eath by suicide is no longer an isolated tragedy whispered about behind closed doors. Mental health professionals warn that the incidence of cases is steadily rising across Khyber Pakhtunkhwa, exposing a silent crisis rooted in poverty, trauma, social pressure and a fragile healthcare system. Behind every reported suicidal death lies a story of emotional pain, unmet needs, and silence—often mistaken for strength.

Despite the presence of psychiatric wards in a few public hospitals and limited counselling services at select universities, mental healthcare in Khyber Pakhtunkhwa remains underfunded, unevenly distributed and poorly integrated into primary health services. Weak implementation of the Khyber Pakhtunkhwa Mental Health Act, 2017, combined with social stigma and low awareness, has left thousands vulnerable, many seeking help only when the crisis has worsened.

Karishma Ahmad, a clinical psychologist with over six years of professional experience, says she is increasingly confronted with preventable loss of life. A visiting lecturer at the University of Peshawar and currently serving as a lecturer in Social and Behavioural Sciences at the North West School of Medicine, she describes suicide as “alarmingly common” in her clinical and academic encounters.

“The rising suicide rate reflects deep structural fractures,” she says. “Persistent poverty, unemployment, academic pressure, domestic violence, substance use and unresolved trauma often shaped by years of conflict and instability have collectively eroded psychological resilience.”

She says that mental distress is often misunderstood or ignored. Individuals struggling with depression or suicidal thoughts are often advised to “be patient,” “pray more,” or remain silent, while their condition continues to deteriorate unnoticed. “Silence is often mistaken for coping; in reality it is a cry for help,” she adds.

From a clinical perspective, one of the most critical gaps is the lack of accessible mental health services. Counselling facilities are scarce, largely confined to major urban centres and severely overstretched. “At the policy level, mental health remains underfunded and poorly integrated into primary healthcare,” says Ahmad. “As a result, people usually seek help only at point of crisis, when intervention becomes far more difficult.”

Public sector psychiatric care exists on a limited scale. Dedicated wards for the treatment of depression and other mental health disorders are functioning in three major public hospitals of Peshawar: Lady Reading Hospital, Khyber Teaching Hospital and Hayatabad Medical Complex. In addition, Mardan Medical Complex has psychiatric wards catering to patients with mental illnesses.

Experts caution that the presence of hospital wards alone is insufficient to address the scale of the problem. Preventive care, early intervention and community-based mental health services remain largely absent, particularly in rural and remote districts.

The availability of clinical psychologists across educational institutions is also uneven. While most university campuses in Khyber Pakhtunkhwa lack full time clinical psychologists, some institutions have introduced counselling services.

An official from the Khyber Pakhtunkhwa Higher Education Department says the University of Peshawar, Abdul Wali Khan University, Mardan and Islamia College University, Peshawar have established specialised mechanisms and centres for students, staff and individuals suffering from mental health disorders. These universities also run clinical psychology programmes, where patients are examined under the supervision of qualified psychologists, allowing students to gain hands-on clinical training.

“At these centres, patients can consult clinical psychologists by paying a nominal fee of Rs 50 to Rs 100,” an official in the provincial ministry of higher education says. “However, awareness about these facilities remains extremely low, and only a small number of people use them.”

Mental health professionals point out that traditional joint family systems often provide strong emotional and social support to individuals struggling with depression, which may help keep suicide rates lower than in some other regions. However, they also warn that family support alone cannot replace structured mental healthcare.

Dr Fazal Rabbani, a psychiatrist, says the field remains one of the most neglected in Pakistan and receives minimal government patronage. “Most research and initiatives in mental health are driven by the Pakistan Psychiatric Society rather than state institutions,” he notes, calling for greater public investment, policy attention and institutional ownership.

Legally, the province has a framework in place. The Khyber Pakhtunkhwa Mental Health Act, 2017, mandates the establishment of a provincial Mental Health Authority and the development of psychiatric facilities by the government. While psychiatric services have been introduced in a handful of hospitals and universities, the Mental Health Authority envisioned under the law has yet to be fully established. Oversight, coordination and long-term planning are limited.

Past government responses highlight both urgency and inconsistency. In 2018, following a spike in reported suicide cases in Chitral district, the provincial government had constituted a three-member committee comprising senior doctors from the Health Department to investigate the causes and submit a comprehensive report.

According to a notification, a copy of which is available with The News on Sunday, the committee was explicitly directed to identify the reasons behind the suicides and recommend psychotherapy-based interventions.

The committee eventually submitted its findings to the government. However, there were no province-wide research or follow-up studies.

Mental health professionals stress that counselling, when provided early and in a culturally sensitive manner, can be life-saving. “Most individuals who express suicidal thoughts are not seeking death,” says Ahmad. “They are seeking relief from unbearable emotional pain. Being heard, validated and supported can restore a sense of hope and control.”

Preventing suicide requires a collective response. Families must be educated to recognise early warning signs; schools and universities need structured counselling systems. The government must invest in community based mental health services, helplines and trained professionals.

Ahmad warns, “silence is costing lives.” “Listening empathetically, seriously and urgently may be the most powerful intervention of all.”

The writer is a multimedia producer.He tweets @daudpasaney.