Understanding Public Mental Health

By Mashal Nadeem


Mental health, or zehni sehat, is not a phrase commonly used by the general population of Pakistan. As internet usage has grown and social media has become widespread, Pakistan’s online sphere has seen a surge in mental health awareness and advocacy, highlighting the prevalence of mental illnesses like depression and anxiety within our society. But for most of the country, this is the singular understanding around mental health: that there is either a healthy human being or a human being with mental illness. However, addressing mental health in such a binary is detrimental to treating it appropriately.

When we speak of physical health, we do not simply mean whether one has a physical illness or not. According to the WHO, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. [Therefore,] mental health is more than just the absence of mental disorders or disabilities.” Yet in Pakistan, this concept is hardly reflected in any of our healthcare practices. The common public perception of mental health treatment is as a last resort: one goes through religious intervention or mental hospitals (or, as they are still frequently called, pagalkhanas). There is no concept of taking care of one’s mental health before it reaches the stage of mental illness.

Pakistan and WHO’s joint National Health Vision (2016-2025) states that half of the burden of disease in the country are non-communicable diseases, within which lies mental health issues. Yet the reasons listed behind these mental health issues are not genetic or caused by physical objects, but societal ones such as “poverty, low literacy, unemployment, gender discrimination, and huge treatment gap[s]”.

None of these are issues that should need to be treated in a mental hospital – or at least, none of them should be. Yet it is from these issues that unsuspecting mental health issues creep in: anxiety, depression, post-traumatic stress disorder, panic attacks. Research has shown countless times over how different underprivileged sections of society are more susceptible to mental illness.

When we know that several groups of people in Pakistan are predisposed to mental health issues, the approach we take cannot be that of leaving care to pirs or waiting until one’s health issues are severe enough to medicate them. So what is a different approach to this?

A potential answer is in a new wave of understanding towards mental health that has been highlighted in Pakistan during the recent COVID-19 pandemic: public mental health.

Public mental health as a field is a way of approaching mental healthcare from a public health perspective: that is, treating mental health not on an individual-to-individual basis as we treat patients who go to hospitals, but on a population scale, as we treat citizens during vaccination and immunization campaigns. Public health acts proactively. Rather than waiting for an issue to occur before attempting to fix it, public health puts a focus on setting up low-cost, widescale structures that both help prevent health issues from occurring and help support patients who are suffering from such issues.

Public mental health often comes with three tiers of interventions. The primary tier addresses the risk factors for mental disorders, including those issues addressed in the National Health Vision 2016-2025, including socio-economic issues, gender discrimination, etc. The secondary tier involves early intervention to prevent mental health issues from progressing into more severe illnesses. Finally, the tertiary tier focuses on treatment of mental illnesses and disorders as well as preventing relapse. By taking a holistic approach to mental health on a population level, as compared to the more individualistic understanding of mental health treatment we have now, we may stand a better chance of reducing the burden of disease that rests on this country.

Executing public mental health initiatives requires an allocation of resources and time that cannot be achieved easily without the help of the government. However, on a policymaking level, this proves difficult due to the 18th Amendment, in which healthcare decisions were devolved to the provincial level.

Still, by using the National Health Vision as a guideline, perhaps public mental health policies and procedures can still be introduced in such a way that the words zehni sehat are no longer foreign in our population.


Mashal Nadeem is a research and psychology enthusiast, looking to learn more about other fields to increase her skills and contribute to the development sector. Her interests include public and psychological health, social protection, gender discrimination and intersectionality. She currently works at an NGO, Tameer e Khalaq Foundation, in Islamabad.

Leave a Reply