Mental health is no longer a marginal public health issue; it is now recognised as one of the defining development challenges of the 21st century.
Across the world, governments are beginning to treat mental well-being as a core component of national policy, linked not only to healthcare but also to economic productivity, human rights and social stability. In Pakistan, the consultative review of mental health legislation initiated by the Mental Health Strategic Planning & Coordination Unit at the Ministry of Planning, Development & Special Initiatives represents a critical step towards modernising the country’s mental health governance framework.
The initiative brings together a multidisciplinary working group comprising representatives from the Ministry of National Health Services, provincial health departments, the Ministry of Law and Justice, the Ministry of Human Rights and experts in public policy, human rights, law and strategic communications. This collaborative approach reflects an important policy shift. Mental health cannot be treated solely as a medical issue confined to hospitals and clinics. It requires a whole-of-government approach involving legal safeguards, institutional coordination, social services and public awareness.
The urgency of this reform becomes clear when one looks at the scale of the global mental health challenge. According to global health assessments, more than one billion people worldwide are currently living with some form of mental health disorder, making mental illness one of the most widespread public health challenges globally. Anxiety disorders alone affect around 359 million people worldwide, making them the most common mental health condition globally. Depression, meanwhile, has become one of the leading causes of disability worldwide, affecting hundreds of millions of people and contributing significantly to the global disease burden.
Mental health disorders also show clear gender disparities. Studies consistently show that women are disproportionately affected by conditions such as depression and anxiety. For example, global data suggests that major depressive disorder affects around 5.8 per cent of women compared with 3.5 per cent of men. In fact, depression is estimated to be nearly twice as common among women as among men, reflecting a combination of biological, social and economic factors. At the same time, men are more likely to experience externalising disorders such as substance abuse, and they are often less likely to seek treatment due to social stigma and cultural expectations around masculinity.
These global patterns are mirrored, and often intensified, in Pakistan. According to estimates from international health organisations, approximately 24 million people in Pakistan require psychiatric assistance, reflecting a substantial mental health burden within the population. Mental disorders account for more than 4.0 per cent of the country’s total disease burden, and this burden tends to be higher among women than men. Research studies have further suggested that between 30 and 50 per cent of adults in Pakistan may experience symptoms of anxiety or depression, highlighting the widespread nature of the problem.
Despite these numbers, Pakistan’s mental health infrastructure remains severely under-resourced. The country has a very limited number of trained mental health professionals relative to its population. In some estimates, Pakistan has fewer than one psychiatrist for every 100,000 people, far below international benchmarks. Access to mental health services is uneven across provinces, and many individuals rely on informal, traditional, or unregulated sources of support.
These realities highlight the importance of legislative reform. Laws do more than regulate medical practice; they define institutional responsibilities, establish rights protections and create regulatory mechanisms that enable effective service delivery. Without a strong legislative framework, mental health systems struggle to develop coherent institutional structures or ensure accountability in the provision of care.
Pakistan’s current mental health legal framework originates from the Mental Health Ordinance (MHO) of 2001. Following the 18th Amendment, which devolved health governance to the provinces, various provincial governments enacted provincial legislation based on this ordinance between 2013 and 2019. While this was an important step toward decentralisation, the implementation of these laws has remained limited due to institutional capacity constraints, resource limitations and weak enforcement mechanisms.
Another major limitation of the existing legal framework is that it predates the global shift toward a rights-based approach to mental health governance. The United Nations Convention on the Rights of Persons with Disabilities (CRPD), adopted in 2006, fundamentally changed how mental health policy is understood. Rather than viewing individuals with mental health conditions as patients who must be controlled or institutionalised, the CRPD recognises them as rights-holders entitled to dignity, autonomy, and full participation in society.
Modern mental health legislation, therefore, emphasises principles such as informed consent, protection against discrimination, community-based care and safeguards against involuntary detention. Aligning Pakistan’s legal framework with these principles is essential for ensuring that mental health policy reflects contemporary international human rights standards.
The legislative review currently underway aims to identify these gaps. Guided by the WHO–OHCHR Guidance on Mental Health, Human Rights and Legislation (2023), the process will examine how existing provincial laws can be strengthened to better protect rights while improving implementation mechanisms. Importantly, the review also focuses on the operational challenges that have prevented existing laws from being effectively implemented.
The consultative nature of this process is one of its strongest features. Policymakers, legal experts and provincial health authorities are being brought together to discuss both the legal framework and the practical realities of implementation. The planned roundtable discussion involving provincial representatives is therefore particularly significant. Since provinces are responsible for health governance under the 18th Amendment, their participation is essential to ensuring that legislative reforms are realistic and implementable.
Mental health legislation must also be understood within a broader development context. Mental well-being has strong links with education outcomes, workforce productivity, gender equality and disaster resilience. Untreated mental health conditions can reduce workforce participation, increase healthcare costs, and weaken social cohesion. In a country where economic pressures, climate disasters and urban stress are increasingly shaping everyday life, mental health resilience is becoming an important component of national stability.
Public awareness is another key dimension. Mental health continues to be heavily stigmatised in many societies, including Pakistan. Individuals experiencing psychological distress often avoid seeking professional help due to fear of social judgment or discrimination. Legal frameworks alone cannot eliminate stigma, but they can provide a foundation for awareness campaigns, professional standards and institutional accountability that gradually reshape societal attitudes.
This is why the inclusion of experts in public policy, human rights and strategic communications in the working groups is particularly significant. Mental health reform requires not only legal and medical expertise but also the ability to communicate policy changes effectively to the public and encourage greater acceptance of mental health services.
Ultimately, the importance of the consultative review lies in its potential to modernise Pakistan’s mental health governance architecture. By aligning legislation with international human rights standards, addressing long-standing implementation gaps and integrating mental health into broader development planning, Pakistan has an opportunity to create a more coherent and responsive mental health policy framework.
Mental health affects millions of citizens, yet it has historically remained at the margins of public policy. Reforming the legislative framework is therefore not simply a legal exercise but a necessary step towards recognising mental well-being as a central pillar of human development.
If the consultative process leads to meaningful reforms, strengthened institutions and greater public awareness, Pakistan can move towards a mental health system that protects rights, expands access to care and supports the resilience of society as a whole – ensuring that mental health is treated not as a neglected issue but as a core priority of national policy.
The writer is a public policy expert and leads the Country Partner Institute of the World Economic Forum in Pakistan. He tweets/posts @amirjahangir and can be reached at: [email protected]
