As the world grapples with the mounting mental health (MH) crisis, a surge of digital solutions has emerged to provide much-needed care at scale. According to a recent report by the WHO, nearly one in eight people worldwide suffers from MH disorders – almost double the number of diabetes patients and greater than those with cardiovascular disease. This prevalence is compounded by the fact that individuals with chronic illnesses and co-morbid anxiety or depression are not only likely to experience a lower quality of life but also die 5-10 years earlier.
Former SAPM Zafar Mirza highlighted the morbidity cost and disability-adjusted life years (DALYs) associated with MH disorders in Pakistan in a recent op-ed. Suicide is a frequent news item, and numerous opinion and analysis pieces have been published on the topic. Multiple social drivers, including poverty, unemployment, political instability, lack of education, and violence, exacerbate the magnitude of MH disorders in Pakistan. There are MH-specific reasons too, such as a lack of uniform policy, limited basic health literacy, and an insufficiently trained workforce. Many people suffering from MH issues don’t seek professional help due to an inability to recognise symptoms, a lack of evidence-based services and referral systems, cost implications, and prior experiences of unsatisfactory care.
The Covid-19 period necessitated an increased use of digital support services in healthcare delivery, including in the MH space. This provided a potential proof of concept that can improve access to MH services by lowering costs, eliminating travel requirements, increasing outreach, and improving schedule flexibility. In Pakistan, tech-based interventions have emerged, including helplines established during the pandemic, MH apps that connect end-users to health professionals, and GPs providing telehealth services using a hub-and-spoke model. Recently, the government proposed a similar intervention to provide free consultation services. The MH app Humraz has pledged to improve the quality of life for individuals with MH disorders.
While recent initiatives like this are welcome, they alone are insufficient to solve the problem. Increased awareness, knowledge, and edification are necessary to make progress in addressing the MH crisis. This also calls for a collaborative discussion on policy, strategic directions, resource mapping, priority setting, and defining the values and guiding principles for interacting with technology.
In this digital age, new tools and technologies are emerging at an unprecedented pace. The potential for digital solutions to improve access to healthcare services and outcomes is immense. However, it is essential to exercise caution and take a deep dive into the contextual macro and microcosm before we embrace it as a panacea for all healthcare challenges.
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The Mental Health Context: In Pakistan, mental healthcare is a major challenge, with fewer than 500 psychologists and 600 trained psychiatrists, mostly located in urban centers. This translates to one psychiatrist for every 10,000 adult patients, and less than eight child and adolescent psychiatrists for about four million children suffering from MHDs. While there are a few counseling training programs, some accredited by international bodies, with varying levels of supervisory oversight, there is no central credentialing body for therapists. Most medical schools provide little quality training in MHDs, leaving generalists and other specialists, who are the gateway to MH referrals, with limited knowledge of MHDs.
Quality-trained mental health professionals are stretched thin between providing clinical care, teaching, training, advocacy, and conducting research. Public health interventions that are urgently needed often fall by the wayside due to a lack of policy, collaborative action, and a unified strategic response. As a result, faith healers and traditional healthcare providers often fill the gap and provide “care” to patients.
Digital Solutions in Healthcare: Digital solutions for healthcare delivery must adhere to ethical, evidence-based, and high-quality care. Globally, frameworks and guidelines in healthcare delivery models have been developed to ensure relevant and applicable engagement with AI and digital technology. New programs that utilize digital interfaces must follow these principles to ensure quality of care, minimize harm to patients, and respect values and priorities. Provider education and training in the use of the new modality are essential, as in-person and online clinical care require differing skill sets and ethical foundations.
Digital MH Services in Pakistan: In Pakistan’s complex backdrop, digital solutions for mental healthcare delivery must be well-researched. Adding new-age services to a scarcity landscape, without buffering and buttressing the system, may prove more catastrophic than beneficial. With such a stark trained workforce shortage, it is crucial to ensure transparency on end providers, processes being used to measure and ensure ongoing quality, and patient usage, satisfaction, and outcomes. As demand for mental health care increases, there must be a trained and credentialed supply of quality management.
Pakistan’s MH Landscape: Pakistan’s mental health landscape requires a comprehensive and strategic approach that includes a legal and policy framework, innovative training and regulation structures, and health literacy and advocacy interventions. An all-encompassing approach will address critical priorities in mental healthcare, including workforce shortages, mental health literacy, quality management, and policy reform. It is vital to bridge the gap between policymakers, healthcare providers, and communities to create a cohesive response to Pakistan’s mental health challenges.
The era of digital technology has revolutionized the healthcare industry, but it’s not a panacea for all its challenges. Instead, we should use it as a tool to enhance and expedite the ongoing efforts. However, before introducing any new digital tool, we must tread cautiously and comprehensively evaluate its micro and macro context.
In the context of mental health care in Pakistan, where there’s an acute shortage of trained professionals, we need to be extra vigilant. Pakistan has only 600 trained psychiatrists and fewer than 500 psychologists, concentrated in urban areas. This translates to one psychiatrist for every 10,000 adult patients and less than eight child and adolescent psychiatrists for about four million children with mental health disorders. While there are some accredited counseling training programs, there’s no central body for credentialing therapists. Moreover, most medical schools offer inadequate training in MHDs. As a result, generalists and specialists who are the gateways to mental health referrals often lack knowledge of MHDs. To make matters worse, there’s a lack of policy, collaborative action, and unified strategic response, which leaves public health interventions neglected. Consequently, patients often rely on faith healers and traditional health providers.
While digital technology can potentially bridge the gap, its implementation must be ethical, evidence-based, and high-quality. Healthcare frameworks and guidelines have been developed globally to ensure that digital technology is used appropriately. Any new program using digital interfaces must follow these guidelines to ensure quality of care, minimize harm to patients, and respect their values and priorities. In addition, healthcare providers must be trained in the use of these technologies since in-person and online clinical care require different skill sets and ethical foundations.
The complexity of the mental health landscape in Pakistan requires a comprehensive approach. Any digital solutions must be researched and vetted to ensure they meet the needs of the community and are informed by a systems and program evaluation approach. Moreover, it’s critical to have transparency in end providers and processes used to measure ongoing quality. Patient usage, satisfaction, and outcomes must be measured to ensure that mental health care meets the standards of quality care. Finally, any demand for mental health care must be met with a well-trained and credentialed supply of quality management.
In Pakistan, mental health care needs a comprehensive and strategic approach that includes legal and policy frameworks, innovative training and regulation structures, and health literacy and advocacy interventions. It’s vital to have a measured and steady response to the challenges facing mental health care. While digital technology can undoubtedly be an essential tool in scaling up and accelerating mental health care, we must not forget that it’s not a magic bullet that can cure all ills. Instead, we must use it as a tool to enhance and support the ongoing efforts.
In conclusion, addressing the mental health crisis in Pakistan requires a comprehensive and strategic approach. While digital solutions can be a useful tool to scale and accelerate efforts, they should not be used to divert attention from the existing challenges within the mental health system. The shortage of trained professionals, lack of policy and collaborative action, and reliance on traditional healers are just some of the issues that need to be addressed.
It is crucial that any digital intervention in mental health care delivery is well-researched and follows ethical and evidence-based guidelines. This includes the need for provider education and training in the use of digital interfaces, as well as ongoing evaluation of patient usage, satisfaction, and outcomes.
As the discourse around mental health in Pakistan continues to grow, it is important to remember that the effective response must be measured and steady. By taking a contextual approach, staying relevant to community awareness and digital comfort, and informed by a systems and program evaluation approach, we can work towards a more comprehensive and equitable mental health system in Pakistan.
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