Mental health, now

A man in Quetta kills himself and his family. An elderly husband kills his wife after years of sexual frustration. A lady doctor survives an acid attack. In Lahore, a mother allegedly slit the throats of her three children. In Sargodha, a man killed his wife and children with an axe. Each time such a tragedy occurs, we search for explanations in crime, sin, morality or personal failure. Television screens fill with outrage, social media demands punishment and religious and legal arguments dominate the discussion. Then the story fades, only to be replaced by another. What remains striking is not just the violence itself, but our collective refusal to ask whether these events are also telling us something about the state of mental health in Pakistan. We continue to speak about mental health as though it is a challenge that lies somewhere in the future. It is not. It is already here. It is in our homes, our schools, our workplaces, our hospitals and increasingly in our headlines. Yet we remain reluctant to recognize it because doing so would force us to confront uncomfortable truths about the society we have built. Mental illness does not always announce itself in obvious ways. It often appears first as persistent sadness, crippling anxiety, paranoia, rage, substance misuse, social withdrawal, hopelessness or an inability to cope with life’s pressures. Left untreated, these conditions can devastate individuals, families and communities. Most people who suffer from mental illness never become violent, but when severe mental distress combines with isolation, trauma, addiction, poverty or untreated psychiatric disorders, the consequences can be catastrophic. The frightening reality is that Pakistan is profoundly unprepared to respond. We have roughly 500 registered psychiatrists serving one of the largest populations on earth and most of them are concentrated in major urban centres. Entire districts have little or no access to specialist care. Yet the shortage of psychiat