The National Roundtable on Mental Health Law Reform, held in Islamabad on March 25, 2026, marked a key moment in Pakistan’s evolving approach to mental health governance.
Organized by the Mental Health Strategic Planning and Coordination Unit (MHSP&C Unit) under the Ministry of Planning, Development and Special Initiatives, and supported by international partners, the roundtable brought together a diverse group of stakeholders from federal and state governments, international organizations, professional bodies, and policy experts. More than just a consultative exercise, the conference served as an important platform to align perspectives, identify systemic gaps, and build consensus on the future direction of mental health law in Pakistan.
The debate was rooted in the common recognition that Pakistan’s mental health legal framework, while cross-jurisdictional, remains largely ineffective in practice. Participants noted that the 2001 Mental Health Ordinance, originally enacted to replace colonial-era legislation, no longer reflects modern human rights standards, particularly those outlined in the United Nations Convention on the Rights of Persons with Disabilities. State laws enacted between 2013 and 2019 have attempted to localize this framework, but still face similar structural and operational limitations. This roundtable provided an opportunity to frankly acknowledge that legislation alone does not lead to meaningful service delivery or organizational accountability.
Opening remarks emphasized the urgency of moving from fragmented legal provisions to a harmonized rights-based implementation strategy. The Chairs emphasized that effective mental health governance requires not only legislative reform, but also institutional strengthening, cross-sector collaboration, and sustained political engagement. This framework set the tone for deliberations, consistently returning to the gap between policy design and reality on the ground.
A major portion of the roundtable focused on the legislative review process led by the MHSP&C Division. Participants were briefed on the introduction of international guidance frameworks for assessing existing laws against rights-based criteria, particularly those developed by WHO and OHCHR. The presented methodology, which combines legal analysis, stakeholder consultation, and a comparative statewide review, was widely praised as a structured, evidence-based approach. It also highlighted the complexity of reform, given the need to balance international standards and local institutional capacity.
State representatives provided detailed explanations of the current state of mental health laws in their respective jurisdictions, providing valuable insight into both progress and constraints. Sindh’s experience reflected gradual progress through regulatory reform and policy development, but implementation remained incomplete. While Punjab’s law reform efforts have demonstrated technological progress, they have also exposed procedural bottlenecks.
Khyber Pakhtunkhwa’s notified but non-functional authorities indicated a gap between formal establishment and operational readiness. Resource constraints have limited operations in Balochistan, and AJK continues to rely on the revised version of the 2001 ordinance, further reinforcing the uneven situation between regions.
Collectively, these interventions highlighted a common pattern in which, although legislative intent exists, institutional capacity and resource allocation remain inadequate.
Contributions from international partners and technical experts added a broader range of perspectives to the discussion. Emphasis was placed on integrating mental health within broader legal and policy frameworks, including health, social protection and humanitarian response systems. The need to address vulnerable groups, especially women, children and communities affected by the crisis, was strongly expressed. These inputs reinforced the idea that mental health cannot be treated as an isolated issue and must be embedded within an overall governance framework.
One of the most important themes to emerge from the roundtable was the lack of clear monitoring and accountability mechanisms. Participants repeatedly pointed to ambiguity surrounding the role and powers of mental health authorities and overlap with existing healthcare regulatory bodies. This lack of clarity contributes to organizational inertia, with distributed responsibility and delayed implementation. The consensus on establishing a consistent national coordination mechanism reflects a shared understanding that federal leadership is essential to guiding and harmonizing state efforts.
The roundtable also included a substantive discussion on the conceptual shift needed in mental health policy. Participants advocated for a biopsychosocial approach that goes beyond a purely biomedical model and integrates mental health into primary care and community-based services. This change was considered essential to expand access, reduce stigma, and align services with individuals’ life realities. The inclusion of mental health and psychosocial support (MHPSS) in the context of climate change and humanitarian crises further broadened the policy horizon and recognized the intersection of mental health and broader social and environmental challenges.
Importantly, the roundtable was not limited to diagnosis. We also outlined our future direction. A key outcome was an agreement to develop a digital survey tool to systematically assess rights-based disparities and implementation disparities across states. This initiative represents a shift towards data-driven policymaking, allowing for the collection of structured stakeholder feedback and the creation of a comparative evidence base. Participants recognized that such tools could serve as the basis for more informed and targeted reforms.
Based on this, the discussion naturally expanded to the idea of local scorecards as a mechanism for turning data into action. Although not formally institutionalized at the conference, the concept gained traction as a logical next step. Scorecards can provide a transparent comparative framework for performance evaluation by evaluating states and federal capitals using standardized indicators such as legal integrity, organizational capacity, and service delivery outcomes. This approach not only facilitates benchmarking, but also introduces a constructive element of competition and encourages states to improve their position through concrete reforms.
The proposed mechanism envisions a hybrid model that combines survey data with hard evidence from legislative documents, institutional records, and service delivery indicators. Such an approach ensures that the evaluation is grounded in reality and reflects the experiences of stakeholders. Over time, this may evolve into an annual reporting system that allows for continuous monitoring and policy improvement. Because the MHSP&C department occupies a central position in coordinating legislative review, its role in managing this process was tacitly acknowledged.
As the roundtable concluded, there was a clear sense of both urgency and opportunity. The discussion moved beyond general calls for reform to a more nuanced understanding of challenges and solutions. The emphasis on coordination, data and accountability signals a shift towards a more mature policy debate that recognizes the complexity of mental health governance and the need for sustained, multi-level engagement.
In essence, the Roundtable reframed mental health law from a static legal issue to a dynamic governance challenge. The report emphasized that the future of mental health in Pakistan depends not only on changing laws, but also on building systems that can effectively implement them. Bringing together federal and state stakeholders, international partners, and technical experts formed the basis for collective action. The real test will be translating this agreement into concrete results and ensuring that mental health is not just legislated, but realized as a fundamental right for all citizens.
The author is a public policy expert and heads the World Economic Forum’s Country Partner Institute in Pakistan. He tweets/posts at @amirjahangir and can be reached at: [email protected]
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