Mental health in developing countries like Pakistan is a matter of serious concern. The country is sixth most populous in the world with half of its population under the age of 18 years. Adolescents alone form 23% percent of its total population. Nevertheless, the mental health services to the most vulnerable population are very limited considering the population demand. The condition, however, is most alarming in provinces like Balochistan and Khyber Pakhtunkhwa. While there are several reasons behind the poor status of a serious health issue in Pakistan, the stigma attached to mental health overpowers all other reasons. World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” However, in Pakistan, an ailment which does not show physical symptoms is not considered an ailment. While cold is considered a serious condition to take a day off at work/school, emotional distress, on the other hand, is barely looked at as a condition. This not only paints a picture of a society with little to no awareness of mental health, but also lack of a sensitized environment.

The history of non-clinical methods established to heal mental instability in the subcontinent dates back to the pre-colonial era; the techniques mostly included traditional or religious methods. Muslims mostly looked at ailment as a result of the imbalance of equilibrium between body and soul, causing the person affected to protest, hue and cry, seek revenge and show lack of interest and lack of innovation and creativity. The narrative around mental health changed in the colonial era with the advent of modern psychiatry. While the traditional methods predating modern psychiatry, treated the disadvantaged segment of the community with a humane and compassionate manner by making spaces such as Khanaqahs and shrines inclusive, the modern psychiatry in the 19th century excluded people with mental instability calling them dangerous for societies thus separating them by putting them in asylums. With the passage of time, the number of asylums increased, and the attitude towards mental health changed causing the stigmatization of mental health. The stigmatization largely influenced the language associated with mental health. Asylums in the local language were called “mad houses”, and people with mental health conditions were addressed as “idiots” and “criminal lunatics”. Two centuries have passed until the introduction of asylums, and modern psychiatry in the subcontinent, and yet the stigma attached to mental health remains stagnant in Pakistani societies.

Before the Mental Health Ordinance came into effect in 2001, Pakistan’s mental health law was based on the Lunacy Act of 1912, which the country had inherited after partition. The MHO strategic goal focused on the improvement of mental health and the reduction of related disability, mortality, suicide and substance abuse. The Ordinance stressed on primary mental health services by training and supervising primary care staff. Despite the relatively comprehensive Ordinance, the status of mental health in the country is deteriorating because the implementation of the policy is only limited to papers. Pakistan spends 2.5% of its total budget on health out of which only 0.4% is spent on mental health. With the devolution of power as per the 18th amendment, when health became a provincial subject, the situation of mental health services got worse. While Sindh Provincial Assembly and Punjab government enacted Mental Health Acts in 2013 and 2014 respectively, Balochistan to date has not replaced the Ordinance with a mental health act despite the number of cases pouring from local communities.

The population most affected by the stigma is adolescents and young adults. Nevertheless, there is a lack of awareness of mental health services and treatment option among youth. The subject of mental health is not even mentioned in schools, workplaces and other institutions, let alone service provision. In the absence of comprehensive research on mental health, it is difficult to measure the prevalence of mental health conditions in the country. However, according to some studies, factors that contribute to the increasing number of mental health condition among youth are insecurity, terrorism, unemployment, unsettled social fabric, economic problems, and school pressure for youth going to universities. The factor igniting the poor status of mental is not only the lack of awareness but also lack of efficient mental health services. National University of Science and Technology (NUST) is the only university in Pakistan which has a center for mental health counseling. The counseling provided at the university is free of charges, and the center caters to students/faculty/staff with mental health conditions. However, it is essential that other public universities in the country follow the steps of NUST and make mental health services available on campuses.

The cultural, economic, political and religious factors greatly influence the treatment choices of an individual. In this case, Balochistan is a region that lacks infrastructural development, health care facilities, and socio-economic welfare. Due to the lack of mental health services in hospitals, people usually seek traditional healing methods, which transpire across homeopathy, Chinese herbal medicine, and acupuncturists. Even though recently a separate department for psychiatry has been established in the province by the name of Balochistan Institute of Psychiatry and Behavioral Sciences, but unfortunately, it is not operational and is based in Quetta, while other major cities i.e. Turbat, Gwadar, Khuzdar lacking proper mental health services. As a developing country where insecurity, unemployment, economic problems are very prominent, mental health should be given the same status as anything other physical ailments.

The staggering condition of mental health in the country calls for mental health awareness programs, comprehensive policies and mental health services in workplaces, schools, and other institutions. An efficient way to tackle mental health problems among youth in schools would be to organize mental health literacy programs for the teachers so they can provide initial assistance to students with mental health problems. Apart from that, schools should provide mental health services by appointing mental health professionals to cater to students with such conditions. This, however, could only be possible if the budget for the health sector especially mental health is increased.


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Hatoon Gul is a Turbat based YES alumna studying Social Development and Policy at Habib University, Karachi.

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