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IMPACT – Integrating Mental Health through Primary Care and Community Ties


Pakistan reports one of the highest rates of psychiatric morbidity in the world, with 66% of women depressed and with the prevalence of depression and anxiety at 34% in the general population (Mirza, 2004).  It is estimated that approximately 50 million people suffer from common mental disorders.  

Currently, just 0.4% of the budget is allocated to health (WHO,  2009), with a negligible amount of this allocated to mental health. On the other hand, the economic  burden of mental illnesses in Pakistan is estimated to be US$ 4.2 billion annually, 90% of which is met  through out-of-pocket expenditure. (Malik & Khan, 2016)

There is an urgent need to address barriers to mental health care, and improve access across communities who are most affected.


IMPACT was launched in an effort to integrate mental health services within existing Primary and Tertiary care centers across Pakistan. 

The program has the following components:

Partnerships – IRD has been working in partnership with hospitals and in healthcare provider settings in Pakistan since 2004. The mental health team has also been involved in several facility-based projects in the last few years and has developed collaborative partnerships with three of the largest primary care networks in the city of Karachi. (SINA, ZMT and IHHN)

Training of Lay Counselors – IRD has developed and tested a training manual on Basic Counseling Skills. This manual includes modules on the basic signs and symptoms of depression and anxiety; the importance of mental health; introduction to  counseling (types, roles, stages, effective counseling techniques); basics of interpersonal communication; and problem solving techniques. 

Use of a mHealth app – This app was developed with initial seed funding from Grand Challenges Canada and is a screening  platform for depression and anxiety. It is used by Mental Health Workers to screen, register,  enroll and input treatment progress/follow-up information about clients.

Training and Supervision Model – Since our model utilizes lay counselors, it is important to  ensure adequate training for them to be able to provide first line counseling for depression and anxiety,  supplemented with strong quality assurance mechanisms. An 8-day Basic Counselling Training is followed  by bi-monthly refresher training/group sessions. Each counselor meets with our team psychologist for weekly supervision sessions in addition to weekly spot checks by the program team.


Since 2018, the program has integrated mental health services at 20 primary care facilities with 52 counsellors trained and deployed to provide mental health support. 

Over 156,000 patients visiting primary care clinics have been screened for depression & anxiety with 6% presenting with symptoms requiring further intervention. 

Over 10,000 counselling sessions have been conducted with 2,307 people completing the intervention  with improved mental health outcomes.

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