass. However, often the shows/dramas deal with delicate and taboo issues such mental health itself, in an irresponsible and/or problematic manner. This makes seeking professional help even more difficult, negating the entire purpose of “awareness”, let alone addressing it.

MB: Giving out the right kind of information is always tricky. Little and incomplete knowledge is dangerous, which unfortunately we deal with quite often with people walking in with a self-diagnosis from Google search. Moreover, alongside creating awareness, there is a growing need to now also focus on the people who mock mental illnesses. That is also somewhere an underlying root cause for the hesitation associated with seeking professional help. It not only reverses the efforts made for well-being, but also worsens the problem.

BRR: As a mental health professional yourself, what would you like to say to the general population and aspiring psychologists?

MB: I’d say that we need to stop focusing on beautiful facades created on social media, because it is not always true. People do not post their failures, but that does not mean that have not faced any. To the aspiring psychologists, I’d say that it is okay to have cognitive distortions but learn to ensure that it does not interrupt your work as a therapist. Working on ourselves is a life time process. People are unaware of the fact that as mental health practitioners, after seeing a certain number of patients, we have to go to a counseling session and detoxify ourselves. Lastly, organizations that value their employees, are considerate of their health, and do not compromise on their professional and ethical values will go a long way.