The National Round Table on Mental Health Legislative Reforms, convened in Islamabad on March 25, 2026, marked a significant moment in Pakistan’s evolving approach to mental health governance.
Organised by the Mental Health Strategic Planning and Coordination Unit (MHSP&C Unit) under the Ministry of Planning, Development and Special Initiatives, and supported by international partners, the roundtable brought together a diverse group of stakeholders from federal and provincial governments, international organisations, professional bodies and policy experts. More than a consultative exercise, the meeting served as a critical platform to align perspectives, identify systemic gaps and build consensus on the future direction of mental health legislation in Pakistan.
The discussions were anchored in a shared recognition that Pakistan’s mental health legal framework, while present across jurisdictions, remains largely ineffective in practice. Participants noted that the Mental Health Ordinance of 2001, originally designed to replace colonial-era legislation, no longer reflects contemporary human rights standards, particularly those outlined in the UN Convention on the Rights of Persons with Disabilities. Provincial laws, developed between 2013 and 2019, have attempted to localise the framework, yet they continue to face similar structural and operational limitations. The roundtable created space for a candid acknowledgement that legislation alone has not translated into meaningful service delivery or institutional accountability.
Opening remarks emphasised the urgency of moving from fragmented legal provisions to a coordinated, rights-based implementation strategy. The chair highlighted that effective mental health governance requires not only legislative reform but also institutional strengthening, cross-sector collaboration and sustained political commitment. This framing set the tone for the deliberations, which consistently returned to the gap between policy design and on-the-ground realities.
A key segment of the roundtable focused on the legislative review process led by the MHSP&C Unit. Participants were briefed on adopting international guidance frameworks, particularly those developed by WHO and OHCHR, to assess existing laws against rights-based standards. The methodology presented, combining legal analysis, stakeholder consultations and comparative reviews across provinces, was widely appreciated as a structured, evidence-based approach. It also highlighted the complexity of reform, given the need to balance international benchmarks with local institutional capacities.
Provincial representatives provided detailed accounts of the status of mental health legislation in their respective jurisdictions, offering valuable insights into both progress and constraints. Sindh’s experience reflected incremental advancement through regulatory reforms and policy development, yet implementation remained incomplete. Punjab’s efforts to revise its legislation demonstrated technical progress but also exposed procedural bottlenecks.
Khyber Pakhtunkhwa’s notified but non-functional authority illustrated the gap between formal establishment and operational readiness. Balochistan’s limited activity due to resource constraints and AJK’s continued reliance on an adapted version of the 2001 ordinance further reinforced the uneven landscape across regions.
Collectively, these interventions highlighted a common pattern: while legislative intent exists, institutional capacity and resource allocation remain inadequate.
The contributions of international partners and technical experts added a broader perspective to the discussions. Emphasis was placed on integrating mental health within wider legal and policy frameworks, including health, social protection and humanitarian response systems. The need to address vulnerable populations, particularly women, children and communities affected by crises, was strongly articulated. These inputs reinforced the idea that mental health cannot be treated as a standalone issue but must be embedded within a holistic governance framework.
One of the most critical themes emerging from the roundtable was the absence of clear oversight and accountability mechanisms. Participants repeatedly pointed to the ambiguity surrounding the roles and powers of mental health authorities, as well as their overlap with existing healthcare regulatory bodies. This lack of clarity has contributed to institutional inertia, where responsibilities are diffused and implementation is delayed. The consensus around establishing a coherent national coordination mechanism reflected a shared understanding that federal leadership is essential to guide and harmonise provincial efforts.
The roundtable also engaged in a substantive discussion on the conceptual shift required in mental health policy. Moving beyond a purely biomedical model, participants advocated for a bio-psychosocial approach that integrates mental health into primary care and community-based services. This shift was seen as essential to expanding access, reducing stigma and aligning services with individuals’ lived realities. The inclusion of Mental Health and Psychosocial Support (MHPSS) in the context of climate change and humanitarian crises further expanded the policy horizon, recognising the intersection of mental health with broader social and environmental challenges.
Importantly, the roundtable did not limit itself to diagnosis; it also outlined a pathway forward. A key outcome was the agreement to develop a digital survey tool to systematically assess rights-based and implementation gaps across provinces. This initiative represents a shift towards data-driven policymaking, enabling the collection of structured stakeholder feedback and the creation of a comparative evidence base. Participants recognised that such a tool could serve as the foundation for more informed and targeted reforms.
Building on this, the discussion naturally extended to the idea of provincial scorecards as a mechanism for translating data into action. While not formally institutionalised during the meeting, the concept gained traction as a logical next step. By evaluating provinces and the federal capital using standardised indicators, such as legislative alignment, institutional capacity and service delivery outcomes, scorecards can provide a transparent, comparative framework for performance assessment. This approach not only facilitates benchmarking but also introduces a constructive element of competition, encouraging provinces to improve their standing through tangible reforms.
The proposed mechanism envisions a hybrid model that combines survey data with hard evidence from legislative documents, institutional records and service delivery metrics. Such an approach ensures that assessments are both grounded in reality and reflective of stakeholder experiences. Over time, this can evolve into an annual reporting system that enables continuous monitoring and policy refinement. The MHSP&C Unit’s role in managing this process was implicitly acknowledged, given its central position in coordinating the legislative review.
As the roundtable concluded, there was a clear sense of both urgency and opportunity. The discussions had moved beyond generic calls for reform to a more nuanced understanding of the challenges and solutions. The emphasis on coordination, data, and accountability signalled a shift towards a more mature policy discourse, one that recognises the complexity of mental health governance and the need for sustained, multi-level engagement.
In essence, the roundtable meeting reframed mental health legislation from a static legal issue into a dynamic governance challenge. It highlighted that the future of mental health in Pakistan will depend not only on revising laws but on building systems that can implement them effectively. The convergence of federal and provincial stakeholders, international partners and technical experts created a foundation for collective action. The real test now lies in translating this consensus into concrete outcomes, ensuring that mental health is not only legislated but realised as a fundamental right for all citizens.
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]
