Globally, someone dies by suicide every 40 seconds, and 80% of disease burden is felt in low- and middle-income countries. Pakistan has one of the highest rates of depression including postnatal depression, and limited access to treatment.
Climate change is also having a major impact on Pakistan. Around 33 million people, including approximately 16 million children, were affected by the heavy monsoon rains in Pakistan in 2022, which has added to an existing mental health crisis.
Decriminalisation bill
Recognising the scale of the problem and in a bid to support mental health rehabilitation, a bill was passed in the Pakistan Senate in 2022 to decriminalise acts of self-harm and suicide, and eradicate stigma around mental illness.
After the bill was passed, the President of Pakistan, Dr Arif Alvi, approved the Criminal Laws Amendment Bill 2022, which abolished the suicide punishment law in the Pakistan Penal Code, officially decriminalising attempted suicide in Pakistan.
Professor Nusrat Hussain
Nusrat is Professor of Psychiatry and director of the Global Mental Health Cultural Psychiatry Research Group at The University of Manchester.
Suicide prevention
A team from The University of Manchester's Global Mental Health Cultural Psychiatry Research Group, led by Professor of Psychiatry Nusrat Hussain met with the National Assembly lead for UN Sustainable Development Goals and the Pakistan Institute of Living and Learning (PILL) to discuss a suicide prevention strategy for the country.
Referencing the research group's South Asian Harm Reduction Movement (SAHAR-M) project, the meeting focused on understanding the causes of self-harm and suicidal behaviour in Pakistan, and developing targeted programmes.
As a result, the research team from Manchester were asked to support PILL in developing and implementing the first mental health policy in Pakistan.
Devolving policy
Health is a devolved service across Pakistan, controlled at the provincial level, with decisions such as implementing a mental health policy decided by the Provincial Parliament.
In 2022, a delegation from The University of Manchester and PILL attended meetings to look at policy formation across Pakistan. The Sindh Minister for Health and Population Welfare not only decided to take the mental health policy forward, but also took the initiative to establish the Improving Access to Psychological Therapies (IAPT-PK) programme to be delivered by PILL in collaboration with The University of Manchester, starting initially in the two districts of Sindh, Sukkur and Qambar Shahdadkot.
The Sindh Mental Health Policy and Implementation Plan also contains essential strategies to improve access to mental health care in Pakistan. It will incorporate telehealth to scale up mental health intervention, which will improve access to appropriate psychological support, especially in remote areas. It will play a vital role in levelling up access to mental health care across the country.
"We're partnering with Manchester in a lot of mental health-related research, as we're serious about changing our healthcare systems, improving them wherever we can. For that, we want to use Manchester's experience to help guide us, build capacity and also create global links," says Dr Saad Khalid Niaz, Health Minister for the Sindh region.
"Our partnership is reciprocal. We have a lot of problems in Pakistan that students, researchers, and experts working in mental health in Manchester and the UK can learn from, based on the experiences and insights that we will be sharing. In the process of learning from each other, we'll hopefully improve outcomes in mental health in Pakistan.
"The world of medicine is shifting from being cost-effective and universal, to becoming restricted to those who can afford it. That's why Pakistan, a relatively poor developing country like many others, wants to give universal healthcare, but just cant afford to do so.
"With medical cost-effectiveness disappearing from the western world, this will have an impact no matter how much money you have, because the way the cost is going up, it is becoming more and more difficult for most countries to sustain what you would call health services to their populations. We need to redress this.
"Our partnership is great step forward in collaborative working and in helping us to improve the system that we have."
Learn more about Manchester's global health collaborations.