Integration of mental health into the primary healthcare system

Why this is important 

It is estimated that over 50 million people in Pakistan are affected by mental health issues. Mental health remains heavily under-resourced, with only 500 psychiatrists in the whole country, translating to a 1:100,000 beneficiary ratio.1 The Government spends less than 1% of its health budget on mental health services, and support for mental health care at community level reaches just 0.34% of the population. Mental health literacy is also very low, estimated to be less than 5% in urban areas, leading to high prevalence of stigma. 

Despite the severity of the problem, healthcare services are scarce and prevailing attitudes towards mental health negative. Many individuals do not seek support due to stigma, lack of awareness and limited resources, and also due to fear of the unknown. By integrating mental health services into existing the healthcare system, people will be able to receive mental health care in familiar settings, hence reducing barriers to access. 

The British Asian Trust is seeking to rectify this situation by driving systemic change across Pakistan through motivating behavioural change; influencing policy decisions; and increasing the provision of quality services for those who require them the most. To this end, we have been partnering with experts, people with lived experience, health providers, and future-thinking funders to transform the current landscape.  

Project Partners: Global Institute of Human Development (GIHD), Sehat Kahani, Taskeen  

Duration:2022 - 2025

Project goals  

The direct impact of this project will be to improve the mental health and wellbeing of 16,000 people with mental health issues in Pakistan. This impact will be a result of the project achieving the following key outcomes:  

  1. Improved access to mental health information and support for 50,000 people in low-income communities  
  1. Provision of quality mental health services in 282 communities (including 250 new to the programme)  
  1. Strengthened health systems through the development of quality standards and key stakeholder engagement 

The British Asian Trust is developing a ‘systems change’ approach to improving mental health awareness, access and provision in Pakistan. This involves developing evidenced models for quality provision, influencing government policy and quality standards, as well as engaging and collaborating with key stakeholders from across sectors (including funders) to sustainably scale programme interventions. 

What we are doing

With the support of Vitol and the CareTech Foundation grant, the project aims to: 

  • Train nurses and administrative staff across 52 telehealth clinics on the identification of mental health issues, basic counselling skills and referral pathways. The new clinics, which are a part of this project, are located in primarily rural and semi-rural areas and enable underserved communities who otherwise have little access to medical services to access quality mental health information and support. 
  • Develop a university-led and certified mental health curriculum for training Family Physicians (FPs) and General Physicians (GPs) based on the Universal Health Coverage (UHC) Benefit Package. Once established, at least 225 practitioners will be able to effectively screen, manage and refer mental health clients over the three-year programme. 
  • Offer one-on-one counselling to symptomatic individuals in need of mental health support. Counselling will be provided in-person or by phone /app, depending on the individual’s needs and circumstances. For moderate to severe cases, a clear referral pathway will be provided which will be referred to mental health experts, psychologists and psychiatrists.  
  • Collaborate with the Pakistan Mental Health Coalition on the development of a comprehensive set of quality standards, including minimum standards relating to medications, training, staff and confidentiality. Bring key stakeholders together (including the private sector and funders) through meetings, events/webinars and targeted communications, to engage them in supporting the sustainable development of quality mental health provision.  

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