A complex field.

VARIOUS social factors contribute to poor mental health outcomes. These may include childhood experiences, nutrition, education, poverty, income inequality, housing, transport, etc. But it is important to realise that these factors mean different things to different people. Any vulnerable population is more likely to be suffering from mental health disorders. For example, in a gendered context, all these social determinants in Pakistan will be exacerbated by systemic sexism that reinforces health inequities. Mere investment will only have a minimal effect without a full understanding of how existing policies perpetuate the system. This is where the role of policymakers is critical.

Like many other health challenges, mental health is a complex field. But little attention has been paid to it, and it lags far behind other areas of physical healthcare. Many LMICs lack the resources to provide access to their communities. Barring areas where the elite reside, neighbourhoods comprising underserved people are likely to be far from hospitals, clinics and doctors - a problem made worse by the lack of public transport to get to medical providers in high-income areas. Stigma and lack of social awareness further aggravate the problem.

Meanwhile, mental health also faces an acute workforce shortage in LMICs. With an estimated one per cent of the health budget devoted to mental health, the psychiatrist-to-population ratio in Pakistan is dangerously low at one to 0.5 million-1m people (against a recommended 1:10,000). The ratio of psychologists is similarly critical. There are only a handful of mental health hospitals across the country, with rural communities almost completely cut-off. At the same time, the workforce we do have is not representative of the population it serves. The result is disparities in the quality of care, constrained access to linguistic and culturally appropriate services, lower patient satisfaction, workforce burnout and overrepresentation in coercive treatment environments for people with serious mental illnesses.

We must address disparities if we aim to advance social justice. This is the part of the story which we have heard countless times. In fact, addressing disparities is equally important to the entire society because it is crucial to overall national economic prosperity. Lack of resources result in stress, loss of productivity, and job absenteeism, costing us trillions of rupees annually.

Little attention has been paid to...

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