n December 2022, Pakistan crossed a long-feared threshold, quietly, almost solemnly, by repealing Section 325 of the Pakistan Penal Code. With this, the country decriminalised attempted suicide, tearing down a century-old legal framework that had, for decades, punished people at their lowest moments. But if this legal repeal felt like a victory, it was only the prologue to a far more complex tale—one in which the real battle for care, dignity and systemic change has only just begun.

This historic shift marked a profound reimagining: away from a moralistic, punitive response to suicide toward something more humane, a recognition of pain, vulnerability and societal failure. For the first time, Pakistan officially acknowledged what its survivors and advocates had long known: suicide is not a crime; it is a crisis.

Nearly four years on, the law has outpaced the institutions meant to enforce it. In 2026, the country finds itself poised on a razor’s edge, between symbolic reform and tangible transformation.

What decriminalisation did not automatically deliver was capacity: the systems required to identify distress early, intervene effectively and prevent loss of life before it occured. Across hospitals, schools and communities, the absence of standardised suicide screening remains a critical gap. Children and adolescents, often the least visible and least believed, continue to navigate emotional crises without systematic detection. Internationally validated tools such as brief suicide screening questionnaires exist, designed for rapid use by non-specialists, yet their integration into Pakistan’s healthcare and education systems remains inconsistent and fragmented. Without routine screening, risk is discovered too late, often only after tragedy.

Once, survivors of suicide attempts were greeted not with care, but with handcuffs; hauled into police stations, interrogated, prosecuted. The repeal of Section 325 was meant to end this cycle of re-traumatisation.

Old habits die hard. In many districts, police still act on the ghost of a law that no longer exists. Frontline responders, including the police, doctors and hospital staff, have not been trained to treat suicide as a health emergency. In rural and lower-income regions, survivors still face detention, shame and suspicion.

The law may have changed, but the system hasn’t caught up.

This disconnect is especially dangerous for young people. Emergency departments remain one of the most frequent points of contact for adolescents in crisis. However, suicide risk assessments are still not consistently embedded into routine paediatric or adolescent care. Clear referral pathways, linking at-risk youth to mental health professionals, crisis response teams and follow-up care are uneven, at best. Too often, identification does not lead to intervention and intervention to continuity of care.

Then came the challenge; quiet but potent.

In late 2023, a petition was filed in the Federal Shariat Court, arguing that decriminalising suicide contradicted Islamic teachings. Religious scholars and mental health experts have spoken out, citing Islam’s emphasis on compassion and healing. But the legal uncertainty casts a shadow over the 2022 reform, threatening to undo years of evidence-based advocacy. It’s more than a legal debate, it’s a frontline in the broad cultural struggle over how Pakistan understands mental illness, suffering and the state’s role in healing it.

That struggle plays out not only in courts, but in classrooms, clinics and households, where stigma still dictates silence. Public education around mental health remains limited, sporadic and underfunded. Myths persist: suicidal thoughts reflect weak faith, moral failure or poor character. Without sustained national campaigns to normalise help-seeking and reframe suicide as a preventable public health issue, legal reform risks remaining abstract—felt on paper but not in people’s lives.

In the midst of this tension, new structures are emerging.

In May 2024, Pakistan launched its first National Mental Health Policy (2024-2029), a blueprint for reform that promises community-based programmes, integration into primary healthcare and a national emergency response network. Teachers, clerics, police officers and health workers are to be trained to recognise early signs of distress. The vision is there. But without serious funding and real commitment, vision alone cannot heal.

This vision implicitly acknowledges a hard truth: Pakistan does not have enough mental health professionals to meet demand. Task-sharing models, where teachers, community health workers and trained volunteers provide basic psychosocial support under supervision are no longer optional; they are essential. Properly structured, trained and monitored, these models offer a way to extend care into communities that specialists may never reach. Without them, large segments of the population, especially youth, remain invisible.

Some signs of progress flicker. A National Mental Health Helpline is operational, but suffers from low awareness and weak referral systems. Civil society groups like Taskeen and Umang offer critical support, but they are small, underfunded and concentrated in urban areas. Survivors still fall through the cracks. Follow-up care is inconsistent. For many, there is no hand to hold after the fall.

Schools, where emotional distress often first surfaces, remain an under-focused frontline. Academic pressure, social media exposure, bullying and family stress converge in classrooms, yet mental health literacy is rarely embedded into curricula. Confidential counselling services are scarce. Crisis protocols are unclear. Without structured wellbeing check-ins and peer support systems, warning signs are frequently missed or dismissed.

Demographics expose a raw edge of the crisis. Suicide risk runs highest among young single men and young married women. For men, it’s the weight of failure, unemployment, academic defeat, domestic strife. For women, it’s a cage: gender violence, isolation, the crushing grip of patriarchal control. These are not isolated events. They are patterns. Mental health, in Pakistan, cannot be separated from the deeper fight for gender equity, education and economic justice.

But how can a system respond to what it cannot see? As of 2026, suicide is still absent from national health data. There is no centralised system to track attempts or deaths. Families, fearing shame or police intrusion, misreport deaths. Hospitals lack standardised reporting protocols. Without data, there is no map; without a map, reform is little more than blind guesswork. The absence of a comprehensive suicide surveillance system does more than obscure statistics, it cripples prevention. Without real-time data, emerging risk patterns go unnoticed, resources are misallocated and interventions cannot be evaluated. Surveillance is not bureaucracy; it is the backbone of accountability.

Within the silence, a subtle shift is under way. Religious leaders, long seen as gatekeepers of stigma, are beginning to rewrite the script. In sermons, training rooms and on media, a new narrative is taking root: Islam does not punish the suffering. It offers compassion. This shift, while quiet, is monumental in rural areas, where the voice of the pulpit still outweighs a policy brief. The clerics now carry the message of empathy and the potential to reach those the system cannot.

Still, the old ghosts remain. Mental illness is still cloaked in shame. Survivors are shunned. Families stay silent. Schools rarely mention mental health and state-led awareness campaigns are scarce. The media often chooses spectacle over sensitivity, framing suicides in ways that deepen fear and misunderstanding. The weight of societal silence is heavier than any law. Yet, the building blocks exist. A misdirected law is gone. A progressive policy has been written. Civil society is active. Professionals are training. Cultural frameworks are emerging.

However, the system is fractured, underfunded and incomplete. Just 0.4 percent of Pakistan’s health budget goes to mental health. There is one psychiatrist for every 100,000 people, in almost all cities. Some regions have no psychiatric care at all. The absence is not symbolic. It is deadly.

Coordination remains missing: standardised screening across sectors; clear referral pathways; measurable national targets; and routine evaluation of what works and what fails. Without these, reform risks becoming static, well-intentioned but insufficient.

The story of suicide decriminalisation in Pakistan is not about a single moment of reform. It is about what comes after, the long, gruelling, often invisible, work of building care where there was once punishment, of replacing silence with systems. It is about the police who must learn to protect instead of arrest; teachers who must learn to see instead of dismiss; and hospitals that must become sanctuaries rather than gateways to shame.

The writer is an advocate and managing partner at the Lex Mercatoria law firm. He is a visiting faculty member at TMUC and CEO at ZAK Casa Enterprises.