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ental health is a basic human right for all people, according to the World Health Organisation. Everyone, wherever and whoever they are, has the right to standard mental health. However, there has been unequal access to mental health services. This is attributed not only to stigma but also to geographical location and neglect. In theory, every person has the right to mental healthcare but in practice, many can’t even afford the bus fare to get to a psychiatrist, let alone any other expense.
There are many barriers to access to mental healthcare services: stigma, fear of being judged and embarrassment. In addition to these, one of the major reasons is the cost of treatment. When someone says “see a psychiatrist,” many nod—but fewer follow through. This highlights that the reason lies deeper than stigma and ignorance. This factor often goes unspoken but is very real.
In the US, only 47 percent received mental health services in 2021. There is a shortage of mental health professionals in the United States. The rural states are most affected due to non-availability of psychiatrists. Child and adolescent psychiatrists and geriatric psychiatrists are also limited. Countries like Bangladesh, Nigeria and Kenya have fewer than one mental health professional per 100,000 people.
According to the World Health Organisation Atlas, 2020, there are around 800 psychiatric units in general hospitals. The total number of beds stood at 2.1 per 100,000 population. While there are outpatient psychiatric facilities, only 1 percent of those have child and adolescent mental health services. 51 percent of the psychiatrists work in urban areas in private facilities, restricting the focus to urban areas. Around 45 percent of psychiatrists work in the public sector.
Currently, there are only 900 psychiatrists for a population of 255 million in Pakistan. This shortage of psychiatrists affects the access to care. This is affecting not only developing but also developed countries. There are a few specialised centres working for child, adolescents, geriatric and addiction related issues.
Another problem with access to care is the exclusive availability in urban areas, which makes the access even more difficult for people residing in rural areas.
Hidden costs
According to a study published in 2025, many patients with mental illness do not seek help because of the financial burden. Financial problems prevent patients in rural areas suffering from psychiatric issues to seek help. Prior to each visit, the patient or the caregiver has to consider the transport fare, lost wages and long waiting hours. These costs go unnoticed in official records but weigh heavily on families already struggling to cope.
These expenses do not appear on the bills but silently impair the capacity to seek help.
People travel from far-flung areas to hospitals for regular check-ups. Long waiting time is an additional burden as the outpatient department of a public sector hospital is usually very busy. There is an approximate turnout of 300-400 patients in a day, with an average number of 50 patients assessed by a single psychiatrist in OPD, daily. This affects the provision of adequate care to all patients. For patients coming from rural areas, the financial burden and mental health issues intersect, further aggravating the distress.
This cost is not visible to anyone but is a major barrier in seeking help and affecting the mental health of individuals. If the patient manages to seek help, the availability and cost of medication are a major issue, adding another layer of distress and hardship. Thus, some patients discontinue the medication because of non-affordability.
A survey report showed that of the people who accessed mental healthcare in the past year, about 12 percent had spent more than 20 percent of the family income. In Pakistan as well, psychiatric facilities are concentrated in major cities. A single mental health facility is responsible for not only the city itself but also for the vast adjoining rural and peri-urban areas. This results in immense strain on resources and accessibility. As far as private facilities are concerned, being a low-middle-income country, most of the population in Pakistan cannot afford it.
Human cost
What is the result of unaffordable mental healthcare? The depression deepens, anxiety worsens and functionality is impaired. The burden is carried by the families. This affects the mental health of the individual and in turn their families. In addition, it costs billions in lost productivity. In Pakistan, it adds to cycles of poverty and despair.
Innovation and hope
Despite the difficulties, there is hope. There are many community-based programmes that can help to provide mental health facilities. The Thinking Healthy Programme in Pakistan is aimed at improving the health of mother and child. The WHO Parents Skills Training Programme was delivered to volunteers in rural areas of Pakistan, which accustomed them to developmental disorders.
Mental health awareness is also raised by radio, television and social media platforms. During Covid-19, the first mental health coalition took place in Pakistan. This brought together organisations to formulate strategic plans and national advocacy. The Ministry of Planning, Development and Special Initiatives launched a multilayered and digitalised mental health programme to develop intersectoral collaboration and reduce gaps.
What must change?
The number of mental health facilities should be increased. There should be greater emphasis on increasing the number of postgraduate training centres, which in turn will increase the number of mental health professionals in Pakistan. Rural healthcare should be strengthened and mental healthcare facilities should be included in it. Tele-mental health facilities should be expanded so that mental health services can be provided at low cost to underserved areas.
Mental health should be affordable and decentralised. We should scale-up community-based models such as the Thinking Healthy Programme, integrating counselling into primary healthcare and expanding tele-mental health which can bridge both the economic and geographical gaps.
Access to mental health is not only about acceptance or awareness alone; it is about affordability as well. If care is not affordable, many will remain silent. Mental health is a human right and should be accessible to all. It should be supported through public funding and compassion-driven policy.
The writer is chairman of the Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi.