cknowledging the challenge of a widening gap between mental health experts and mental illnesses, Pakistan has launched a mental health application called Humraaz and a dedicated helpline (1166) – to make mental health services accessible to the vulnerable population. How much of a difference this can make remains to be seen.

The launch of mobile phone application is a first step towards the use of technology to meet the shortage of human resources and funds to make mental health services accessible for people. “Humraaz is a public-funded initiative owned and managed by the government. International standards will be followed here unlike some private online services,” Prof Dr Ali Hashmi, the head of the Department of Psychiatry at King Edward Medical University/ Mayo Hospital, Lahore, tells The News on Sunday.

“However, not everything can be managed virtually. In cases of emergency or a requirement for admission, there has to be a strong and reliable network at the backend to support the initiative,” said Dr Hashmi.

Mental disorders constitute at least four percent of the total disease burden in Pakistan. The mental health burden is higher among women. An estimated 24 million people in Pakistan need psychiatric assistance. A rise in mental illnesses has been recorded in the post-Covid period.

According to the Pakistan Psychiatric Society (PPS), the number of psychiatrists available in Pakistan ranges between 500 and 600. The doctor-patient ratio, therefore, comes to nearly 400,000, far from the World Health Organisation’s (WHO) recommendation of 15,000-20,000. The number of psychologists needed for the treatment of patients through counselling and psychotherapy, too, is inadequate. Also, most of the qualified professionals are clustered in big cities. There’s hardly a psychiatrist or a psychologist in semi-urban and rural areas.

Considering the importance of mental health, Prime Minister’s Strategic Reforms Unit has developed the digital tool in collaboration with the Ministry of Health Services, Regulations and Coordination, the WHO, the National Information Technology Board (NITB) and the Federal Directorate of Immunisation (1166 Helpline).

“The initiative aims to provide consultative services of relevant practitioners/ groups for curative purposes to citizens having psychological issues, i.e. depression/ self-harming thoughts, etc, says Salman Sufi, the head of SRU.

The application, Humraaz, is now available at the Google store and Apple store, and the toll-free helpline, 1166, is active.

Sufi says that more than 100 trained professionals/ staff are managing the services to assist individuals experiencing mental health issues. “This robust app will provide one-stop solution through a confidential medium,” he adds.

It offers a range of resources, including self-help tools, counselling and psychotherapy sessions/ meditation, daily mood tracking, stress management content and mental health support material embedded in the Humraaz application. Its key features include 24/7 connection with professionals, appointment booking with a doctor/ clinic/ hospital of choice, international standard knowledge base, ChatBot (including self-assessment) and WhatsApp support groups of people for mutual help and sharing of experiences.

It also features Humnawa, a public and private group chat platform, to discuss and seek support across Pakistan.

More than 150 psychologists/ psychiatrists have registered themselves to render services under the initiative – nearly half of them are psychiatry resident doctors and counsellors. More than 40 government psychologists/ psychiatrists are on board for providing free consultation services. The initiative has also registered more than 100 private psychologists/ psychiatrists to provide both free-of-cost initial consultation via phone and paid one-on-one consultation at clinics/ hospitals.

More doctors, i.e. psychologists/ psychiatrists, can sign up or register by simply sending profiles at Humraaz (https://humraaz.nhsrc.gov.pk) to provide consultative and treatment services. The profiles are reviewed and approved by a panel of experts at the Ministry of National Health Services Regulations and Coordination.

The SRU is mapping primary healthcare centres to be updated at 1166 helpline web portal. The helpline will assist those experiencing accessibility issues like mobile phone, internet or transport facility by connecting them to the nearest mental health care facility.

Muhammad Idrees Akhtar, an intending subscriber, complains, “I have not been able to register myself using the App. There is no data for the city, and the App doesn’t move ahead. Waste of time.”

Dawood Nasir, another subscriber, says, “I’m not sure why some people are giving it (the App) a negative rating; I downloaded the App and found it quite user-friendly and smooth. It is a good initiative. I understand, with time, the App will get more features. Even now, it’s exceptional. Something like this was needed.”

Although a wide array of evidence-based treatments exist, a majority of individuals with symptoms of mental disorders remain undiagnosed and untreated. A sizeable number of people suffer due to various mental health challenges ranging in severity and types from anxiety and panic attacks to bipolar disorder and depression, schizophrenia, post-traumatic stress disorder (PTSD), etc. Apart from structural treatment barriers such as availability, affordability and time constraints, stigma, some attitudinal factors lead to no-treatment-seeking behaviour.

“Asking for help is not a sign of weakness. We need to normalise help-seeking for mental health issues,” says the SRU head. We will continue to improve and strengthen the service by adding new features and more professionals.

Prof Dr Syed Ali Wasif, a consultant psychiatrist at Dr Zia-ud Din University Hospital and acting president of the Pakistan Association of Mental Health in Karachi, says that the Sindh Mental Health Authority conducted a post-Covid study, suggesting that 85 percent of the population in Sindh was experiencing anxiety and 42 percent from depression. 25 percent of the people were found harbouring passive suicidal thoughts.

Poverty, unemployment and inflation, family disputes and social injustice can lead to suicides. In some cases, says Dr Wasif, the patients try to kill all family members before committing suicide. He says economic hardships have also contributed to an increase in the divorce rate, which in turn adversely affects the mental stability of the children.

Dr Wasif says use of unnecessary aphrodisiacs too has been a factor in physical and mental disorders.

He says that qualified psychiatrists are currently looking after only about one percent of the patients. The remaining patients go to quacks, shrines and faith healers or suffer in oblivion.

He says there is a great need to remove the stigma attached with mental disorders. The taboos around divorce, sexual health and education and substance use must also be removed.

There is no health without mental health. The experts, therefore, emphasise the integration of mental health into Universal Health Coverage (UHC) programmes in Pakistan.

The writer is an investigative journalist associated with The News International, Pakistan. An EWC and GIJN fellow, he also contributes to various international media outlets. He tweets at @AmerMalik3