A COUNTRY’S socioeconomic challenges and the risk of ill mental health among the population are closely related. According to the World Health Organisation (WHO), there is a benefit-cost ratio of five to one on national investments in mental healthcare.
In this regard, efforts to develop mental health and psychosocial support (MHPSS) services directly align with UN Sustainable Development Goals’ targets 3.4 and 3.5, pertaining to the promotion and prevention of mental health and well-being, and the treatment of substance abuse.
They also implicitly align with targets 1.4 and 10.2, ensuring equal rights and access to services, and the promotion of social and economic inclusion.
Unfortunately, Pakistan’s existing mental health services remain under-resourced and inequitably distributed. Although access to evidence-based mental health services is a fundamental right, more than 80 per cent of those suffering from ill mental health lack adequate care.
A recent systematic review of factors that hindered access to services in Pakistan included financial, geographical and logistics constraints; stigma and poor mental health literacy; unsatisfactory outcomes of previous treatments; and reliance on religious leaders and faith healers.
Gaps in existing mental healthcare are not limited to a dearth of services, but also quality of care. In the public sector, psychiatric services are mainly biomedical in their approach, focusing on brief consultations exploring medical symptoms, followed by pharmacological prescriptions.
The pre-service training we are currently offering our medical graduates is inadequate due to outdated curricula, shortage of qualified faculty, and the lack of priority given to psychiatry as an essential subject.
As a result, primary care physicians are simply not trained to even identify mental disorders. This is evident from the health information system in KP which includes three mental disorders — depression, epilepsy, and drug dependence — but there is little reported data from primary care.
In addition, hundreds of clinical psychologists are working in NGOs, rehabilitation centres, and the private sector. Unfortunately, there simply aren’t enough opportunities or incentives for them to seek supervision or to strengthen their skills, as most work in project-based, short-term positions.
Pakistan has committed to providing universal health coverage and has endorsed the WHO’s Comprehensive Mental Health Action Plan 2013-2030; both aim at developing accessible services by integrating mental healthcare into primary care services. But the National Action Framework for non-communicable diseases and mental health (2021-2030) acknowledges that Pakistan currently lacks the resources and capacity to respond to the challenge.
Pakistan’s Ministry of Planning, Development & Special Initiatives (MoPD&SI) recognises that prioritising mental health and well-being in national policies is a critical step if Pakistan is to achieve its SDGs.
To prioritise mental health agenda in the national development portfolio, the strategic initiative of the 5Es Framework by the ministry, approved by the National Economic Council, envisions MHPSS as a key area that can ensure equitable access to mental health services under the fifth component, which addresses the fundamental issues of accessibility, inclusivity and social justice in healthcare delivery. It is also aligned with the government’s Uraan initiative, to build an equitable and inclusive society by directly supporting the initiative’s emphasis on equity, ethics and empowerment.
Gaps in mental healthcare are not limited to a dearth of services, but also quality of care.
Under its exclusive mandate and per a collaborative framework, the MoPD&SI has set up a Mental Health Strategic Planning and Coordination Unit to support a planning and coordinating mechanism at the national level, and to provide technical support to the federal and provincial health departments for effective implementation of MHPSS services.
To achieve this, a comprehensive multilayered, digital MHPSS model has been developed. This model focuses on building the capacity of a mental health workforce to offer MHPSS services; set up referral links; and collecting vital data to allow for the tracking of mental health needs — crucial for future policymaking and resource allocation. Last year, a part of this model was successfully tested by training primary care physicians across nine districts in KP.
This year, in collaboration with the KP Health Department and Deutsche Gesellschaft für Internationale Zusammenarbeit, the MoPD&SI is providing technical support to pilot MHPSS services in two districts of KP.
To achieve this, 500 people in the community will be trained as Hamdard Force to help people access MHPSS services; a dozen clinical psychologists will be trained to support individuals experiencing extreme stress; and 80 doctors will be trained to manage common mental disorders; and coordinated care will help establish efficient referral pathway to specialist services.
It is estimated that at least 20pc of the population in KP may be at risk of suffering from a mental disorder. Yet, the province continues to face a critical shortage and uneven distribution of mental health services. For 40 million people, there are only 50 psychiatrists, half of whom are based in Peshawar.
In addition to existing psychiatric services in the capital city, there is a plan to shift the Sarhad Hospital for Psychiatric Diseases from the central jail’s premises to a newly constructed large psychiatric hospital in Hayatabad, to ‘upgrade psychiatric services in the province’. It is imperative that services are allocated uniformly across districts to promote inclusivity and equity.
It is also worth considering that the provincial government is currently spending around Rs190m each year to support a single Dadar Hospital at Mansehra. This hospital, spread over 72 acres, offers 100 beds for mentally ill patients. There are sanctioned posts to appoint a psychiatrist and a clinical psychologist, which are lying vacant.
It is alarming that without any specialist supervision, the bed occupancy rate is more than 90pc across the five psychiatric wards. By scaling up the MHPSS model across the province, the same funds could be used to provide comprehensive evidence-based and rights-based services across all districts.
There is a critical opportunity for provincial policymakers and healthcare planners to equitably decentralise distant, urban-centered services into comprehensive mental health service across all districts.
The writer works as a national technical adviser on mental health for the Ministry of Planning, Development & Special Initiatives
X: @AsmaHumayun
Published in Dawn, May 21st, 2025
