A man in Quetta kills himself and his family. An elderly husband kills his wife after years of sexual frustration. A lady doctor survives an acid attack. In Lahore, a mother allegedly slit the throats of her three children. In Sargodha, a man killed his wife and children with an axe. Each time such a tragedy occurs, we search for explanations in crime, sin, morality or personal failure. Television screens fill with outrage, social media demands punishment and religious and legal arguments dominate the discussion. Then the story fades, only to be replaced by another. What remains striking is not just the violence itself, but our collective refusal to ask whether these events are also telling us something about the state of mental health in Pakistan.
We continue to speak about mental health as though it is a challenge that lies somewhere in the future. It is not. It is already here. It is in our homes, our schools, our workplaces, our hospitals and increasingly in our headlines. Yet we remain reluctant to recognize it because doing so would force us to confront uncomfortable truths about the society we have built.
Mental illness does not always announce itself in obvious ways. It often appears first as persistent sadness, crippling anxiety, paranoia, rage, substance misuse, social withdrawal, hopelessness or an inability to cope with life’s pressures. Left untreated, these conditions can devastate individuals, families and communities. Most people who suffer from mental illness never become violent, but when severe mental distress combines with isolation, trauma, addiction, poverty or untreated psychiatric disorders, the consequences can be catastrophic.
The frightening reality is that Pakistan is profoundly unprepared to respond. We have roughly 500 registered psychiatrists serving one of the largest populations on earth and most of them are concentrated in major urban centres. Entire districts have little or no access to specialist care. Yet the shortage of psychiatrists is only part of the problem. Even if we doubled their numbers tomorrow, we would still be failing. Mental healthcare cannot depend solely on specialists working in tertiary hospitals. By the time many patients reach those facilities, years of suffering have already passed.
Mental healthcare must begin where people actually live. It should start in primary care clinics, where family physicians are often the first and only healthcare professionals a person will ever consult. It should start in schools, where emotional difficulties are frequently punished instead of understood. It should start in workplaces, where burnout and distress are treated as weakness rather than warning signs. It should start within families, where many people continue to suffer in silence because they fear ridicule more than illness itself.
Our language reflects this stigma. We casually use the word pagal to describe almost every form of mental illness, reducing a vast spectrum of conditions to a single insult. Depression becomes madness. Psychosis becomes madness. Intellectual disability becomes madness. Dementia becomes madness. The word does more than offend; it prevents understanding. Once a person has been labelled, society stops listening.
The consequences can be dangerous. We frequently hear of individuals uttering bizarre, grandiose or irrational statements. Instead of asking whether they may be suffering from psychosis or delusional disorders, we often respond with anger, punishment or moral condemnation. We encounter distressed children and respond with humiliation. We encounter troubled young people and respond with violence. We encounter trauma and respond with indifference. Too often, we mistake suffering for disobedience and illness for character failure.
The problem extends beyond healthcare. Schools continue to normalize practices that would be unacceptable in many parts of the world. Our law enforcement institutions are often better known for coercion than compassion. Economic insecurity, social isolation, domestic violence and substance misuse continue to fuel distress across the country. Meanwhile, many of those who occupy the corridors of power appear disconnected from the daily struggles of ordinary citizens, treating mental health as a secondary concern rather than a national priority.
Nearly two thousand years ago, Seneca wrote, “We often suffer more in imagination than in reality.” Today, Pakistan faces the opposite problem. We continue imagining that a mental health crisis is approaching while failing to recognize that it has already arrived.
The solution is neither simple nor quick, but it is clear. Mental health must become part of primary healthcare. Teachers, police officers, community leaders and healthcare workers need basic training to recognize psychological distress. Schools should teach emotional literacy alongside academic subjects. Public awareness campaigns must challenge stigma and encourage help-seeking. Communities need accessible counselling and crisis services. Families caring for loved ones with mental illness need support rather than judgment.
Most importantly, we must learn to see mental illness not as a moral failing, a source of shame or a subject for ridicule, but as a human condition deserving of compassion and care.
The tragedies that continue to dominate our news cycles are not isolated incidents. They are warning signs. They are telling us that something is deeply wrong. The real question is not whether Pakistan has a mental health crisis. The real question is how many more lives will be lost before we finally admit it.
—The writer is Professor of Public Health, Shifa Tameer-e-Millat University, Islamabad.([email protected])
