Social and societal context of women’s mental health, what women want, what they get: gap analysis in Pakistan of mental health services, polices and research

Introduction: The burden of mental illness is increasing in Pakistan as political instability, violence and terrorism beset the country. Mental health in Pakistan can be examined from three perspectives—services, research and policy. Services are provided in major public sector hospitals and some private institutions. Trained health professionals including psychiatrists and clinical psychologists are limited, and people often access faith healers for mental illnesses. Research on mental health is also being conducted, the focus being on the clinical aspects of mental health. Public health initiatives in Pakistan are yet to develop disease prevention and health promotion programmes. Intervention studies on the social context of women’s mental health are scarce. There is a mental health policy and a mental health Ordinance, Pakistan’s National health policy documents do not integrate mental health as a priority area. Women’s mental health, in contrast, is well recognized as an issue, but no national or provincial programme is to be found. Main Body: This chapter has two reviews—one, the mental health services in Pakistan, and two, the nature of research on mental health in Pakistan. It also includes what urban and rural women at community level have said about mental health. Women’s voices have been taken from two community-based research initiatives in three sites in Sindh and Baluchistan. What women say about mental health is juxtaposed with the services offered and research priorities in Pakistan. The three areas of services, research and women’s account of their needs are examined, and way forward is proposed. Discussion: The analysis of policies, mental health services and research helps identify the possible consonance between what women want and what is available. Gaps between what women want and what they get are highlighted and further analysed for identifying policy entry points, need for human resource development and research agenda for mental health. Based on this analysis a framework for advancing mental health of women is developed and recommendations prepared for improvement in women’s mental health in Pakistan. Implications: The importance of listening to women’s understanding of their mental health needs serious consideration by researchers and health providers. Researchers could pay more attention to searching for research methods that allow for expansion of women’s voices to deal with the stressors they carry. Response: Two Urdu poets have written poems after reading the chapter