Every Third Pakistani Has a Mental Disorder, Yet the Country Has Only a Few Hundred Psychiatrists
Pakistan’s mental health burden has reached an alarming level, while the number of trained specialists to treat it remains far too small. According to the country’s first nationally representative psychiatric survey, 32.3 percent of adults, or one in three, currently suffer from a diagnosable mental or psychological disorder. Prof. Dr. Muhammad Iqbal Afridi, a leading psychiatrist, says Pakistan has only about 700 psychiatrists, counting junior and senior practitioners together, and many districts have no psychiatrist or psychologist at all.
Dr. Afridi is a Distinguished National Professor and a member of the Sindh Mental Health Authority. He is also one of the survey’s authors, and the research was published in the medical journal BMJ Public Health. In an exclusive conversation with Ummat, he said the country urgently needs to increase the number of trained, registered professionals, offer incentives for working in remote areas, and bring Pakistani specialists abroad back home.
The survey ran between 2019 and 2022 in Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan. Researchers contacted 20,833 people and completed face-to-face interviews with 17,773 adults at their homes, a response rate of 86.2 percent. Diagnosis relied on an internationally recognized tool, translated into Urdu, and every team included at least one man and one woman. Most interviewers were graduates in psychology or health sciences and received five days of training. Fieldwork paused during the COVID lockdown and resumed with safety precautions. According to the paper, participants who showed suicide plans or signs of serious illness were referred to local mental health services.
The findings show that the current prevalence of mental and behavioral disorders among adults is 32.3 percent, while the lifetime prevalence is 37.9 percent. Neurotic, stress-related and somatoform disorders were the most common category at 24.5 percent. Post-traumatic stress disorder (PTSD) stood at 19.9 percent, meaning one in five people. Mood disorders were found in 11.6 percent, of which depression accounts for 10.6 percent. Other anxiety disorders affected 5.3 percent, generalized anxiety 4.5 percent, schizophrenia and delusional disorders 2.7 percent, bipolar disorder 2.4 percent, phobias 1.4 percent, obsessive-compulsive disorder 1.3 percent and panic disorder 1.2 percent. Drug and alcohol-related disorders appeared in 0.85 percent.
Dr. Afridi says anxiety and depression are the most common conditions in Pakistan, followed by somatoform disorder. “In this condition, the patient believes a stomach or heart problem is physical, when its roots are actually psychological,” he explained. “Substance abuse, OCD, schizophrenia, bipolar disorder and eating disorders are also quite common.” He noted that the findings of the recent BMJ paper by Dr. Raza ur Rehman make clear that one in three adults is struggling with some psychological problem.
The most striking result of the survey is the high rate of PTSD. “We have had many tragic events, yet our people have a great deal of resilience, so this rate is actually lower than expected,” Dr. Afridi said. He explained that when distressing memories or flashbacks keep recurring a month after a severe trauma, it is considered PTSD. The paper notes that Pakistan has endured decades of armed conflict, displacement, floods, earthquakes, drought and economic instability, and that the effects of COVID-19 may also play a role. The authors stress, however, that the survey does not attribute the rate to any single event, and that these explanations are speculative and should be treated with caution.
Risk is not spread evenly across social groups. Among adults aged 18 to 29, the current rate was 15.8 percent, rising to 22.7 percent for those aged 30 to 39, 57 percent for those aged 40 to 49, and 60.7 percent for those aged 50 to 59. Unmarried people showed a rate of 18.6 percent, compared with 63.8 percent among the divorced or separated and 60.9 percent among widowed people. Those with no formal education recorded 39.1 percent, against 18.9 percent at the intermediate level. By occupation, the rate was 27.4 percent among the employed, 31.1 percent among the unemployed, 39 percent among housewives and 62.7 percent among retirees. People earning up to Rs25,000 a month had a rate of 34.1 percent, while those earning above Rs45,000 recorded 26.6 percent. The rate was 31.1 percent among men and 33.5 percent among women, and 33.8 percent in urban areas against 31.5 percent in rural areas. After adjusting for other factors, women turned out to be less likely than men to be affected. The authors suggest one possible reason: men may under-report their condition because of social expectations and fear of stigma.
The survey also measured everyday disability. The average score across all disorders was 19.2, which falls in the moderate disability range. Alcohol-related disorders scored 23.7, bipolar disorder 23.5, schizophrenia 23.3, generalized anxiety 21.5 and PTSD 20.9. According to the authors, these conditions affect work, home and social life alike.
The shortage of specialists is severe. Citing World Health Organization data, the paper puts Pakistan’s psychiatrist density at just 0.19 per 100,000 people, roughly 470 in total, most of them in major cities. Less than half a percent of the total health budget goes to mental health, while the WHO estimates that about 24 million people need psychological support. Dr. Afridi’s own estimate is around 700, and both figures agree that the number is very small for a population this size. The paper also cites a study of 87 patients at government hospitals in Lahore, most of whom had consulted more than one traditional or spiritual healer before seeing a psychiatrist.
Dr. Afridi said there are about 4,000 Pakistani-origin psychiatrists in the UK, London and the US. “They should be offered incentives, especially to serve in underserved areas,” he said. During his presidency of the Pakistan Psychiatric Society, he wrote to the chief ministers and governors of all provinces urging higher salaries and benefits for psychiatrists and psychologists working in such areas. He singled out Balochistan for praise, where the government has formally set double salaries. “There is a lack of facilities to bring back specialists trained abroad,” he said. “They face socio-economic problems and law-and-order concerns here.” He argued that domestic training deserves special attention and should not be limited to the College of Physicians and Surgeons. Universities, he said, should launch programs such as DPM and MD, along with certificate courses.
The national mental health policy now being drafted, he said, will require approved psychiatrists, trained, registered and approved by the relevant mental health authority. He pointed to Sindh as an example: “Sindh took the lead.” After the Mental Health Ordinance of 2001, Sindh became the first province to pass a formal act through its assembly, in 2013. The authority has met regularly and has trained, registered and approved psychiatrists across the province. This matters because, without an approved psychiatrist, a patient who refuses admission cannot be admitted. He urged the other provinces to follow Sindh’s lead.
Dr. Syed Zafar Mehdi, Secretary of the Sindh Mental Health Authority, said the authority was set up to implement the Sindh Mental Health Act of 2013 and is chaired by Senator Dr. Karim Khawaja. About 140 psychiatrists are currently approved and registered with the authority, “but the total number of mental health professionals in the country is far lower than what is needed.” Given this shortage, the authority trained general practitioners in 30 districts of the province according to WHO guidelines, “so that no patient is deprived of a solution to their psychological problem.”
Dr. Mehdi said a “suicide autopsy” in Tharparkar revealed that the district had the highest suicide rate, and he and Dr. Afridi visited the area to understand the causes. According to Dr. Afridi, 140 general practitioners were trained to diagnose and treat depression before it leads to suicide, and the authority also held 10 to 15 free medical camps and awareness sessions. Dr. Mehdi said that, according to the Director General Health’s information system, “Tharparkar has moved from first place to fourth in suicide rates.” Free camps, awareness sessions and free medicines were also provided in coastal areas, which have the highest rates.
On suicide, Dr. Afridi clarified that it is not itself an illness but a consequence of depression and other psychiatric disorders. He said it is severely under-reported in Pakistan, partly because of confusion over whether a funeral prayer can be offered for someone who dies by suicide. “Religious scholars should come forward on this issue,” he appealed. Families hide such deaths, so the data remain incomplete. Available figures suggest that eight to nine in every 100,000 people in Pakistan die by suicide, compared with rates as high as 30 in some countries, and Dr. Afridi said the rate is relatively lower in Muslim countries because of religious barriers. He described the progression: suicide usually begins as a thought. Of every hundred people who think about it, about twenty attempt it and one takes their life.
In the national survey, 6.2 percent of respondents reported suicidal thoughts or behaviors in the previous month. Passive ideation was reported by 4.1 percent and active ideation by 3.2 percent, while 1.1 percent had attempted suicide at some point in their lives. According to the paper, attempting suicide was a punishable offense until December 2022, and stigma leads families to conceal such cases, so the real rate may be higher.
Dr. Afridi believes investing in mental health is highly productive. “According to global data, 36 percent of the economy is linked to it, meaning investment in mental health can grow the economy,” he said. The paper states that the indirect economic burden of mental illness in Pakistan is very large, though it has not yet been accurately estimated.
The authors caution that direct comparisons with other countries should be made carefully because methods and cultural contexts differ. Even so, Pakistan’s lifetime prevalence of 37.9 percent falls within the range of 12 to 47.4 percent reported by the WHO’s World Mental Health Survey. India’s 2015–16 national survey reported a current prevalence of 10.6 percent, Iran reported a 12-month rate of 23.6 percent, and Malaysia reported an overall rate of 29 percent.
The authors also acknowledge the study’s limitations. Stigma likely led to under-reporting of suicidal thoughts and drug use, about 13.7 percent of participants did not disclose their income, and because some details of the complex survey design were unavailable, some statistically significant results may appear stronger than they are. The paper recommends integrating mental health into primary healthcare, training frontline health workers to identify mental health problems, investing in community-based and culturally appropriate services, launching suicide prevention programs, and strengthening collaboration with the education, social welfare and justice sectors.
The views expressed in this article are solely those of the author and do not necessarily reflect the views of The Opinion Desk.