The debate related to mental health in Pakistan has reached to crossroads. The awareness is increasing but we are still stuck in a colonial paradigm of institutionalization. The system into which we have been born perceives psychological suffering as a clinical aberration, a failure in being human and to be contained in a psychiatric ward or handled by a generous dose of pharmacological treatment.It is, however, becoming increasingly clear as the weight of anxiety and depression becomes epidemic in such a scale that we cannot clinic our way out of a social crisis. It is in the deinstitutionalization of grief, the transfer of the healing place out of the sterile seclusion of the hospital, into the natural stitching of the community, where the answer lies.

The existing medical paradigm is based on a deep-rooted bias of biomedicine.It views mental distress as a mostly personal disease without taking into account socioeconomic and cultural factors that create it. In a nation where the psychiatrist-to-patient ratio is pathetic, a clinical intervention alone is not only inefficient; it is also limiting. By calling every moment of deep sadness or social fatigue a clinical disorder, we are unwittingly depriving the person of his or her agency as well as the community of its responsibility. This type of clinical monopoly has developed a culture that the average citizen is not qualified to support in any way, and that the response is professional assistance, which is the only correct answer. As a result of this, the suffering person is alienated, and the community's muscles of sympathy and support are made to diminish.

Deinstitutionalization is not the denial of modern psychology, but demands a radical incorporation of modern science and traditional support systems.In earlier times, the South Asian environment was filled with communal places like baithak, dera, and the courtyard, where collective listening was an extension of social life. This is what used to be the first helpline in Pakistan.The rigor and the ethics and the special means of trauma, which are offered by modern psychology, ensue, whereas the sustainable, long-term recovery is presented by the community. One such model is community-based, where they employ the concept of task-shifting, where non-specialists, including teachers, lady health workers, and community leaders, are trained on basic psychological first aid. By providing the already existing people in the life of a person with the means of listening and validating, we build a safety net that is culturally resonant and geographically accessible.

The case of community-based care is as economically driven as it is a humanitarian one.The price of an untreated mental health condition in Pakistan in terms of wasted productivity, physical ill health, and destroyed family is hefty. Our existing system of infrastructure, which is concentrated primarily in large cities, pays no attention to the rural masses. Such centralization forms a mental health divide on which the care of the urban elite is not the privilege of all citizens. True mental health equity can only be realized through a decentralized community-based approach. Once support is instilled in schools, workplaces, and local centers, it becomes non-negotiable.It ceases to be a luxury and a popular good.It is necessary to understand that grief is a social reality, and its solution involves social involvement.

Also, the change towards the community model is the best way to eliminate the stigma that has been breeding in the dark in the context of institutional care.Psychiatric hospitals are inherently concealing the sight of the “afflicted people to society and are further supporting the notion that mental struggle is a shameful thing that should be under wraps. The process of deinstitutionalization, on the other hand, introduces mental health to the common ground. It requires us to cease considering a mentally challenged person as a patient and consider them a neighbor, a colleague, or a friend whose mind has been crushed by the burden of his surroundings. When we make the stigma the status quo through regular places, we depower it.

The aim is to create a resilient society in which resilience is not an individual possession but a social one. We require a care economy in which the neighbor who knows how to listen becomes the first line of defense, backed by the formal system, which only provides the escalation of the professional kind when it is needed.This model recognizes a mere fact: some people may require a doctor, but everybody requires a community. Conceptualizing a mental health helpline or a community support group is a statement that makes the internal well-being of the citizen a concern for both the state and society.

We should abandon the so-called asylum model and create a system of strong communal care.The future of mental health in Pakistan is not in the number of beds in the psychiatric wards, but the number of ears in the community. In deinstitutionalizing grief, we give it the opportunity to be experienced, to be shared, and eventually cured.Our culture of clinical isolation should give way to a culture of collective strength, so that no Pakistani has to drag this dark side of his mind all by himself. By keeping on medicalizing all the amount of distress, we can only manage to make society even more lonely. In case, though, we revert to the communal aspect of healing, then we can create a nation not only surviving but blossoming.