How to seek help for mental health in Pakistan — the complete map
The real doors: hospital OPDs, private clinics, online, helplines, the health unit down the road. Who is who and what registration means, what it costs honestly, what the first visit is like, how to get past "log kya kahenge", and ten things that get you through the door.
If you know something is wrong and do not know where to go, this page is the map. It shows the real doors in Pakistan (hospital OPDs, private clinics, online, helplines, the health unit down the road), who is who and what registration actually means, what it costs as honestly as we can say, what the first visit is like, how to get past "log kya kahenge", and ten things that get you through the door, starting today.
The question we are asked more than any other is not "what is wrong with me". It is "where do I go". Here are three answers that actually happened.
Asma, 34, Sukkur: the hospital route
There is no psychologist in Asma's town. There is a hakeem, a pir her mother-in-law trusts, and a medical store that sells sleeping tablets without a prescription. She tried the first two for a year. What she has is early waking, no appetite, and a sentence she keeps not saying about being a burden. Her cousin, a nurse, said one word: Larkana. The teaching hospital there has a psychiatry OPD. Asma went with her cousin on a Tuesday, paid a registration fee that was less than the rickshaw fare, sat for three hours on a bench with forty other people none of whom knew why any of the others were there, was seen for twenty minutes by a resident and then briefly by a consultant, and came home with a diagnosis, a generic tablet costing a few hundred rupees a month, and a follow-up in three weeks. Her mother-in-law was told it was for her "nerves and stomach", which was not a lie. Four months later she is sleeping through, and she has stopped saying the sentence.
Hamza, 26, Karachi: the private route
Hamza has panic attacks and a job. He also has a Karachi salary, which changes the map. He found a clinical psychologist through a friend who had actually been, messaged to ask three questions (qualification, approach, fee), and booked a Saturday morning. Twelve sessions of CBT over four months, mostly exposure work on buses and lifts. Nobody at work knows; the sessions are on Saturdays and the clinic is on the second floor of a building with a dentist. He also saw a psychiatrist once, at the psychologist's suggestion, and decided with her not to start medicine. It cost him, in total, roughly what a mid-range phone costs. He says it was the best thing he bought that year.
Rehmat, 58, a village near Mardan: the route through the door that was there
Rehmat has been "not himself" since his shop closed. His son, in Dubai, read something online and called the local basic health unit. The doctor there, a general physician, had done a short training on depression and knew the questions. He started Rehmat on a common antidepressant, told the son exactly what to expect in the first three weeks, and referred him to the district hospital for a psychiatric review at the next monthly visit. The lady health worker who already visited the house for the grandchildren's vaccinations started asking Rehmat, each visit, one question about his sleep. That was the whole system: a BHU doctor with a two-day course, a worker who already knew the house, and a son who made one phone call.
What these three have in common. None of them started with a psychiatrist. Each found the door that was actually reachable from where they stood: a hospital OPD two towns over, a private psychologist on a Saturday, a health unit doctor who had done a course. All three were told, by someone, that the first step was either shameful, unaffordable, or unavailable. All three found it was none of those, once they knew where to look. This page is the "where to look".
A two-minute start, if you want one: the PHQ-9 and GAD-7 self-check tells you roughly how bad it is, which decides which door. Nothing is stored. Then the directory lists the doors by city.
The basicsThe map: there is no system, there are doors↑ contents
In some countries you go to your GP, who refers you, and there is a waiting list and a letter. Pakistan is not like that. There is a public hospital system that is stretched, a private sector that is expensive and uneven, a growing remote sector, and a community layer that is mostly informal. Nobody hands you a map. So here is one.
The doors. Pakistan has no single mental-health system and no GP gatekeeper, which is a problem and also a freedom: you can walk into any of these. The green doors are where treatment most often happens. The grey ones are real, often free, and usually lead to a green one. Our directory lists the ones we know, by city.
The public route
Every province has teaching hospitals with psychiatry departments and outpatient clinics (OPDs), and they are the backbone of care for most people who get treated. They are crowded, the visits are short, and they are staffed by real psychiatrists in training and their consultants, and the medicines they prescribe are generic and cheap. Some now have clinical psychologists attached. Below them, district headquarters hospitals sometimes have a psychiatrist and sometimes do not; basic health units have general doctors, an increasing number of whom have had short training in depression and anxiety, and lady health workers who already visit homes. Dedicated mental hospitals exist in a few cities and are for severe illness.
The private route
In the big cities: psychiatrists with clinics, clinical psychologists in private practice, counsellors, and private hospitals with both. Shorter waits, longer sessions, more privacy, and a fee for every visit. Many private psychiatrists also work in a teaching hospital, so the same doctor may be seen for a fraction of the fee at the OPD if you can manage the wait. A family doctor can also start treatment for common depression and anxiety, and many do; the quality depends on the doctor.
The remote route
Video and voice therapy from anywhere with signal has changed the map more than anything else in a decade. A person in a town with no psychologist can see one in Lahore from the roof. Some teaching hospitals run telepsychiatry. Helplines are free and immediate. Our team on WhatsApp is free, private, and awake at 3am. None of the last two is treatment; all of them are a first step.
The community route
NGO counselling centres, university psychology clinics with supervised trainees, and the lady health worker who already knows the house. And the imam, the elder, the friend: not treatment, but for many people the first person they tell, and if that person says "yes, go, I will come with you", the whole map opens.
The basicsWho is who, and what registration means↑ contents
In a country where "psychotherapist" can be printed on anyone's card, knowing what the titles mean, and which ones can be checked, is not pedantry; it is how you avoid spending a year and a salary on the wrong door.
Title
What it should mean
How to check
Can they
Psychiatrist
A doctor (MBBS) with a specialist qualification in psychiatry (FCPS, MCPS, MD, or a foreign equivalent).
Ask for the PMDC (Pakistan Medical and Dental Council) registration number and check it on the PMDC website. Ask what the specialist qualification is.
Diagnose; prescribe; manage severe illness; admit to hospital. Some do therapy, most do not have time.
Clinical psychologist
A psychology graduate with a clinical training degree: MS, MPhil or PhD in clinical psychology, including supervised placements.
No single national register yet. Ask: which degree, which university (HEC-recognised), do you have supervision, are you a member of a professional body.
Ask the same questions as for a psychologist. If the answers are vague, walk away.
Depends entirely on the person behind the title.
Hakeem, pir, aamil
Traditional or spiritual practitioner.
Not a medical qualification.
Comfort and meaning for many. Not treatment for depression or anxiety, and a route that delays it for years when used instead of rather than alongside.
Swipe the table sideways on a phone.
Three steps, ten minutes. The title decides which check applies; the four questions apply to everyone; the reaction is the final test. A real professional of any kind answers without offence, and many are pleased to be asked.
What registration does and does not tell you. A PMDC number tells you the person is a real doctor; a specialist qualification tells you they trained in psychiatry. It does not tell you they are kind, or that they will take more than five minutes. For psychologists there is, at the time of writing, no national licence; there are recognised degrees and professional bodies, and the three questions in the table. A good professional of any kind answers them without offence. That reaction is itself a test.
The basicsWhat it costs, as honestly as we can say↑ contents
We are not going to print a price list, because a price list would be wrong in some city by next year and we would rather be vague than wrong. What we can do is show the shape of the costs, what people report to us, and how to bring each one down.
The cost ladder. The most common mistake is assuming help means the top two rungs. It does not. Medicine from an OPD, therapy online or at a reduced rate, and the free layer in between is how most people who get well actually do it. Prices are not on this picture on purpose; they vary by city and year, and the table below is as specific as we are willing to be.
Item
What people report to us
How to bring it down
Teaching-hospital psychiatry OPD registration
A small fee, often under a few hundred rupees. Some hospitals waive it.
Nothing to bring down. Bring the time.
Generic antidepressant or anxiety medicine, a month
Commonly a few hundred rupees for common generics; brand-name versions several times more.
Ask the doctor for the generic name and buy the generic. Ask the pharmacist too.
Private psychiatrist, first visit, big city
Varies widely; commonly in the low thousands of rupees; more for senior consultants; less in smaller cities.
See the same doctor at their hospital OPD, if they have one, for a fraction of the fee. Ask for a reduced follow-up rate.
Private clinical psychologist, per session
Varies widely by city and experience. Roughly, in the range of a good meal out to a small household bill per session; eight to sixteen sessions in a course.
Ask for a reduced rate; many offer one to students and the unemployed. Ask for the shortest course that fits. University clinics and NGOs for free or nominal.
Online therapy, per session
Often cheaper than in-person; varies by therapist and platform.
Check the therapist’s qualification, not the app. Independent therapists online are often cheaper than platforms.
Blood tests a psychiatrist may ask for (thyroid, blood count, sugar)
A few hundred to a couple of thousand rupees at a private lab; less at a government hospital.
Ask whether they are necessary now or can wait. At the OPD they are usually cheap.
Transport and time
Often the largest hidden cost: a day off work, a rickshaw or bus two towns over.
Combine visits; ask for follow-ups by phone where the doctor allows; consider online for the therapy part.
Helplines, our team, this site
Free.
Nothing.
Swipe the table sideways on a phone.
A rough sense of the whole. A person treated for moderate depression at a teaching-hospital OPD with generic medicine might spend, over six months, less than a mid-range phone costs. The same person seen privately for medicine and twelve full-rate therapy sessions in Karachi might spend several times that. Most people land in between, and the in-between is reachable for most working families with some planning. The money card is that planning.
The basicsWhat the first visit is actually like↑ contents
At a teaching-hospital OPD
A morning at the OPD. The wait is the price; the doctor is real. The most useful thing you can do is arrive with a written list, because the fifteen minutes will go fast and "theek hai" wastes them. Times vary by hospital; some now have appointment systems, most do not.
You will be asked, by a resident, the questions doctors ask everywhere: what brings you, since when, sleep, appetite, energy, interest, concentration, thoughts of self-harm, past episodes, family history, physical illnesses, medicines, alcohol or drugs. Answer honestly and briefly; the list helps. You may then be seen by the consultant for a few minutes. You will leave with a diagnosis (ask them to say it plainly), usually a prescription, an explanation of what to expect (ask if they do not offer it: how long till it works, what side effects, what to do if they are bad, when to come back), and a follow-up date. Nobody will ask why you are there in a way anyone else can hear. Nobody keeps a list that anyone outside the hospital can see.
At a private clinic
Quieter, longer, and with a receptionist who takes your name and a fee. A first psychiatry visit is thirty to sixty minutes of the same questions; a first therapy session is described minute by minute on our what is therapy page. The building is usually anonymous. Ask when you book what the first visit involves and how long it is.
Online
You will need a corner with signal and a door, even if the door is the roof. Earphones. A fixed time. The therapy page has a card on setting this up in a shared house. The first ten minutes are awkward and then it is a session.
Through a family doctor or BHU
Shorter and more variable. A good general doctor will ask the same questions, may start a common medicine, and will tell you when to see a psychiatrist. A less good one will say "tension" and prescribe vitamins. If that happens twice, that is not a verdict on you; it is a signal to go up a step. The card on when the first door fails is about exactly this.
Going deeperOne level down. The reasons people do not go, and what is true about each.
Going deeperNavigating stigma: log kya kahenge, and the rest↑ contents
Most people who write to us already know where a hospital is. What stops them is not geography. It is a set of fears, some of them reasonable, most of them out of date, and one of them (the fear of being recorded somewhere) almost entirely imaginary. Here they are, with what is actually true.
The stigma loop. The shame keeps people silent, the silence keeps them untreated, the untreated illness gets worse and more visible, and the visible illness confirms the shame. It runs in families for generations. It is broken, every time, in the same place: one private conversation, one visit. The person who gets treated and gets better is the most powerful anti-stigma argument a family ever sees.
The fear
What is actually true
What to do
"There will be a record. It will affect the rishta / the job / the visa."
There is no register of psychiatric patients that a family, an employer or a visa office can search. Hospital records are hospital records. Private clinics keep their own. Nobody is checking.
Go. If it worries you, ask the clinic what they record and who can see it; the answer is "us".
"People will see me at the OPD."
Forty people on the bench, none of whom knows why the others are there, all of whom are hoping not to be seen. A general hospital OPD is one of the most anonymous places in the city.
Go with one person. Nobody looks.
"My family will say I am pagal / weak / faithless."
Some will, at first. Most come round when they see the person get better, which is the only argument that has ever worked.
Tell one person, not the family. Let the treatment do the talking. The family card.
"A woman cannot go alone."
Many can and do. Where she cannot, the question is who to take: a sister, a cousin, a friend, a lady health worker. And online therapy from the roof needs no permission.
Choose the companion who will not report back. Or the roof.
"It is a spiritual matter; a doctor is a betrayal of faith."
Whatever you believe about the unseen, there is no rule against treatment, and the people who know the tradition best tend to say so. Many families do dum and the doctor.
Both. Never "instead of".
"The doctor will just give me tablets and call me mad."
Some will be brisk. A good one will explain. Tablets are one tool; therapy is another; you can ask about both.
Bring the list. Ask the questions. If dismissed twice, go up a step.
"I am the eldest son / the mother / the one who holds it together. I cannot be the one who needs help."
The one who holds it together is exactly the one who needs to stay well, and the one whose illness costs the family most.
Frame it as maintenance: "so I can keep doing this."
"It costs too much."
The top rungs do. The bottom three, combined, are within reach of most working families.
MenLeast likely to go, most likely to arrive late and ill. The barrier is usually "men do not need this", and the thing that works is another man who went. If you are a man reading this, the friend who tells you he saw someone is your permission. If you are the friend, say it.
WomenMore likely to be taken than to go, and more likely to be taken to a pir than a psychiatrist. The barrier is often permission and transport. The lever is one ally in the household, or the roof and a phone. Postnatal depression especially goes untreated for want of someone to say the word.
StudentsMany universities now have counselling centres, free, on campus, with real psychologists and confidentiality. They are under-used because nobody believes the confidentiality. It is real. Exams, entry tests and the first year away from home are the peak; this is what the centre is for.
EldersTreated as "old age" or "his nature". Depression in older parents is common, treatable, and usually spotted by a child who notices the newspaper has stopped being read. The route is often through the physician they already see for blood pressure; ask that doctor to ask about mood.
The scienceThe science, kept honest. Skip if you do not want it.
The scienceThe science, stated carefully↑ contents
The gap. In low- and middle-income countries the large majority of people with depression or anxiety get no treatment at all, and Pakistan, with fewer than one psychiatrist per hundred thousand people, is no exception. The gap is not mainly a shortage of people who want help. It is a shortage of doors, of money, and of permission. The best evidence for closing it in Pakistan is trained non-specialists and remote care, which is why this page takes both seriously.
The workforceWHO figures put Pakistan at roughly a fifth of a psychiatrist per hundred thousand people, with clinical psychologists similarly scarce, and both concentrated in the big cities. Whatever the exact number, it means that specialist care cannot reach most people, and that the routes through general doctors, trained non-specialists and remote care are not second best; they are the only way the gap closes.
WHO (2021), Mental Health Atlas 2020, Pakistan profile.
The treatment gapAcross low- and middle-income countries, studies find that the large majority of people with common mental disorders receive no treatment in a given year. Community surveys in Pakistan find depression and anxiety common and treatment rare. The reasons found consistently: not knowing where to go, cost, distance, and stigma.
Rathod, S. et al. (2017), Health Services Insights; Mirza, I., Jenkins, R. (2004), BMJ, 328, 794.
Stigma stops people goingA large review of studies on why people do not seek help found that stigma, especially the fear of being judged and the wish to handle it alone, was a consistent barrier, with the strongest effect among men, young people, and people in professions where disclosure felt risky.
Clement, S. et al. (2015), Psychological Medicine, 45(1), 11–27.
Delay costsLonger periods of untreated depression are associated with worse and slower recovery; the same is found for anxiety disorders. "Wait and see" for months is not neutral.
Ghio, L. et al. (2014), Journal of Affective Disorders; Altamura, A.C. et al. (2008).
Trained non-specialists work, and were proven hereThe Thinking Healthy Programme, delivered by lady health workers to mothers with depression in rural Punjab, roughly halved depression compared with usual care in a large trial, and was adopted by the WHO. Trials of brief training for general doctors and of lay counsellors in South Asia show similar results. This is the evidence that Rehmat’s BHU doctor and his lady health worker were not a poor substitute; they were the model.
Rahman, A. et al. (2008), The Lancet, 372, 902–909; Patel, V. et al. (2017), The Lancet (Healthy Activity Program, India); Singla, D.R. et al. (2017), Annual Review of Clinical Psychology.
Remote care worksTherapist-guided online and video therapy produces outcomes comparable to in-person for depression and anxiety in most comparisons; telephone follow-up of medication is effective. For a person two towns from the nearest psychologist, this is the difference between treatment and none.
Andersson, G. et al. (2019), World Psychiatry, 18(1), 20–28.
Stepped care is the right structureStarting with the least intensive help likely to work and stepping up if it does not is the model recommended by major guidelines and is at least as effective as sending everyone to a specialist, with far lower cost. It is also, in practice, the only structure Pakistan can afford.
NICE NG222 (2022); van Straten, A. et al. (2015), Psychological Medicine.
Someone going with you helpsFamily accompaniment and involvement increase the chance a person starts treatment and stays in it, in studies from South Asia and elsewhere, particularly where stigma is high.
Sin, J. et al. (2017), Clinical Psychology Review; Thinking Healthy Programme materials, WHO (2015).
One-paragraph version. Most people with depression and anxiety in Pakistan get no treatment, mainly for want of doors, money and permission, not for want of wanting it. Delay makes it worse. The routes that close the gap are the ones this page is built around: trained general doctors and non-specialists, remote care, stepped care, and one person who goes with you. All of them are proven, and two of them were proven in Pakistan.
Exercises & solutionsThe practical part. Ten cards, same shape each time.
Exercises & solutionsTen things that get you through the door↑ contents
These are not exercises for the illness; every other master page has those. These are the things between you and the door: choosing it, checking it, preparing for it, paying for it, keeping it private, keeping it going, and what to do when it turns out to be the wrong one. Do the first one today.
1
Choosing your door
15 min
What it does
Turns "I should get help" into one named door, one city, one week.
Why it works
The commonest reason people never go is that "get help" is not an action. A door with a name and a day is. The choice depends on three things you already know: how bad, where you are, and what you can spend.
Step by step
Take the self-check. Write the score. Under 10: self-help and a first conversation. 10 to 19: therapy, with a psychiatrist in reserve. 20 or more, or any thought of ending your life: a psychiatrist this week.
Write where you are: big city, small city, town, village. Big city: everything is available. Small city or town: the nearest teaching hospital and online. Village: the BHU or DHQ doctor, a lady health worker, online if there is signal, and the nearest teaching hospital.
Write what you can spend per month, honestly. Then look at the cost ladder and pick the rung.
Open the directory and pick one named place. Write it down, with a day.
If you cannot decide, message our team with the three answers. We will help you choose. That is what we are for.
Use it when
Today.
Common mistake
Choosing the door your family would approve of rather than the one you can actually walk through. The reachable door beats the ideal one.
2
Checking that the person is real
10 min
What it does
Protects you from the "psychotherapist" with a printed card and no training, and from the doctor who is not a doctor.
Why it works
Titles are unregulated for everyone except doctors, and even doctors’ qualifications can be checked in a minute. The questions cost nothing and a real professional answers them gladly.
Step by step
For any doctor: ask for the PMDC registration number. Check it on the PMDC website. Ask what the psychiatry qualification is (FCPS, MCPS, MD, or equivalent).
For a psychologist: ask which degree (MS, MPhil, PhD in clinical psychology), which university, whether they have supervision now, and which professional body they belong to.
For a counsellor: ask about training and supervised hours.
For anyone: what approach do you use for [my problem], how many sessions do you usually suggest, what is the fee, is a reduced rate possible.
Notice the reaction. Openness is the green flag. Offence, vagueness, or "trust me" is the red one.
Ask someone who has actually been, if you can. Not someone who has heard.
Use it when
Before booking anyone you did not find through a hospital or the directory, and even then.
Common mistake
Trusting a large social-media following as a qualification. It is a qualification in social media.
3
The first-visit kit
20 min the night before
What it does
Makes a short, crowded visit count, and takes the fear out of it.
Why it works
Fifteen minutes with a resident goes fast, and "theek hai" wastes it. A written list gets a better decision in fifteen minutes than an unprepared hour. And people who have prepared cancel less on the morning.
Step by step
One page: the story in five lines (what, since when, what it stops you doing, what you have tried, what you want). Sleep, appetite, energy, mood 0 to 10. Any thoughts of self-harm, written down so you do not have to find the words. Past episodes. Every medicine, with the boxes. Anything you use to cope, honestly.
Your questions: What is this? How long till the medicine works? What side effects, and which mean I should call? How long will I take it? Can I stop suddenly? (No.) Is there a generic? Do you recommend therapy alongside? Is there a psychologist here?
CNIC, some cash, water, something to eat, a charger, a book. Comfortable clothes; you may be there four hours.
One companion who will not report back, if you can.
The night before every first visit, and a shorter version before follow-ups.
Common mistake
Leaving the list at home because you will "just explain". Under a queue of eighty, you will not.
4
The privacy plan
10 min
What it does
Answers "what will I tell them" before anyone asks, so that the fear of being seen does not cancel the visit.
Why it works
Most of the stigma fear is about disclosure, and most disclosure is accidental: a question at the door, a prescription left on the table, a message seen. A small plan closes those gaps and lets you go.
Step by step
Decide who knows. Often the honest answer is one person. It is allowed to be nobody.
Choose the sentence for the household: "a doctor for my stomach and nerves", "a check-up", "a friend’s". None of these is a lie you will regret; all are complete.
Medicines: keep them in your bag or a locked drawer, not the kitchen shelf. Ask the pharmacist for a plain bag.
Phone: the clinic’s number saved under a neutral name; appointment reminders on silent; our chat archived if needed.
At the OPD: nobody asks; if someone you know is there, they are there for the same reason and want the same silence.
Ask the clinic what they record and who can see it. The answer will reassure you.
Use it when
Before the first visit.
Common mistake
Deciding that because privacy cannot be perfect, you cannot go. Perfect is not needed; sufficient is.
5
Talking to the family (in tiers)
10 min to prepare
What it does
Gets you one ally without triggering six opinions, and gives you the sentences for each tier if and when you need them.
Why it works
A family told all at once produces a committee; a single ally produces transport, money, and cover. The research on families and treatment says one warm supporter matters more than a household’s agreement.
Step by step
Tier one, one ally: the person most likely to help, not the most senior. Sister, cousin, spouse, a friend who has been. Frame it as health: "Kaafi time se theek nahi hoon. Main doctor se mil raha hoon jaise kisi aur bimari ke liye. Mujhe bas itna chahiye ke aap saath chalein aur kisi ko na batayein."
Tier two, the parents or the spouse, only if the logistics need them: "I have been seeing a doctor for a while for low mood; it is working; I wanted you to know so you are not worried." After it is working, not before.
Tier three, the wider family: never, unless you want to. When someone asks, "I was unwell for a while and I am better" is a complete answer.
For nazar, marriage, pir: "It may be. I am also doing the doctor. Both." Repeat, warmer, as needed.
Tier one before the first visit. Tiers two and three later, or never.
Common mistake
Starting at tier three, at dinner, and spending the evening defending the decision instead of making it.
6
The money plan
20 min
What it does
Makes treatment affordable by choosing the rungs deliberately instead of assuming it is out of reach.
Why it works
Most people picture the top of the cost ladder and give up. Most people who get well spend on the bottom three rungs, combined. Planning it once removes the biggest practical barrier.
Step by step
Medicine: from a teaching-hospital OPD, generic. Ask the doctor for the generic name. Budget a few hundred rupees a month, and the transport.
Therapy: choose one of: a university clinic (free or nominal), an NGO (free or subsidised), online (often cheaper), or a private psychologist at a reduced rate, asked for plainly: "I can manage this much per session; is that possible?" Budget eight sessions, not sixteen; you can add.
The free layer: this site’s exercises daily; our team when you need to talk; a helpline at 3am. This is not padding; it is where a lot of the work happens.
Write the monthly figure. Compare it with what you spend on chai and mobile data. Decide.
If it is still out of reach: the OPD for medicine and the free layer for everything else is a real treatment plan, and it is what a great many people do.
Use it when
Before booking, and again at month three when the first course is done.
Common mistake
Paying for a senior private psychiatrist for medicine that the same doctor prescribes at the OPD, and then having nothing left for therapy.
7
The OPD day
a morning
What it does
Gets you through a teaching-hospital OPD without giving up on the bench.
Why it works
The wait is long, the system is unclear, and many people leave before being seen. A few practical moves make the difference between four hours and a result and four hours and nothing.
Step by step
Find out the OPD day and time for psychiatry (many run on specific days). Phone the hospital or ask at the counter the day before.
Arrive before it opens. The queue for the slip (parchi) forms early.
At the counter, say "psychiatry OPD". Pay the fee, get the slip, ask where to sit and how you will be called.
Sit where you can hear. Water, food, charger, book, companion. Do not leave the area; names are called once.
When called, hand over the list. Answer briefly. Ask your questions. Write the answers.
Before leaving the building: the follow-up date on the slip, the pharmacy (government pharmacy first; outside if they are out of stock), and the generic name of every medicine.
Use it when
Every OPD visit.
Common mistake
Leaving at hour three because "they have forgotten me". Ask at the counter; they have not.
8
The follow-up rhythm
ongoing
What it does
Keeps treatment going past the first prescription, which is where most treatment in Pakistan quietly ends.
Why it works
Antidepressants take weeks, side effects come first, the follow-up is a whole morning, and the first visit felt like the achievement. So people stop after one box. Treatment that stops at week three is treatment that did not happen.
Step by step
Book the follow-up before leaving the first visit. Put it in the phone.
Take the medicine as prescribed, daily, at the same time. Set an alarm. Missing days is the commonest reason it "did not work".
Expect the first two weeks to be unimpressive or slightly worse. Do not stop. If the side effects are bad, call or go back; do not just stop.
Keep a one-line daily note: mood 0 to 10, sleep, side effects. Bring it to the follow-up.
At the follow-up: the list again, the questions, and "how long do I continue once I am well?" (usually months).
Never stop suddenly. When the doctor says it is time, they will reduce it slowly.
If therapy is part of the plan, the therapy page has the three-session rule for the same problem on that side.
Use it when
From the first prescription until the doctor says stop.
Common mistake
"I felt better so I stopped." Feeling better is the medicine working. Stopping then is how it comes back.
9
Using the free layer well
daily
What it does
Gets the most from the things that cost nothing: this site, our team, helplines, the self-check.
Why it works
For mild problems the free layer is the treatment. For moderate and severe ones it is the scaffolding between visits. Used well, it shortens the course and catches relapse. Used as an excuse not to go, it delays.
Step by step
The self-check monthly. Write the score. It tells you when to step up or down.
The questions page for the thing you were afraid to ask.
And the rule: if the score is 10 or more, or has not moved in a month, the free layer is not enough on its own. Step up.
Use it when
Daily, alongside whatever else you are doing.
Common mistake
Reading about it for six months instead of going. This page is the start of the route, not the route.
10
When the first door fails
a decision
What it does
Keeps a bad first experience (a dismissive doctor, "tension", vitamins, a therapist who was wrong) from becoming "I tried and it does not work".
Why it works
The first door is often the wrong one, because it was the nearest. A great many people who write to us "tried once" years ago and concluded help does not exist. It exists; it was behind the next door.
Step by step
Name what went wrong. Dismissed in three minutes? Told "tension" and given vitamins? A therapist who lectured? A pir who took money? Each has a next step.
Dismissed or "tension" from a general doctor: go up a step, to a psychiatrist (OPD or private). Take the list; say the score.
A brisk psychiatrist who did not explain: go back with the questions written, or find another; ask the directory or our team for one known to explain.
Medicine that "did not work": did you take it daily for six weeks? If yes, tell the doctor; the first medicine is often not the last. If no, that is the answer.
Tell our team what happened. We keep track of which doors are good, and "it did not work" is often "that door did not work".
Use it when
After any first visit that left you worse or unhelped.
Common mistake
Deciding that one bad doctor is the whole of medicine. You would not conclude that from one bad mechanic.
A flowchart by severity and place, then the situations people write to us about.
Any thought of ending your life, or unable to eat, wash, or get up most days?
↓
Yes
Psychiatry, this weekA psychiatrist this week: the nearest teaching-hospital OPD or a private clinic (directory). If in danger tonight: 1122 or the helplines. Take one person with you.
No
Where are you, and what is reachable?
↓
Big city
Everything is available; choose by score and moneyScore under 10: self-help plus our team. 10 to 19: a clinical psychologist (private at a reduced rate, a university clinic, an NGO, or online) with the OPD in reserve. 20 or more: OPD or private psychiatrist for medicine, plus therapy.
Small city or town
Hospital for medicine, online for therapyThe nearest teaching hospital psychiatry OPD for assessment and medicine (one morning, a bus). Therapy online from home. Our team between. A family doctor who has done mental-health training can start and monitor medicine if the hospital is far.
Village
The door that is there, then the next oneThe BHU or RHC doctor first: ask directly whether they treat depression and anxiety; many now do. The lady health worker as a check-in. The DHQ or teaching hospital for a psychiatric review on one trip. Online if there is signal. Our team by WhatsApp when the signal is there.
No money at all→OPD for medicine (small fee, generic tablets), a university clinic or NGO for therapy, the free layer daily. The money plan. It is a real plan.
Cannot leave the house alone→One ally for the visit (tier one); online therapy from the roof needs nobody’s permission (the setup card).
Student→The university counselling centre, free and confidential, this week. If it does not exist, the nearest teaching hospital and online.
A parent in their sixties who has "changed"→The physician they already see for blood pressure: ask that doctor to ask about mood and sleep. Then a psychiatry OPD review. Go with them.
After a birth, flat and not sleeping even when the baby sleeps→The lady health worker, the obstetrician, or the family doctor can all start this; a psychiatrist if severe. This week, not next month. Someone else takes the night feed.
Panic attacks, phobia, OCD→A clinical psychologist who does exposure-based CBT or ERP, by name; ask the question. Online is fine. A psychiatrist alongside for OCD is common.
The family insists on the pir first→Both. "We will do dum, and we are also seeing the doctor." Book the doctor the same week.
Started medicine, stopped after two weeks because it did not work→That is the expected two weeks. The follow-up rhythm. Restart with the doctor, not alone.
Do not know which of these you are→Message our team with your score, your city, and what you can spend. We will help you pick the door.
Will there be a record? Will it affect my rishta, my job, my visa?
There is no register of psychiatric patients in Pakistan that a family, an employer, a university or a visa office can search. Hospitals keep hospital records; clinics keep their own; neither is shared. Visa forms in some countries ask about serious conditions requiring hospitalisation; an outpatient course of treatment for depression is not that, and honesty on such forms has not, in our experience, cost anyone a visa. The record that actually affects rishtas and jobs is years of untreated illness that everyone can see.
Can I go without my parents knowing? I am 19.
An adult can see a doctor or psychologist privately, and confidentiality applies. If you are under eighteen, ask the clinic what their rules are; many will see you and will discuss with you what, if anything, needs to involve a parent. University counselling centres are built for exactly this and are confidential. The privacy plan covers the practical side.
I am a woman and I cannot go alone. What are my options?
One companion who will not report back: a sister, a cousin, a friend, a neighbour, a lady health worker. A women-only OPD day, which some hospitals run. A female doctor or psychologist, which you can ask for. And online therapy from the roof, which needs no permission and no companion. Many women who write to us started with the last one.
How do I know the doctor is real? There are so many "specialists".
For a doctor: the PMDC registration number, which you can check on the PMDC website, and the psychiatry qualification (FCPS, MCPS, MD or equivalent). For a psychologist: the degree (MS, MPhil, PhD in clinical psychology), the university, supervision, and a professional body. For anyone: how they react to being asked. The card has the exact questions. A hospital OPD removes the problem: everyone there is real.
The doctor said "tension" and gave me vitamins. Is that it?
No. That is a general doctor without mental-health training doing what they know. It is not a verdict on you. Take the self-check, take the score to a psychiatrist (OPD or private), and say the number. If a psychiatrist also dismisses you in three minutes, find another; our team can suggest one known to explain. When the first door fails.
Are the medicines addictive? Will I be on them for life?
The antidepressant family used for depression and anxiety is not addictive, though it must be reduced slowly rather than stopped suddenly. Most people take it for six to twelve months after getting well and then come off; people with repeated episodes may stay on longer. The "sukoon ki goli" family (benzodiazepines) is habit-forming and is for short, supervised use only; getting it from a medical store without a review is a bad idea that is very common. All of this is the prescriber’s territory; this page never suggests medicines.
Is the hospital OPD any good, or is it only for the poor?
It is the backbone of psychiatric care in the country, staffed by the same consultants who charge many times more privately in the afternoon. The visits are short and the wait is long; the medicine and the diagnosis are the same. A great many people who could afford private care use the OPD for medicine and spend the difference on therapy. The OPD day card is about getting through the morning.
What if the whole family says it is nazar and forbids the doctor?
Then the route is one ally and one private door. An adult does not need the family’s permission to see a doctor; a woman in a household where permission is real needs one person on side, or the roof and a phone. Do not fight the belief; add to it: "we will do the dum, and I am also seeing the doctor." Families that forbid the doctor in month one usually thank the person who went by month six, because they can see the difference. And if they never do, the person is still well.
Are the helplines really free and confidential?
The ones on our helplines page are free to call and staffed by trained volunteers or professionals who do not ask your name. They are for the night that is dangerous and for the first conversation; they are not treatment. Our own team on WhatsApp is the same: free, private, any hour, not treatment, a pointer to it.
I live in a village. Is there really anything for me?
More than there was five years ago. The BHU or RHC doctor, an increasing number of whom have done short training in depression and anxiety, can start and monitor common medicines; ask them directly. The lady health worker who already visits can be a weekly check-in. The DHQ or the nearest teaching hospital is one trip for a proper review. Online therapy works wherever there is signal. And our team is on WhatsApp whenever the signal is there. Rehmat’s route at the top of this page is a real route.
What does all of this cost, really?
From a few hundred rupees a month (OPD plus generic medicine plus the free layer) to several times a mid-range phone (private psychiatrist plus full-rate therapy in a big city). Most people land in between. The cost section gives the shape without pretending to give a price list, and the money plan is how to land on the affordable side.
Can Zara, your WhatsApp companion, refer me to a doctor?
Our team can help you choose a door, find one in the directory, work out what to say, and talk you through the first visit. We cannot make an appointment for you, diagnose you, or replace the doctor; we are not clinicians, and we say so. What we are is free, private, awake at 3am, and very used to the sentence "I do not know where to go".
Getting helpIf you cannot wait for an appointment↑ contents
Everything above is for the person who can get to a door this week or next. Some people cannot wait that long.
Thoughts of ending your life, especially with a plan or the means at hand.
Unable to eat, drink, wash, or get up for days.
Hearing or seeing things, or a conviction that frightens the people around you.
Having hurt yourself, or taken something.
A new mother with thoughts of harming herself or the baby.
Tonight. In Pakistan, emergency services are 1122. Any hospital emergency department will see a psychiatric emergency; go, or be taken. Our crisis helplines page lists free, confidential lines you can call now, and our team on WhatsApp is awake. Tell one person in the house, even if it is only "I am not safe tonight, please stay with me." The door can be found tomorrow; tonight is about being here to find it.
Find the doorOur directory: psychiatrists, psychologists and counsellors across Pakistani cities, including low-cost hospital OPDs, NGOs and online options. What is therapy describes the room.
Talk to our teamFree, private, any hour, in English, Urdu or Roman Urdu. Not therapy, not a crisis line, but a real place to say "I do not know where to go" and be helped to choose. Use the button at the bottom of this page.
Peer supportThe HEALING community below is people walking the same road, many of whom found a door and can tell you what it was like. Not a treatment, not for emergencies.
Everything factual on this page traces to one of these. Where we were not sure of a number, especially on cost and workforce, we said so rather than give one.
World Health Organization (2021). Mental Health Atlas 2020, country profile: Pakistan. Workforce and service figures.
Mirza, I., Jenkins, R. (2004). Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ, 328(7443), 794.
Rathod, S. et al. (2017). Mental health service provision in low- and middle-income countries. Health Services Insights, 10, 1–7.
Clement, S. et al. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.
Ghio, L. et al. (2014). Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. Journal of Affective Disorders, 152–154, 45–51.
Rahman, A., Malik, A., Sikander, S., Roberts, C., Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan (the Thinking Healthy Programme). The Lancet, 372(9642), 902–909. WHO (2015). Thinking Healthy: a manual for psychosocial management of perinatal depression.
Patel, V. et al. (2017). The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India. The Lancet, 389(10065), 176–185.
Singla, D.R. et al. (2017). Psychological treatments for the world: lessons from low- and middle-income countries. Annual Review of Clinical Psychology, 13, 149–181.
Andersson, G. et al. (2019). Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry, 18(1), 20–28.
van Straten, A., Hill, J., Richards, D.A., Cuijpers, P. (2015). Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychological Medicine, 45(2), 231–246.
NICE (2022). Depression in adults: treatment and management (NG222).
Sin, J. et al. (2017). Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis. Clinical Psychology Review, 56, 13–24.
Pakistan Medical and Dental Council: online registration verification. College of Physicians and Surgeons Pakistan: FCPS and MCPS in psychiatry. Higher Education Commission: recognised degree programmes in clinical psychology.
Pakistan Mental Health Act 2001 and the provincial mental health acts (Sindh 2013, Punjab 2014, KP 2017, Balochistan 2019), on rights and confidentiality of patients.
Written by the Depression.pk team. Reviewed for safety before publication. Not medical advice: a map, and a set of things to try. We are not clinicians; we connect people to independent professionals and do not endorse any individual practitioner. Costs and service details change; check before you travel. Last updated September 2026.
You're not alone in this
Join the HEALING community 💚
A free, kind, judgement-free WhatsApp community for people walking the same road — share when you want, listen when you can, and be reminded you matter. Peer support, not a crisis line.
House rules: privacy first · no judgement · no private messages to members · no medical advice · no selling · no politics or religious debate. Read the rules. If you're in danger right now, please use the helplines below — the group is for support between people, not emergencies. Note: group members can see each other's phone numbers, so share only what you're comfortable with.
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