hink of yourself as dead; you have lived your life. Now take what’s left and live it properly.”

— Marcus Aurelius

A few years ago, my wife and I were shaken when one of our children, then in his early teens, expressed thoughts of ending his life. Fortunately, he confided in his older brother and we were able to get him the help he needed. The episode forced me to revisit my own adolescence, marked by intense feelings, including despair and a fear that I would never amount to anything.

Four decades later, the worst possible outcomes of such inner turmoil are being played out, often publicly, across social media. Two widely reported cases of attempted suicide in Lahore have recently shaken the country. Both involved young people at a local university; one of them survived but remains critically ill after a fall from a building. These events raise urgent and painful questions. What drives a young person, energetic, capable and seemingly full of promise, to such despair? Just as importantly, is there anything we can do to reduce the risk? Can we learn to recognise when someone is entering a dangerous psychological zone and intervene in time?

Reliable data on suicide in Pakistan are difficult to obtain. Until 2022, suicide was a criminal offence under a colonial-era law dating back to the mid-19th Century. This legal framework discouraged open discussion, research and help-seeking. Families often concealed suicide attempts or deaths to avoid police involvement. Those who survived attempts and were presented to hospitals were frequently treated as medico-legal cases, exposing them and their families to investigation rather than care.

Although the law has now been repealed, awareness remains limited and the legacy of fear and silence persists.

Available estimates suggest a suicide mortality rate of approximately 8.9 per 100,000 people, slightly below the global average, but this figure almost certainly underestimates the true burden, with many cases unreported or misclassified. Suicide deaths are more common among men, although women may attempt suicide more frequently. Most concerning is the age distribution: suicide is among the leading causes of death in young adults, particularly those between 19 and 39 years of age.

This should give us pause.

Pakistan is one of the youngest countries in the world, with nearly 60 percent of its population under the age of 30. This demographic reality is often described as a national asset, but it also represents a population at heightened risk if mental health needs are neglected. Today’s young people are also among the most globally connected generations in history. Through their phones and screens, they are exposed, continuously and unfiltered, to wars, displacement, climate catastrophe and human suffering across the world. Idealism and energy, when combined with a sense of powerlessness, can easily turn into despair. Add to this an education system that often fails to cultivate resilience or critical life skills, and an economy that offers limited opportunities for meaningful employment, and it becomes easier to understand why so many young people feel trapped, demoralised and desperate.

What, then, can be done?

There are grounds for cautious optimism. Young people themselves are often leading the way. Online communities and peer-led initiatives increasingly address mental health and suicide openly, challenging stigma and silence. Educational institutions are also becoming more attentive. Many schools, colleges and universities now recognise the importance of student wellbeing and have begun to develop counselling services and campus-based mental health supports.

In our own university, students established a peer counselling programme several years ago, organising open mic sessions, poetry readings, art events and discussions focused on emotional wellbeing. As a medical university, we are fortunate to also have a fully staffed Department of Psychiatry that provides care for students and staff. We regularly host seminars, conferences, and training activities aimed at improving mental health literacy among healthcare professionals and the wider academic community. While the quality of services across the country remains uneven, access to mental health support has improved compared to a decade ago.

On a more personal level, I learned long ago, as a parent and as a clinician, that listening matters. People who are contemplating self-harm often try, in subtle or indirect ways, to communicate their distress. In a society where family and social networks remain relatively close-knit, these signals are often present, even if we miss or dismiss them. Recognising such moments is an opportunity to intervene.

Sometimes, the most important first step is to make time to listen without judgment. The next is to help connect the distressed person to appropriate support, preferably in person, when possible, as face-to-face care remains especially important during crises. Staying with someone until they are safely connected to help can make a critical difference.

Many people who survive suicide attempts later express relief that they did not die. Treatable mental illnesses, when identified, can often be managed effectively. The broader social drivers of distress, unemployment, violence, political instability, environmental anxiety, are more complex and harder to resolve, but they should not lead us to fatalism. Our task, individually and collectively, is to help those in despair understand that suicide is not the way out. Even a faint sense of hope, once recognised, can be enough to begin finding a path forward.

The writer is a psychiatrist and faculty member at King Edward Medical University. His forthcoming book, Secrets: Stories of Psychiatry from America and Pakistan, will be published later this month.