Pakistan is home to about 200 million people, but has one of the poorest mental health indicators and less than 500 psychiatrists for this population size. This paucity of mental health professionals in Pakistan creates a massive treatment gap, leaving more than 90% of people with common mental disorders untreated.
Untreated or inadequately treated mental illness can lead to high rates of school dropout, unemployment, substance use, arrest, incarceration and early death. In fact, suicide is the second leading cause of death for youth ages 10-34. Schools can play an important role in helping children and youth get help early. We used ToC workshops to develop an empirically supported, ‘hypothesized pathway’ for the implementation of WHO’s School Mental Health Program in the public schools of rural Pakistan. Three workshops included 90 stakeholders such as policy makers from education and health departments, mental health specialists, researchers, head teachers, teachers and other community stakeholders including non-governmental organizations.
The ToC process linked implementers, organizations, providers and consumers of school mental health services to develop common goals and relate them (improved child socio emotional wellbeing, grades and participation in activities) to interventions (training, monitoring and supervision of teachers; collaboration with parents, teachers and primary health care facilities and schools). Key testable assumptions developed in the process included buy-in from health care providers, education officials and professionals, community-based organizations and families.
For example, teachers needed skills for managing children’s problems, but their motivation might come from seeking improved school performance and working conditions. Poverty, stigma and lack of child mental health literacy among teachers, administration, and parents were identified as key hypothesized barriers. Children and their families were identified as key stakeholders to make such a program successful.
Written by Rahmeen Jumma Student of SZABIST, Email; jkhanrahmeen@gmail.com.
