The state of mental health in Pakistan: analyzing system gaps and social determinants using data from the Global...

Mental health continues to be a neglected issue globally, and it is particularly disregarded in low- and middle-income countries (LMICs), where access to care is shaped by structural inequalities, pervasive stigma, and limited policy implementation. Here, we leverage data from the Global Mental Health Countdown 2030 to assess Pakistan's mental health landscape with respect to 48 core indicators grouped into four domains: (A) social and environmental determinants, (B) demand and need for treatment, (C) quality of services provision, (D) wellbeing.

Comparison groups were provided as medians for South Asia and the larger LMICs.

In relation to LMICs, Pakistan ranks in the bottom quartile for inclusiveness and displacement, and possesses increased concentrations of exposure to school bullying and pandemic-related anxiety. Psychological disorders are common and the treatment gap is over 90%, with much of care delivered by non-specialist or untrained providers. Moreover, decreased capacity levels in the system perpetuates mental health stigma. Although mental, neurological, and substance-use related disorders account for 6% of total DALYs, government spending on mental health is 0.4% of the budget in health. As a result, health outcomes are also reflected in low happiness scores and increasing rates of suicide. Psychosocial services are entirely absent at the primary care level, and systematic surveillance is nonexistent.

This cross-sectional benchmark analysis underscores the urgent need for structural reforms, including primary care integration, investment in digital and community-delivered interventions, gender-responsive policies, and robust data systems to enable accountability and targeted policy action.