Despite rising awareness, the road to acceptance and integration of mental healthcare in everyday life remains long. In Pakistan, conversations around well-being often remain confined to urban centres, while rural populations - the majority of the country - still struggle with access, awareness and affordability. With the economy under stress, job insecurity on the rise and communities still grappling with the effects of climate disasters, the need to integrate mental health into health services is more pressing than ever.
To understand these challenges more deeply, we spoke with Dr Farwa Shahid, a mental health practitioner and Senior Manager of Public Health at SHINE Humanity. Dr Farwa works with both urban and rural communities across Sindh. Her experiences shed light on the misconceptions, ongoing initiatives and aspirations for a healthier future. Read on…
Misconceptions related to mental health
When asked about the most common misconceptions among patients, Dr Farwa replies, “Almost 80 per cent of the patients we see attribute mental health challenges to magic, the evil eye or other supernatural causes. Many families also dismiss mental illness altogether, refusing to accept that conditions such as depression, anxiety or bipolar disorder can have biological and genetic links.”
“Beyond cultural myths, gender roles also play a role in stigma. For men in particular, seeking psychological support is often perceived as weakness. There is a widespread perception that seeking help reduces their masculinity,” she adds.
This underscores a larger truth: addressing mental health in Pakistan requires more than just services. It requires culturally sensitive education that dismantles long-held misconceptions and reframes care as a strength rather than a weakness.
Services on the ground
What does care look like in practical terms? To this end, Dr Farwa explains, “We offer individual counselling to patients who visit us with anxiety, depression or related concerns. Alongside this, we conduct group counselling sessions aimed at raising awareness, facilitated by our community health workers and mental health counsellors. Capacity-building plays a central role in this work.”
“The staff is trained in counselling approaches through a partnership with IRD Global, (a Singapore-based global health delivery and research organisation) which ensures that care is not only professional but also compassionate,” she informs.
But services do not stop at therapy rooms. To make mental health education more accessible, they have ensured to create materials in local languages, including Sindhi. Posters and guides are displayed in clinics, helping patients and their families identify potential warning signs. Staff working in general healthcare settings, such as those treating long-term illnesses, also receive counselling guidelines, given the strong link between chronic disease and depression.
These interventions are small but important steps toward mainstreaming mental health within everyday healthcare, particularly in communities where the concept is still blurred.
Practical routines in rural communities
For rural populations - often isolated by geography and tradition - the idea of ‘mental healthcare’ can feel abstract. Here, the approach has been to anchor well-being in simple, everyday routines.
Dr Farwa highlights three recommendations frequently given to patients:
1. Incorporating regular physical activity into daily schedules, whether through walking, farming or household chores.
2. Engaging socially and becoming active in community life, which helps counter loneliness and build support systems.
3. Practicing healthy sleep routines to ensure proper rest and recovery.
Through counselling sessions, patients are encouraged to view these small steps as investments in their mental well-being. The message is clear: well-being is not about drastic transformations but about consistent, manageable habits that accumulate over time.
Reshaping narratives
According to Dr Farwa, shifting the narrative around men and mental health is of utmost importance. “In a society where men are expected to shoulder family responsibilities without showing vulnerability, breaking the taboo around seeking help is crucial. Empowering men to access mental health support without judgment would mark a significant cultural shift,” she emphasises.
The larger vision is ambitious but necessary: normalising mental healthcare as an essential part of overall health. This includes reducing stigma, expanding services, integrating counselling into primary care and using community-level education to reshape narratives.
Mental health challenges in Pakistan
In Pakistan, where roughly one in four people are estimated to experience mental health challenges at some point in their lives, the stakes are high. Yet, the country has less than 500 psychiatrists for a population of over 240 million. Most of these are concentrated in major cities, leaving rural areas underserved.
“The issue of postpartum depression is often overlooked and stigmatised in rural areas. We have heard countless stories of women struggling with postpartum challenges but unfortunately, counselling is not readily available to them,” points out Dr Farwa.
The economic implications are equally pressing. Untreated mental health conditions translate into lower productivity, higher healthcare costs and reduced participation in the workforce. For businesses and policymakers alike, this makes mental health not just a personal issue but an economic one.
Cultural silence, fear of stigma and weak healthcare infrastructure further distance affected individuals from receiving care. In many cases, symptoms are normalised or misinterpreted as spiritual or behavioural issues rather than signs of post-traumatic stress disorder.
Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. While it can affect anyone, the risk multiplies in communities exposed to violence, displacement or natural disasters.
PTSD is not simply stress or sadness. It manifests through persistent flashbacks, avoidance behaviours, emotional numbness and hyper arousal. Individuals with PTSD often struggle with trust, concentration or even basic social interaction. Left unaddressed, these symptoms can grow into chronic mental health issues.
The challenge now is scale and sustainability. Reducing stigma around issues such as postpartum depression, normalising care for men and embedding well-being into routine health services are long-term goals that require both policy support and societal change.
In crisis-affected communities, the nature of post-traumatic stress disorder takes on a different and more complex dimension. Unlike in stable, high-income countries where trauma is often followed by immediate access to care, people in war zones, disaster-hit regions, or displacement camps face repeated and prolonged exposure to distress. The absence of safety, food insecurity, loss of shelter and constant uncertainty create conditions where recovery is nearly impossible. Instead of a single traumatic event, individuals often endure a cycle of recurring trauma that leaves deeper and more lasting psychological scars. In refugee camps and internally displaced populations, trauma is ongoing. The disruption of social ties, schooling and identity makes healing elusive. Emergency response teams often focus on survival essentials such as food, water and medicine, while emotional wounds go unseen and untreated.
Trauma in such emergencies is rarely a one-time experience. It builds in layers, compounding over time and shaping how individuals cope with daily life. At the surface, there is acute trauma - the immediate psychological shock that comes from witnessing or experiencing a violent event, such as an airstrike, an assault or the sudden destruction of one’s home.
For many, this initial wound is followed by complex trauma. This develops when individuals are subjected to repeated abuse, prolonged violence or constant exposure to distressing conditions. Living in conflict zones, facing continuous displacement or enduring cycles of loss can make the trauma feel unending, leaving little room for healing.
Then there is developmental trauma, which takes root during childhood. For children who grow up amidst instability, insecurity and fear, the impact is particularly devastating and long lasting. Interrupted schooling, disrupted family structures and the absence of nurturing environments can alter their emotional and psychological development, affecting their ability to build trust and stability later in life.
Together, these layers of trauma form an invisible but heavy burden on crisis-affected populations, one that shapes not just individual lives but the collective resilience of entire communities.
PTSD often surfaces through nightmares and flashbacks, forcing survivors to relive traumatic events as if they were happening again. Many also experience emotional detachment or irritability, withdrawing from loved ones or reacting sharply to small triggers.
Another common sign is avoidance: steering clear of places or conversations linked to the trauma, which often makes it hard to focus on daily tasks. In addition, survivors may live in a constant state of alert, exhibiting an exaggerated startle response and difficulty sleeping. These symptoms disrupt everyday life, straining relationships, work and overall well-being. In children, they may appear as aggression, withdrawal or delayed development.
Mental well-being is not a side issue. It is central to Pakistan’s future health, productivity and resilience. As awareness grows, the question is whether the country can turn the momentum of mental health awareness into sustained action, making mental healthcare a normal, accepted and accessible part of life for all Pakistanis.
Mental health in underserved populations
In underserved regions, mental health is often side-lined in policy and practice. Many humanitarian agencies lack trained personnel to identify or treat PTSD. Moreover, communities themselves may not view mental illness as medical.
Key challenges include:
* Insufficient funding for mental health programmes.
* Scarcity of culturally competent professionals.
* Lack of local-language resources for psychoeducation.
* Over-reliance on foreign aid without building local capacity.
The result is a cycle in which trauma continues across generations. In crisis zones, the integration of mental health into emergency care is no longer optional; it is essential.
Humanitarian mental health aid bridges this gap by offering:
* Psychoeducation to reduce stigma.
* Trauma-informed care in clinics and shelters.
* Mobile mental health units for remote areas.
* Peer-support training for community resilience.
According to the World Health Organization, nearly 1 in 5 people living in post-conflict areas suffer from a mental disorder, including PTSD. Without targeted interventions, these individuals remain untreated for years, often leading to compounded health issues.
Global examples demonstrate that low-cost, community-based strategies can work. In parts of East Africa and South Asia, school-based trauma screening and peer-led support groups have proven effective in reaching underserved populations. These approaches also strengthen local capacity, helping communities respond to future emergencies with resilience and structure.
The writer is a freelance journalist based in Karachi. She can be reached at sara.amjhotmail.co.uk