ISLAMABAD (Urdu Times) The greatest suffering is often the one that remains unnamed.

Author:Fatimah Ahmed

Student of Psycology

Diploma Holder yale University USA

ISLAMABAD  (Urdu Times) In this article/ op-ed, a Pakistani high school graduate explores mental health challenges in Pakistan through social, economic, religious, gender and institutional perspective.

A student preparing for an exam sleeps two hours a night and calls it discipline. A mother dismisses exhaustion to put up with the expectations. A worker hides his depression behind gratitude. A sick person relies on miracles rather than seeking professional help. What is it that no one’s ready to accept? What is it that needs to be brought to light? What is it that we all are running from?

“People will do anything, no matter how absurd, to avoid facing their own souls.”

                                                                                                                        — Carl Jung

Mental health is a serious and often overlooked issue in Pakistan, even though it is just as important as physical health. According to the World Health Organization (WHO), “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” While remarkable progress has been made in treating physical health conditions, mental health care continues to face significant shortcomings and persistent neglect in our country. It is not only a medical issue, rather a phenomenon shaped simultaneously by society, economy, religion, gender roles, inadequate institutional structure and one’s personal beliefs.

Pakistan is a developing country with limited socioeconomic resources and mental healthcare access. 10-16% of the adult population suffer from anxiety and depression with symptoms ranging from mild to extreme. 1-2% of the population suffer from severe mental illness such as schizophrenia and bipolar disorder. 15% have adolescent and child mental health disorders. Around 4 million people use illicit drugs of which 70% are men. The common illicit drugs used include Heroin, Marijuana, Ice and Benzodiazepines. Pakistan faces a severe shortage of mental health professionals, with estimates suggesting there are only about 400-564 qualified psychiatrists for a population exceeding 240 million, that is, 2-3 per million inhabitants, far below the recommended WHO standard. While there are other mental health professionals, such as approximately 3,000 clinical psychologists, the overall number of specialists remains critically low for the population size. Despite the high rate of psychiatric disorders in the country, help-seeking is very low due to prevailing stigma, lack of awareness, low literacy rate, help-seeking from alternate sources such as spiritual healers, scarcity of specialized mental health units and providers, the low budget dedicated to mental health care, and limited financial resources. This suggests a dire need to not only address but understand and perhaps restructure the mental healthcare system in Pakistan.

In Pakistan, the classic “log kya kahengay” mindset pushes stigmatization of mental health. Mental illness is seen as a weakness instead of a condition to be cured. Families hide problems from society due to fear of being declared as an outcast. Reputation is prioritized over the wellbeing of the patient battling mental illness. People fear judgement more than the illness itself. Ultimately, emotional suffering becomes private. In many households expression is discouraged and vulnerability is mocked, meanwhile endurance is praised. A person is forced to wear a mask of performative strength which rather won’t help. As a result people learn to “perform” strength instead of learning to name their pain and seeking help, which results in long-term mental health issues.

The conversations regarding mental health begin with avoidance instead of acknowledgement. So as Viktor Frankl suggested, “An abnormal reaction to an abnormal situation is normal behavior.” Perhaps understanding this as a society is one way to reduce stigma and acknowledge individual suffering.

People focused on survival cannot prioritize mental health. Pakistan belongs to one of those low- and middle-income countries (LIMCs). Affording mental health care is not only a psychological struggle, it is an economic privilege. On average, families depend on one earning member. The rising inflation in the country leaves little to no room for access to expensive mental healthcare for an average person. When basic needs are unstable and remain unachieved emotional wellbeing becomes secondary. Although limited public mental healthcare services exist in both urban and rural areas in Pakistan; the quality and standard of care differ greatly. Private healthcare coverage is mostly limited to urban populations which creates further inequality. Government spending largely prioritizes major urban hospitals. This leaves the primary prevention and basic mental health services underfunded and insufficiently developed. The total health budget less than 1% of gross domestic product (GDP) is dedicated to mental health issues which amounts to 9.31 dollars per person/year and is much less than the international recommendation of 60 dollars per person/year. The estimated economic burden of mental illness is 250 billion PKR and 70-80% is out of pocket. Nationally, 24.3% of people live below the poverty line with an unemployment rate of 4.8%, which further aggravates the problem.

In Pakistan, religious and spiritual beliefs, both individual and collective, play a huge role in how mental illness/ health is interpreted. They shape the understanding and management of mental health, sometimes providing comfort, and other times perpetuating misunderstanding through false preaching. Many people see mental illness as a test from God, a punishment for sins, and is oftentimes associated with demonic possession or a supernatural phenomenon. People seek religious remedies before they even acknowledge the root cause. Belief systems sometimes mislabel symptoms of, for example, depression as laziness and lack of faith, anxiety as overthinking and insufficient prayer. Families and communities reinforce these interpretations. This results in delayed seeking of medical help and added self-blame.

One’s personal beliefs, such as relying completely on miracles, or more so, replacing medicine entirely with spiritual interventions can lead to partial improvement, misdiagnosis and extended suffering for both the patient and the caregivers (family).

When Prophet ʿAyyūb (A.S) was tested with severe illness and loss, he remained patient and faithful. Allah guided him to a healing spring, and by following it, he recovered. This teaches that trusting Allah doesn’t mean ignoring means of treatment. Faith and effort together matter. We trust Allah and use the means He provides. If implemented correctly, religion provides spiritual healing, community support, increases resilience and faith. Through prayers, recitations and meditation religion displays positive outcomes. By understanding this mental health system can be improved on the religious level.

Typical gender norms show how mental health is perceived in our country. Men are generally pressured to appear strong. Cultural ideas link masculinity with toughness which discourage men from seeking needed psychological help. Men expressing sadness may be seen as weak and vulnerable which leads to emotional restraint, frequent anger expression and untreated stress. Studies indicate that women are affected more psychologically by gender disparity. They experience higher rates of depression, anxiety, and internalizing disorders compared to men. Women are roughly twice as likely to suffer from mental illness due to societal inequalities, such as gender pay gaps and discrimination. While women experience higher rates of internalizing disorders, men often experience higher rates of substance abuse and antisocial behavior, partly due to different socialization and help-seeking behaviors.

A future that prioritizes mental health must move beyond rigid gender roles. We, as a society, should create spaces where every individual is equally permitted to struggle and heal.

The education sector in Pakistan plays a critical role in shaping students’ mental wellbeing, yet it often prioritizes academic performance over psychological health. Approximately 1 in 5 children in Pakistan experience mental health problems, often caused by academic pressure. From an early age, students face intense academic pressure, long hours of study, constant fear of failure and high family expectations. High-stakes tests, board exams, and competitive admissions create chronic stress, anxiety, even burnout. Most educational institutions lack proper mental health support. Counselors are rare, and teachers are usually not trained to recognize psychological distress. In 2019, a 5-year project was launched to train teachers in recognizing and managing student mental health issues. University students face severe stress, with 55% reporting awareness of mental health services. However, significant stigma and lack of professional counseling hinder help-seeking behavior. Mental health in schools is a systemic problem that affects the next generation’s ability to thrive both academically and emotionally. Introducing counselors, teaching emotional literacy through curriculum, training staff to recognize distress, and fostering open, supportive environments can improve student mental health in the education sector.

Mental health in Pakistan is shaped by social expectations, economic realities, gender norms, religious interpretations, and institutional gaps. Each lens reveals unique challenges but together they show a society struggling to see, understand, and support emotional wellbeing. Progress will require awareness, adequate and accessible services, union, and a cultural shift that values mental health as much as physical health. By recognizing these barriers and acting collectively, Pakistan can build a future where seeking help regarding mental health is not a weakness, but a shared responsibility and a path toward growth and development in all areas of life.

  “Not everything that is faced can be changed, but nothing can be changed until it is faced.” — James Baldwin

Author’s note: This article is an analytical opinion piece intended to raise awareness about mental health in Pakistan. Statistical information is drawn from publicly available reports, published literature, and research sources, while the interpretations and opinions presented reflect the author’s independent analysis and perspective.