Embracing hope

May 5, 2024

A first-of-its-kind mental health ambulance service

Embracing hope


ental health issues are alarmingly widespread in Pakistan. Almost every family can report a chronic mental health patient among relatives or friends. Some of such patients are blamed for not having enough faith. Others are believed to be under some kind of spell or demonic possession and are taken to pirs or spiritual healers. Very few reach the right medical facility or rehabilitation facility where appropriate treatment is provided to such patients.

According to the World Health Organisation, an estimated 45.5 million people suffer from mental disorders. Depression, anxiety and schizophrenia are the most common disorders. However, only 10 per cent of individuals with mental illness receive any form of treatment due to factors such as societal stigma, lack of awareness, inadequate resources and limited access.

In the chaos, ignorance and irresponsibility towards mental health issues, a few young minds, motivated by their experience of witnessing a dear one suffering through chronic mental health issues, initiated Embrace - Asia’s first mental health ambulance service.

In 2021, in collaboration with Columbia University’s Tamer Center for Social Enterprise and Climate Change, an initiative with the name Saving 9 was piloted in Islamabad.

The Saving 9 team says the service is the first of its kind in Asia and only the second such initiative in the world. The initiative aims to facilitate access to comprehensive, affordable mental health services, including emergency crisis intervention for violent patients in a state of psychosis needing to be restrained, sedated and transported in complete privacy.

“Our first responders are trained in psychological first aid, compassionate communication, psychiatric disorders, pharmacology and de-escalation. They are also instructed in self-defence to ensure they can keep themselves, the patients, and their families safe in case of a violent physical struggle,” Abdullah bin Abbas, the Saving 9 CEO tells The News on Sunday.

He says that the priority of Emergency Medical First Responders is to counsel and convince the patients to make them realise their condition and agree to visit mental health providers. “In most cases, the patient agrees. Some of them follow the ambulance in their own vehicles,” says Abdullah. If the patient is violent, the Embrace team uses sedatives to calm them down so that they can be taken to the medical facility.

Describing the procedure, Abdullah says that for every emergency, a senior consulting psychologist is included in a group call with a family member to extract and formulate a detailed history of the patient’s condition and make a final decision regarding the need for pickup based on the circumstances.

“In case of violent patients, our SOPs adhere to international standards. We have built a roster of affiliated clinics, psychiatrists and psychologists that scrutinise and endorse all our emergency procedures,” he says.

The most exclusive feature of the project is the vehicle. Stepping inside the Embrace ambulance feels like entering a safe space. The interior is meticulously designed to evoke feelings of calmness and tranquillity, with soft lighting, soothing colours and a comfortable seating arrangement. Every detail has been carefully curated to create a space where an individual experiencing a mental health crisis could feel secure.

“Our vehicle is equipped with the apparatus needed for any medical emergency but it is hidden as it can make a patient uneasy,” says Abdullah. He adds that the vehicle is completely unmarked to preserve patient privacy in urban neighbourhoods.

The true magic of Embrace lies in the dedication and empathy of its staff. Trained professionals work tirelessly to offer personalised care to each patient. The Embrace team has extensive experience in managing complex cases ranging from patients with schizophrenia and bipolar disorder to drug-induced psychosis and severe mood disorders.

The journey begins with a meeting with the patient’s family, where the team listens attentively to their concerns and collaborates on a plan of action. In case the patient is unable to pay for Embrace’s service or the subsequent clinic, Zakat funds are used to help the patient get the needed short-term care.

“Despite all precautions, it is not easy to convince a mental health patient to go to a health facility. We have come across some chronic cases where the patient poses danger to not only themselves but also to the responders,” says Zainab Nosheen, one of the Emergency Medical First Responders.

Recalling one such incident, she says that once their team was able to convince a patient to go to a medical facility but as soon as they arrived at the facility, the patient started running and shouting as she panicked on seeing the board and the medical staff. “It took us another hour to convince her to enter the medical facility. Meanwhile, she was getting increasingly violent. Finally, we requested the medical staff to assist us and sedated the patient,” she says.

Since 2022, in the pilot phase, the Embrace ambulance has handled around 40 mental health emergencies in Islamabad and Rawalpindi, as well as some cases in Lahore, Peshawar and Mirpur. Among these cases, 70 per cent were male and 30 per cent were female. 40 per cent were non-violent and 60 per cent were violent. A majority belonged to urban areas,” says Abdullah. He says that after the public launch of the service, they received around 60 cases during the first month. “This shows the need for this service among the general public,” he says.

At this stage, the service includes therapeutic and counselling services in collaboration with Mahir-i-Nafsiyat, Ruhbaru and several other clinics in the twin cities. “This coalition of organisations ensures comprehensive mental health service delivery across all tiers of care, including emergency helplines, online and in-person counselling and emergency and crisis intervention.” He says that in future, the Embrace will particularly focus on universities and educational institutes to try and address the rising levels of mental health issues and student suicides across campuses in Pakistan.

Abdullah says they believe that there are a significant number of psychological emergencies happening across the country, especially in densely populated urban areas. He says that psychological emergencies can be broadly categorised as those involving psychosis including hallucinations, altered mental status, mania and drug overdose etc besides extreme anxiety like panic attacks and suicide attempts. Sometimes these emergencies are compounded by physical health complications as well.

A person experiencing a psychological emergency in Pakistan does not generally know which service can be contacted. As a result many mental health struggles go unnoticed or untreated, Embrace offers hope to the suffering in their darkest moments.

The writer is a reporter for The News International

Embracing hope