n less than three weeks, two pharmacy students at a private university in Lahore fell from the upper floors of campus buildings. One died. The other survived with critical injuries after an apparent suicide attempt.

The details will be debated: domestic pressure, grades, finances, “personal reasons.” But focusing only on motive is how we keep missing the point. When young people reach the edge, Pakistan’s systems are simply not built to catch them—not on campuses, not in clinics, not in communities. This is not a tragedy we should respond to with “awareness” alone; it is a governance failure; one we must fund, staff and measure our way out of.

Pakistan’s mental-health crisis is not invisible. It is unbudgeted.

Start with the workforce. A widely cited WHO-AIMS country report documented just 342 psychiatrists nationwide, around 0.20 per 100,000 people, alongside severe shortages of psychologists, psychiatric nurses and trained mental-health staff. More recent health-policy analyses continue to place Pakistan’s psychiatrist density at around 0.19 per 100,000, which, put plainly, means millions of young people have no realistic access to specialist care when distress becomes dangerous.

Mental health receives roughly 0.4 percent of Pakistan’s total health budget. The result is a fragmented, urban-centred system, largely inaccessible outside elite private care. This in a country, where according to estimates from research and news reports, between 15 and 35 people die by suicide every day. This is equivalent to approximately one person every hour.

In public facilities, outpatient waits are long, inpatient beds are few and follow-up is inconsistent. For students navigating academic pressure away from family support, care often fails before it begins.

Within this already critical shortage lies a particularly dangerous gap in how Pakistan cares for children, adolescents and university-age youth.

Best available estimates indicate that the country has only a handful of formally trained child and adolescent psychiatrists and, to the best of our knowledge, no formally trained child and adolescent clinical psychologists. In practice, most youth mental healthcare is delivered by adult psychiatrists without specialist training in child or adolescent development, or by pediatricians with minimal exposure to mental healthcare.

The burden this leaves uncovered is not small.

Pakistan’s youth bulge is enormous: about 26 percent of the population is aged 15-29, roughly 62.6 million people. Even using conservative global benchmarks, 10-20 percent of children and adolescents are estimated to have mental or behavioural problems. Globally, around one in seven adolescents (ages 10-19) lives with a mental disorder. This translates into millions of young Pakistanis needing timely, developmentally informed support. Against that level of need, a specialist workforce that can be counted on one hand is not a gap; it is a vacuum.

This is not a technical distinction. Young people experience depression, anxiety, trauma and suicidality differently from adults. Risk assessment, medication use, family dynamics, neurodevelopment and academic stressors require specialised training. Misaligned assessment or treatment can be clinically unsafe.

Crucially, this is not a gap that can be closed by producing more specialists alone. Given Pakistan’s population size and the length of specialty training, we will never have enough child and adolescent psychiatrists or psychologists to meet demand through tertiary care alone. Any serious suicide-prevention strategy must therefore move upstream—toward early identification, non-specialist intervention and environments that reduce risk long before crisis develops.

This failure begins in medical education. Psychiatry is not a mandatory clinical rotation in most Pakistani medical schools. Where it exists, exposure is often brief and limited to adult inpatient wards. Training in youth mental health is virtually absent.

The consequences are predictable. General practitioners are the first and often only point of contact for distressed young people, delivering care that is poorly informed, inconsistently supervised and sometimes outright dangerous: inappropriate medication, missed suicide risk, moralising advice or dismissal of symptoms as “stress” or “teenage behaviour.”

This is not a failure of individual doctors. It is a policy failure.

If Pakistan accepts the reality that specialist numbers will always be limited, prevention must be built where young people actually live: in schools and universities.

This requires mandated training in social-emotional learning and basic mental-health literacy for teachers and university faculty. Educators are not expected to become therapists, but they must be able to recognise distress, respond safely and refer appropriately. At present, most receive no training at all.

Universities must also stop treating mental health as an optional wellness initiative. Mental wellbeing must be integrated into the student experience through structured mentoring, protected time for co-curriculars, access to sports and creative play, peer-support systems and deliberate efforts to build ego strength, belonging and purpose. These are not luxuries. They are established protective factors against suicide.

Campuses should also be sites of innovation, not just risk. Government-funded mental-health incubators within large universities could support low-cost digital tools, peer-support models and culturally grounded interventions. Pakistan does not lack talent. It lacks institutional support to turn ideas into scalable solutions.

I write this not only as a citizen, but as someone working within this system every day, a system that was never designed to carry the psychological weight it places on its young people.

It is taxing to keep raising awareness while watching preventable harm continue. Suicide is among the leading causes of death for people under 29. For every young person who dies by suicide, at least ten are actively suicidal and hundreds more are passively thinking about dying. This is not the suffering youth we should accept as normal.

We need to stop speculating and start acting. We need to stop behaving like ostriches, burying our heads in cultural explanations, academic-pressure narratives or moral discomfort and confront the reality that silence, shame and systemic neglect are costing lives.

Mental health must be named plainly, taught early and discussed without euphemism. Students, parents, teachers, doctors; in short, everyone, needs the language to recognise distress and the confidence to call it out. Shame does not protect families. Silence does not preserve values; it isolates young people when they are most vulnerable.

Medical professionals are not exempt. Too often, we are part of the problem. We minimise risk, moralise suffering or practice beyond our training. This is not about blame. It is about accountability.

Pakistan does not lack compassion. It lacks infrastructure, trained people and political will. Until mental health is built into our schools, universities, clinics and policies, rather than discussed only after tragedy, we will keep responding after young people fall, instead of before they reach the edge.

The writer is a consultant child, adolescent and adult psychiatrist. She is the founder and CEO of Synapse Pakistan Neuroscience Institute.