With rising suicide rates, Pakistan must prioritize mental health

Self-immolation by an unemployed man in Karachi, suicide by a man in Rawalpindi a few days after his marriage, news of a woman killing her children and herself in Peshawar, reports of various young girls and boys committing suicide as a result of social media blackmailing in all major cities of the country-- all of it sends chills down spines and at the same time highlights that vulnerability transcends social groups, gender and age cohorts in Pakistan. The suicide rate in Pakistan has alarmingly crossed 8 percent (per 100,000 people), according to the World Health Organization, and this can significantly be associated with mental health problems.

Pakistan is home to over 220 million people, ranking fifth in the list of countries by population, as well as fifth in the list of countries with a young population. According to the UN Population Fund Report, around 63 percent of the population in Pakistan comprises youth aged 15 to 33 years. Yet, despite the data and numbers available, mental health issues and their management is a subject few are ready to acknowledge and address.

Pakistan has one of the highest rates of mental ill health in the world; according to one estimate, around 50 million people in Pakistan suffer from mental disabilities, which manifest in many shades and hues namely depression, substance abuse, alcoholism, post traumatic disorder, eating disorders, manic depressive psychosis, schizophrenia. At the same time. Pakistan has a staggeringly low number of psychiatrists and psychologists. According to a paper published in Lancet Psychiatry in 2020, there are fewer than 500 psychiatrists in the country for this population size. 

There are myriad reasons for such a huge burden of mental health conditions compounded by the pressures of ongoing socio-political collapse, insecurities, economic crisis and an alarming amount of bad news constantly playing out on mainstream and social media.

Dr. Mehreen Mujtaba

According to WHO, there are only 0.19 psychiatrists in Pakistan per 100,000 inhabitants, one of the lowest numbers in WHO EMRO region as well as the entire world. This absence of trained mental health professionals in the country has created a major treatment gap, leaving more than 90 percent of the people with mental health issues untreated.

There are a myriad reasons for such a huge burden of mental health conditions prevalent in the country compounded by the pressures of an ongoing socio-political collapse, insecurities, economic crisis, lack of recreational environments and facilities and an alarming amount of bad news constantly playing out on mainstream and social media.

Depression and anxiety are some of the leading causes of morbidity in children and adolescents worldwide. In Pakistan, young people are exposed to many chronic adversities including socioeconomic inequalities, violence and are at greater risk of developing mental health problems. Yet there is a lack of trained human resources, in-patient child and adolescent mental health care facilities, and training opportunities in child and adolescent psychiatry and mental health in Pakistan.

Mental health surveys carried out by various research institutes have clearly identified that the most impacted population in Pakistan are millennials, indicating that there is certainly something wrong in the way the society and government is handling its young people. Under-utilized, unskilled, jobless youth in Pakistan are rapidly getting disenfranchised by the system, resulting in a rise in depression and substance abuse. Youth in Pakistan in particular, who can either be an economic dividend or a ticking time bomb, a group with the highest stakes in the country, are getting more frustrated, isolated and hopeless. 

In addition to all the above mentioned factors, one of the most important issue is that of a stigma and sociocultural taboos associated with seeking medical help for mental health conditions. 

Services to treat mental health in Pakistan are completely under-financed, without much budgetary allocation in public sector hospitals to developing robust outpatient and inpatient psychiatric units. There is a widespread disregard for mental health related concerns at all levels of government planning and implementation. Although it doesn’t have a separate budget, it is roughly estimated that mental health accounts for 1 percent of the national health budget, which represents about 0.8 percent of the GDP.

Although the situation appears grim, useful amendments in educational reforms and government policies can help in prioritizing mental health in Pakistan. Many organizations, and NGOs are trying to raise awareness for those most in need of professional help. Grassroots community-based organizations can take the lead on efforts to provide urgently needed advocacy and sensitization programs for key population groups, mainly women and adolescents.

In this regard, one of the most promising initiatives undertaken by the Government of Pakistan is the launch of a mental health app called “Humraaz” in March 2023. This app aims to give access to and help anyone with suicidal thoughts or any form of a mental health emergency, providing patients treatment under complete confidentiality. Through this app, patients will also be able to arrange appointments with psychiatrists and psychologists, and the government has pledged to work toward hiring and training professionals to combat the epidemic of mental health illness. It’s at least heartening to see the beginning of a discourse and acknowledgment of the issue. 

- Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health.