Mental health commitments

Pakistan's Global Mental Health Summit has ended with an ambitious promise to move mental healthcare out of the margins of public policy. The Islamabad Declaration commits the country to better coordination, sustainable financing, community-based care and, importantly, accountable implementation. These are sensible commitments. Their value, however, will depend on what happens after the conference halls have emptied.

The scale of the challenge leaves little room for another policy that exists largely on paper. Around 32.4 million Pakistanis are estimated to require mental-health care, while the treatment gap is about 95%. Pakistan has roughly 0.19 psychiatrists for every 100,000 people. For a population of this size, specialist treatment alone can never provide the answer. This makes the National Mental Health Policy 2026-35, launched at the summit, potentially important. Its emphasis on integrating mental-health services into primary healthcare, schools and communities recognises that people cannot be expected to travel to major urban hospitals every time they require psychological support. Care has to become available much closer to where people reside. The federal government has also asked the provinces and federating areas to endorse the policy within 45 days and has promised a costed, time-bound implementation and monitoring plan within 12 months. This is where the declaration must begin turning into a health-system reform programme. Since healthcare delivery rests substantially with the provinces, national ambition will accomplish little without provincial budgets and measurable targets. Pakistan will need more specialists, but it must also build capacity among general physicians, nurses and community health workers.

The next 12 months must establish who will deliver services, how they will be financed and how progress will be measured. For millions currently outside the mental-health system, implementation is not the final stage of the policy. It is the part that matters most.