Listening before legislating

AI Summary

The article argues that Pakistan’s mental-health policy must incorporate the experiences of people living with distress rather than relying solely on diagnostic or institutional perspectives. It welcomes the launch of a national policy but warns that implementation will be difficult given stigma, gender inequality, limited awareness and a severe shortage of mental-health professionals.

EVERY World Mental Health Day arrives with a theme, a hashtag, and a flurry of panels. This year’s call to centre the voices of people with lived experience deserves more than a single day. It requires an honest accounting of whose voices have shaped our mental health agenda, and whose have been absent from it. In clinical practice, one learns that people rarely describe their distress in the language of diagnosis. Recent events shape, and at times fortify, age-old dogmas. A young woman laments that recent allegations of sexual assault on a university campus have reinforced the view for her parents that places of learning are not safe for girls and that she must rethink her dreams. A teenage boy says he has not cried since he was nine, because he learned early what crying would cost him. A man in his 40s says he cannot tell his family he has stopped sleeping, because the word ‘depression’ would be heard as weakness, or worse, as madness. None of them is describing a disorder alone. Each is describing a world, and a mind adapting to it. Mental health does not reside only within individuals. It is shaped by homes, classrooms, workplaces, streets, and the narratives a society sustains about who may be safe, who may be vulnerable, and who may speak. Pakistan ranks near the bottom of global gender parity indices; millions of girls remain out of school. When women fear pursuing an education, or when their aspirations are quietly renegotiated, the consequences extend well beyond the economic. They appear as hopelessness, chronic anxiety, and a constriction of possibility. Boys raised to equate emotion with weakness and dominance with worth bear a different burden: silence, aggression turned inward or outward, and little vocabulary for distress. Patriarchy shapes the psychological lives of every gender. Stigma compounds this. Mental illness is still widely seen as a moral failing, a spiritual affliction, a source of family shame. Public awareness of what depression, anxiety, psychosis, or trauma actually involves — and that they are treatable — is limited. People wait for years before seeking care, often turning first to faith healers, informal practitioners, or no one at all. Many of us carry a sense of heaviness at how slowly some things change. It is worth naming that feeling rather than suppressing it. Despair can be worked through collectively. On this World Mental Health Day and beyond, people with lived experience must be heard. Against this backdrop, the launch of the national mental health policy on Oct 1 was a necessary step. A policy places mental health on the public agenda, gives advocates a reference point, and offers the system a direction. The political will behind it must be acknowledged. A launch, however, is a moment, whereas implementation is the work of a decade. Pakistan has over 250 million people. By most estimates, it has roughly 500 psychiatrists and a comparable number of psychologists, with no licensing body to regulate the practice of psychology, and, therefore, no uniform standard of training, scope, or accountability. The scarcity is sharper still in specialist areas. There are fewer than 10 child and adolescent psychiatrists in the country, and child psychologists are almost non-existent. Mental health has been under-resourced for decades. This is not a criticism of any individual or institution. It is the arithmetic of a neglected field, with far-reaching consequences. Where specialists are scarce, implementation tends to fall on others: dedicated NGOs, short-course trainees, and well-intentioned professionals who have not had the opportunity to work with many patients over many years, often without regular supervision. Nuanced, effective mental healthcare rests on the clinical judgement to distinguish grief from depression, trauma from defiance, and a cry for help from a pattern of behaviour that signals something more. That judgement is built through years of practice, mentorship, error corrected under guidance, and slow accumulation of patients’ stories. Without it, even well-designed programmes can overlook those most in need. The need for distinction is greater still given the context. Pakistan contends with floods and heatwaves, economic precarity, displacement, gender-based violence, and the effects of regional conflict — among the principal determinants of mental health. Implementation in such conditions requires people who understand both the science and the street. As we welcome the policy, and look forward to its implementation, some principles deserve consideration. Implementation is best guided by practitioners with long front-line clinical and research experience in the country, supported by public health and systems expertise. Second, a rigorous, costed strategic plan is essential. The design must specify which services will be delivered in which districts, by whom, under whose supervision, and measured against what indicators. Aspiration must be translated