MENTAL health is a vital dimension of human well-being, yet in Pakistan, access to care remains profoundly unequal.

The National Psychiatric Morbidity Survey (NPMS) 2022 reports a lifetime prevalence of psychiatric disorders at 37.91% and current prevalence at 32.28%. Neurotic and stress-related disorders account for about 25%, mood disorders nearly 20% and psychotic disorders roughly 4.5%. Despite this burden, Pakistan has only 0.19 psychiatrists per 100,000 people -- among the lowest ratios globally. The World Health Organization notes 3,729 outpatient mental health facilities and 624 community-based inpatient units nationwide, but just 1% cater specifically to children and adolescents. With only about 2 inpatient beds per 100,000 population, over 90% of common mental disorders go untreated.

Urban psychiatric departments often handle 300-400 patients daily, forcing psychiatrists to see around 50 patients each -- limiting the quality of care. Given that about 95% of psychiatric morbidity involves mild-to-moderate conditions, relying solely on psychiatrists is neither practical nor equitable. Only about 4-5% of patients with severe psychotic or mood disorders truly require specialist attention. The majority would benefit more from accessible, community-based psychological and preventive services rather than pharmacotherapy alone. A whole-person, community-centered care model offers a practical path forward. In this approach, Primary Health Care (PHC) physicians act as first responders -- screening for distress, guiding lifestyle modification and managing early symptoms. Psychologists and counselors provide cognitive behavioral therapy, family counseling and psychosocial interventions, while Lady Health Workers (LHWs) and community agents deliver psycho-education, follow-ups and referrals at the grassroots level. Schools should integrate emotional literacy and resilience training to normalize discussions on mental health from an early age. Families, too, must be equipped to identify warning signs such as social withdrawal, declining functioning, or suicidal thoughts, rather than dismissing them as personality traits.

This writer's proposed "Triad of Nurturing" -- parenting, community norms and early screening -- offers a guiding framework for embedding mental well-being into everyday life. This model's advantages include broader reach despite the scarcity of psychiatrists, prevention of progression to severe illness, improved continuity through structured record-keeping and reduced over-medication. However, implementing such a system requires addressing key challenges: inadequate training among PHC doctors, LHWs and teachers; cultural stigma surrounding mental illness; poor data infrastructure; and insufficient policy and funding support. To operationalize reform, Pakistan must integrate mental health screening and counseling into PHC workflows, establish digital mental health registries and standardize training programs with ongoing supervision. Emotional literacy should be a core element of school curricula, supported by sustained public awareness campaigns to reduce stigma and encourage help-seeking behavior.

Incentivizing prevention, continuity and community-based outcomes -- rather than focusing solely on tertiary psychiatric care -- will be essential to creating a resilient system. Psychiatry alone cannot bridge Pakistan's mental health divide. Most people in psychological distress require not a psychiatrist, but understanding, accessible support within their own communities. Only by decentralizing care and empowering families, schools and neighborhoods can Pakistan move toward an equitable, efficient and humane mental health system.

-- The writer is PhD Scholar, Public Health Specialist/Gold Medal Innovation Lecturer/Community Medicine Department, Rawalpindi.