What happens when somebody using this platform is at risk: what the platform does automatically, what we ask of the clinicians listed here, how to escalate to us, and — stated plainly — what we do not provide.
Written for the psychologists, psychiatrists, therapists, doctors and psychiatric nurses listed on depression.pk, and for anybody deciding whether to be. The client-facing version of this is our safeguarding page.
If somebody’s life is in danger right now, this page is the wrong place. Call 1122 or 15 in Pakistan, or take them to the nearest emergency department. Escalate to us afterwards, not instead.
A free awareness, education and peer-support platform, and a directory of registered professionals. We run moderated WhatsApp support rooms, a website, self-tests, courses and a chat assistant, and we put people in touch with clinicians who set their own fees.
Not an emergency service. Not a clinic, hospital or licensed mental-health facility. Not your employer, and not a body that supervises, directs or governs your clinical practice. We hold no admitting rights, no prescribing authority and no statutory safeguarding mandate.
With you. A professional who sees a client through this platform does so under their own council registration, their own scope of competence and their own indemnity, exactly as in their own practice. Nothing on this page transfers any part of that to us, and nothing on it overrides your council’s code or your own clinical judgement.
A fast route to a human being on this team, the same day, when a case worries you. Checked crisis resources that are kept current. A peer discussion with a senior clinician on our team when you ask for one. And an honest account, like this one, of what we can and cannot do.
Risk detection runs server-side on every inbound message, on every channel — the WhatsApp support rooms, the website chat and the app — and it runs before any reply is generated. It is deliberately not a model judgement at the first stage: it is a curated phrase set in English, Urdu script, Roman Urdu and Hindi, because the people who write to us switch between all four inside one sentence.
Detections are graded in three tiers. Imminent — stated intent, a plan, a named method, means to hand, or an act already begun. Severe — passive ideation, hopelessness, self-harm. Distress — acute panic or overwhelm. The set is tuned so that false positives are acceptable and false negatives are not.
An imminent detection is never second-guessed. It is acted on in the same message. Severe and distress detections get a second read that decides whether the person is at risk or discussing the subject — and that second read fails safe: anything that errors, times out or comes back unreadable is treated as a real crisis, and a suppressed flag is still written to the panel so the judgement can be audited rather than trusted.
At that point three things happen at once. The person is answered, in the language and script they wrote in, and told plainly that they are not alone. They are given the crisis numbers for their own country — not a generic list. And the duty contact on this team is alerted within the same minute, by Telegram and by WhatsApp, with whatever identifying detail we hold. The WhatsApp alert goes through a durable queue on purpose, so an alert raised while WhatsApp is logged out is delivered the moment it reconnects instead of being lost at exactly the moment it mattered.
Every detection is written to an audit table: tier, language, channel and timestamp. The message text is deliberately not stored. At the time of writing (4 November 2026) that table holds 731 events since 31 July 2026, 460 of them in the last 30 days, of which 73 were graded imminent. A human on this team follows up one-to-one, never in the room.
This is screening and first response, nothing more. It is not triage, it is not assessment, and it produces no clinical formulation. It exists so that nobody writes the worst sentence of their life into a quiet room at 3am and gets silence back.
This is your clinical decision and your council’s code governs it. What follows is the sequence we ask you to work through and to record, written so that a case can be reviewed afterwards against something, instead of against memory.
Do not defer the question to the end of the session and do not soften it. Asking directly about suicide does not plant the idea; not asking leaves you formulating risk from inference. Separate the four things that are routinely collapsed into one: ideation (thoughts, and their frequency, intensity and duration), intent (do they mean to act), plan (how, where, when) and means (do they have access, now). A structured screen such as the Columbia protocol (C-SSRS) is free, validated and takes minutes; use one rather than relying on impression.
Previous attempts, recent discharge, bereavement, acute shame or dishonour, intimate-partner violence, substance use, command hallucinations, chronic pain, debt, and — in our population particularly — forced marriage, honour threat and family rejection. Protective factors count too and must be recorded, not assumed. No checklist predicts an individual act; the point of the structure is defensible reasoning, not a number.
This is the single intervention with the best evidence behind it, and it is routinely skipped. Name the method the person named. Agree, concretely, who removes it and when — the tablets, the rope, the pesticide, the blade, the keys. In Pakistan, agricultural pesticide and prescription hoarding are the commonest routes; ask about both by name.
A written, collaborative plan in the client’s own words: their warning signs, what they will do first, who they will contact, which numbers they will ring, and what makes the environment safer. The Stanley–Brown safety planning intervention is the standard form and is freely available. They keep a copy. A “contract for safety” is not a safety plan and has no evidence behind it — do not use one.
If you have not already set this out at the start of the work, set it out now. Confidentiality holds except where there is a risk to life — theirs or someone else’s — or a child or vulnerable adult at risk. Where you do breach it, tell the client you are doing so, disclose the minimum necessary to the smallest number of people who can act, and record your reasoning. A breach you have explained is clinical practice; one they discover afterwards is a rupture you will not repair.
For immediate danger to life: emergency services, or the nearest emergency department with psychiatric cover, and stay in contact until someone is with them. For high but not immediate risk: same-day or next-day psychiatric assessment, an agreed named emergency contact, increased session frequency, and a defined review point. Involve family only with consent where consent is possible — and be alert to the case where the family is the source of the risk, which in our caseload is not rare.
See the legal note below. It changed in May 2026 and it changes what involving the police may cost your client.
What they said, in their words where it matters. What you asked. What you found on each of ideation, intent, plan and means. Your formulation of risk and the reasoning behind it. What you agreed, what you did, who you contacted, and the review date. Records are your protection and their continuity of care. They are yours to hold, under your own data obligations — we neither hold them nor want them.
Email the route below the same day so a human on this team knows. Follow up with the client within 24 hours, not at the next scheduled session, and record that contact too — including a failure to make contact, and what you did about it.
Write to hello@depression.pk with CLINICAL ESCALATION in the subject, or message any admin in the staff room directly. It reaches a person, not a queue, and it is read the same day.
What we will do. Confirm we have it. Put you in contact with a senior clinician on our team for a peer discussion where you want one. Check on the person from our side, one-to-one, where they are a member of our rooms and that will not cut across your work. Give you the current checked resources for their city. Act on our own side if the risk is visible in the rooms. Keep what you send out of every group.
What this route is not. It is not a clinical on-call service, it is not staffed overnight, and it is not an answer to immediate danger. If your client’s life is at risk right now, emergency services come first and we come second. Nobody on this team is watching a screen at four in the morning waiting for your email, and we will not pretend otherwise to look better organised than we are.
Asked directly, because it was asked directly: we do not provide clinical supervision. We do not review your case load, we do not sign off your practice, and we cannot carry clinical responsibility for a session we were not in. Any platform telling a clinician otherwise is selling them a comfort that will not hold.
What we do instead, and will do on request: arrange a peer discussion with a senior clinician on our team, usually the same day. That is peer consultation, not supervision, and the distinction is not pedantry — it determines who answers for the decision.
We also do not provide professional indemnity insurance, inpatient admission or a referral pathway into a bed, medication or prescribing cover, out-of-hours clinical cover, or interpreting for a language we do not have. You are expected to hold your own registration, your own indemnity and your own supervision arrangement, as you would for any other part of your practice. If you do not currently have a supervisor, say so and we will help you find one — we would rather know.
Attempted suicide is currently a criminal offence in Pakistan again. Section 325 of the Pakistan Penal Code was repealed by the Criminal Laws (Amendment) Act 2022, and on 18 May 2026 the Federal Shariat Court struck that repeal down, restoring Section 325 — simple imprisonment up to one year, a fine, or both. The Pakistan Psychiatric Society has appealed to the Shariat Appellate Bench of the Supreme Court and, at the time of writing, that appeal has not been decided.
The clinical consequence is immediate and it is not abstract. A survivor presenting at a hospital after an attempt may face a police referral, and your client may know that before you do. It is a live reason people conceal attempts, refuse an emergency department, and bring a relative’s “accident” to you instead of to a casualty department. Factor it into how you plan an escalation, be honest with the client about it rather than reassuring them wrongly, and prefer a psychiatric route over a police route wherever the clinical picture allows.
Involuntary assessment and admission sit under provincial mental-health legislation — Sindh (2013), Punjab (2014), Khyber Pakhtunkhwa (2017) and Balochistan (2019), all descended from the Mental Health Ordinance 2001 — and are exercised by authorised facilities and the authorities named in those acts. They are not exercised by us, and not by you on our behalf.
This is not legal advice. It is the position as we understand it on 4 November 2026, recorded here because the ground moved this year. Check the current status before you rely on it, and tell us if it has changed so we can correct this page.
Our support rooms are for adults and everybody working with people in distress here confirms they are 18 or over. Where a person who appears to be a minor reaches us, they are not left unanswered: they are given age-appropriate help and the team is told.
A disclosure of current abuse of a child or a vulnerable adult, or of a credible threat to a third party, is not covered by confidentiality. Act on it under your own professional code and the relevant provincial law, and tell us so that we act on anything visible on our side — for example a member posting in a room, or a listed professional.
If your concern is about anyone on this platform — a member, a volunteer, an admin or another listed professional — use the safeguarding route. You do not need evidence and you do not need to be certain. A concern is enough, nothing you raise is posted in any group, and raising it will not affect your listing.
Say it at the start, in plain words, in the language your client thinks in. Read out or adapt:
“What you tell me stays between us. There are two situations where I would have to tell somebody else, and I would tell you first: if I believed your life, or somebody else’s, was in immediate danger, or if a child or a vulnerable adult was being harmed. Outside those two, nothing leaves this room — not to your family, and not to the platform you found me through.”
“جو آپ مجھے بتائیں گے وہ ہمارے درمیان رہے گا۔ صرف دو صورتوں میں مجھے کسی اور کو بتانا پڑے گا، اور ایسا کرنے سے پہلے میں آپ کو بتاؤں گا: اگر مجھے لگے کہ آپ کی، یا کسی اور کی جان کو فوری خطرہ ہے، یا اگر کسی بچے یا کسی کمزور فرد کو نقصان پہنچ رہا ہو۔ ان دو کے علاوہ کوئی بات یہاں سے باہر نہیں جائے گی — نہ آپ کے گھر والوں تک، اور نہ اُس پلیٹ فارم تک جس کے ذریعے آپ مجھ تک پہنچے۔”Record that you said it, and on what date. A limit the client heard at the start is the difference between an explained disclosure and a betrayal.
Kept current and served to people in crisis automatically, matched to their country. Our emergency page carries the full list, including the UK, US, Canada, Australia, UAE and Saudi Arabia.
| Rescue 1122 | 1122 | Nationwide emergency, Pakistan |
|---|---|---|
| Emergency (police) | 15 | Nationwide, Pakistan |
| JPMC Psychiatry Emergency | 021-9241-0000 | Karachi · 24 hours |
| Befrienders Pakistan | 021-2645-6872 | Karachi · emotional support |
| Umang Helpline | 0311-778-6264 | Trained volunteers · free |
| Rozan Counselling | 0304-111-1741 | Counselling helpline |
| Taskeen Helpline | 0311-783-3000 | Mental health support |
| IBS Counselling Centre | 042-5830-5930 | Lahore |
Found one of these dead or changed? Tell us the same day — a wrong number on a crisis page is a fault of the worst kind: hello@depression.pk.
Free, standard, and none of them ours. We name them because a protocol that says “assess risk” without naming an instrument is not a protocol.
Email hello@depression.pk with CLINICAL ESCALATION in the subject, or message any admin in the staff room. Read by a person the same day. For a concern about somebody on this platform, use SAFEGUARDING instead — how that works.
Not an out-of-hours clinical service. Emergency services first, always.
This page describes what we actually do, including the parts that are thinner than we would like. Last reviewed 4 November 2026. It was written because a clinical psychologist on our team asked for it and there was no document behind the answer; if you can see something in it that is wrong, missing, or stated more confidently than it deserves, that is worth an email: hello@depression.pk.