What are Pakistan's educational institutes doing to manage their mental health crisis?

"Every time I missed a class or didn’t do well on a course, I went on a guilt trip that didn’t need much to spiral out of control," says A*. 

“All I could think about was the blood and sweat my parents had put in for me to get a degree. It was just too much pressure. There were times when I felt so alone that all I wanted to do was swallow a bunch of pills but in the end, I didn’t because I was afraid,” she added while talking about her time at university in London. 

While help was available, she explains, the university had counsellors who would listen but it wasn’t something she felt comfortable with.

The situation isn’t any different in Pakistan, if not worse. While people are opening up about mental health and reaching out, a large number of people still consider it taboo.

The death of Beaconhouse National University student, M* in November last year forced people on social media websites such as Twitter and Facebook, along with university/school teachers, students and parents to talk about mental well-being. According to reports, when she reached the top of the building to jump off, no one took her seriously or reported it to the administration, teachers or authorities.

And this is someone who had been vocal about her depression, anxiety and self-harm tendencies.

There are other examples as well. This summer, a university student in Islamabad killed himself due to pressure at school. In a letter, which went viral online, the student claimed that two teachers kept failing him in class because of his ethnicity which led him to his decision to commit suicide.

"You would think an educational institution's understanding of mental health would be nuanced and complex. However, driven by profit but run within opaque non-profit structures, educational institutions are worse off than say private corporations in how they handle employee (teachers, faculty) and customer (students) wellbeing.”

Similarly, in February, a medical student in Bolan committed suicide because of the constant stress and anxiety. A news report claimed that the young man had failed to clear his supplementary exams. A few days earlier, a medical student in Peshawar also killed herself for similar reasons.

Who can students turn to for help?

Students at the Dow University of Health Sciences, Greenwich University and the National College of Arts (NCA) claimed that they were not aware of any therapist on campus. Most of them said that they talk or confide in teachers or friends they are close to or.

A teacher at NCA alleged that despite M's tragic death hitting so close to home, the administration still did not take mental health seriously.

“They are not doing anything to help the students. I've been after them for many years but they laugh at me and tell me that I get too emotional or students are just doing ‘drama’,” she said, adding that when students approach her for help in dealing with stress or other problems they face, she usually refers them to trained professionals.

At universities such as the Institute of Business Administration (IBA), a first year told  Images that a student had an anxiety attack in class and the professor helped the student calm down.

“We were supposed to have an intense group discussion but this girl in my class started hyperventilating. The teacher, in an effort to calm her down, cancelled the discussion and we did a whole bunch of breathing exercises. The teacher did not single the girl out but turned it into a group activity,” she shared.

At Habib University, a student in her second year claimed that they took mental health seriously. “We have a few therapists on board and all of them are booked,” she said.

Read: Anam Tanoli's death proves we still don't know how to talk about depression

In Karachi, the death of a student shook many others for years.

“Back in 2006, a classmate of mine killed herself. She didn’t come back to school after a long weekend and eventually we found out that she had committed suicide,” said a graduate of the Indus Valley School of Art and Architecture.

“We didn’t know how to respond to what had happened or how to process it. A teacher spoke to us about it but nothing really happened. In retrospect, I think we all knew she wasn’t well. She would often get triggered and think that people were laughing at her when they weren’t. There were a few teachers who were helping/supporting her but they weren’t trained therapists."

IVSAA'S registrar, Umair Saeed reveals that when the institute made counselling mandatory, there was some reluctance on the part of some parents who don’t want their children seeing a therapist. “They say that our kid is not crazy, they don’t need help. We try to have meetings with them to explain that it's just to help their child with stress and other issues. Although I must say that this number has declined.”

A few years later, things changed at IVSAA. Former students of the 2014 and 2016 batch said that during their first semester, it was mandatory to have a session with the school counsellor.

The varsity’s registrar, Umair Saeed confirmed that they had a student counsellor who came in on a weekly basis.

“Over a period of one semester, the therapist makes it a point to meet each and every student. In addition to that, there are some students who want to meet her, sometimes parents set up appointments for their kids and teachers also flag out students who they think are struggling. These sessions are strictly confidential,” he said.

“The student body has increased over the years so we are considering bringing in more counsellors and increasing their hours etc; our new dean is looking into this very seriously. We try to have these sessions with students to create awareness about mental health and tell them that they have someone they can talk to,” he added.

According to Mr Saeed, there was some reluctance on the part of some parents who don’t want their children seeing a therapist. “They say that our kid is not crazy, they don’t need help. We try to have meetings with them to explain that it is just to help their child with stress and other issues. I must say, however, that this number has declined.”

Talking to Images, an art student claimed: “There is too much pressure here and I am unhappy with it. I have no life. Whatever time I get off I prefer sleeping in or getting out of the city. They don't give us a break. We are constantly working.” 

In some cases, students take matters into their own hands to help peers

A teacher from a private university who did not wish to be named said: “Unsurprisingly, how institutions, particularly educational institutions, understand mental health is rather simplistic. You would think because it is an educational institution the understanding would be nuanced and complex.

However, driven by profit but run within opaque non-profit structures, educational institutions are worse off than say private corporations in how they handle employee (teachers, faculty) and customer (students) wellbeing.”

She elaborated, “They seem to believe that they need to just hire a counsellor and the work is done. There is no real understanding of what mental well-being is, no thought on how to choose counsellors and what kinds of ecosystems need to be created to support the counsellor's work. Counsellors alone do not create a healthy environment to study in.

That is a result of mindfull self-reflection and leadership, creating multilayered processes that involve a series of activities in and outside classrooms and administrative policies that are inclusive and intersectional."

Which is why she explains it's absolutely crucial that educational institutions start taking this kind of reflection and work seriously because "young people today are exposed to diverse ideas around sexuality, religion, politics, mental health that resonate strongly but don’t always match their lived reality. These contradictions can cause a lot of pain and result in unfortunate emotional and physical harm.”

“The women still had better support groups to vent out. For men, it was closeted. Providing them with a safe space in terms of having a counsellor really helps them feel better. We don’t have proper statistics to back these findings but that just stresses on how grave this matter is and we urgently need proper data and policies to handle this issue.".

In some cases, students have tried to help students too. According to Anamta Rafique Ghur, who used to study at Szabist, they didn’t have any counsellor or therapist within the university at least while she was there nearly two years ago.

Along with her friend Aiman Khan, they applied for a grant to promote mental health in universities in Karachi. 

“It was a pilot and was done in minimum budget. We decided to go for peer to peer counseling. The counsellors were psychology students at Bahria University, some who had completed their degree and some who were in their last semester but with some experience. They were shortlisted after extensive interviews and later trained by a professional psychologist,” she revealed.

“We visited IBA for our two day session. Students had registered previously and were facilitated on a given time slot of almost an hour. The turnout was more than we expected. Male students had higher turn out as compared to female students.

We covered three universities. Unfortunately, Szabist wasn’t one of them due to exam schedule and our time limitation,” she added.

“I think IBA got a professional counsellor for students later on, which is amazing, slow progress but at least something was being done.

According to Anamta, one of the reasons they were motivated to pursue this were conversations they overheard in the canteen and restrooms where everyone would be like “we are anxious, stressed or depressed. With every passing day as we neared exams or final weeks loaded with essays and presentations, these talks would increase”.

Also read: Pakistanis just don't understand depression. This initiative seeks to teach us more

An interesting thing, she noted was that young men who are reluctant to publicly express their stress or depression or anxiety were the most affected ones. 

“The women still had better support groups to vent out anywhere and at any time. For men, it was closeted. Providing them with a safe space in terms of having a counsellor really helps them to vent out and feel better. We don’t have proper statistics to back these findings but that just stresses on how grave this matter is and we urgently need proper data and policies to handle this issue,” she said.

Are universities finally taking notice of the student mental health crisis at hand?

According to IBA’s HR Director Mashooque Ali Bhatti, the university has taken initiatives to maintain a healthy work-life balance for students and faculty/staff. With various facilities available on campus such as a gym, cricket ground, tennis, badminton, table tennis etc., the institute provides plenty of activities to release stress.

“Recently, the institute has pioneered  a  first-of-its-kind counselling programme for students, staff and faculty. The significance of this service has been identified while observing gradual decline patterns in some cases of students and employees,” said Mr Bhatti.

“The programme has been based on an online platform that enables the user to consult with the counsellor at their convenience. The service is being facilitated by Saaya Health, a  tech startup that provides online solutions geared towards well-being for companies and individuals."

“The idea of online counselling sessions, although newly introduced, has  been studied by the American Psychology Association; it's been concluded that online counselling is as effective as physical counselling for most issues. The uniqueness of these sessions is flexibility of time; while the user can access the service at any time, it also respects the privacy of personal/sensitive details. 

“The programme, successfully running through the institute, was initiated with a stress management workshop conducted by Saaya Health.” 

Discussing Saaya further, Mr Bhatti said: “Saaya Health has dedicated a panel of  six full-time counsellors available for the users as per mutual convenience, while IBA has had two on-campus counsellors for individuals who prefer meeting their counsellors in person.”

How has the university’s outlook on mental health changed over the years? 

“While the norm for every institute in this concern has usually been career-oriented counselling, IBA has focused on the need for counselling on all domains of stress; study/work stress, relationship problems, traumas, coping with physical illness or loss of a loved one. These elements are directly proportional to the performance and efficiency of an individual.

All faculty members dedicate certain counselling hours for students to align their academic paths and goals, while the presence of separate counsellors at the on-campus Martin Dow Clinic are some of the measures taken to ensure healthy well-being of the students. With the latest initiative being online counselling, IBA is ahead of its time in the discussed subject.” 

Alizeh Valijee who heads Saaya said: “Saaya is currently providing its online mental health solution to IBA. We are approaching other institutions and companies as well to increase access to quality mental health support.”

When someone on campus commits suicide, the entire student population becomes at risk of developing mental health issues

Looking at M's case, Alizeh explained what a university should do if a student/faculty member does something similar.  

“Ideally, universities should be focusing on preventing such cases from happening. The focus should be on improving mental health of students, faculty and staff by firstly offering mental health awareness sessions/stress management trainings, secondly enabling avenues for healthy coping within campus through sports, yoga, meditation, community activities and finally offering counselling to those who are at risk of developing more severe mental health issues. "

She added: “When someone on campus commits suicide, the entire population becomes at risk of developing mental health issues, because that's a trauma they have faced. It's definitely a good idea to offer counselling on campus after a campus suicide and it's important to keep the service open for an extended period of time as some people may suffer the impact at a later stage.” 

“The idea of online counselling sessions, although newly introduced has  been studied by the American Psychology Association; it's been concluded that online counselling is as effective as physical counselling for most issues. The uniqueness of these sessions is flexibility of time; while the user can access the service at any time, it also respects the privacy of personal/sensitive details."

According to AKUH faculty member Professor Murad Moosa Khan, the university has seen five to six  suicides  over 30 years and this led to management taking some serious decisions.

“At AKUH, we take mental health very seriously and have a proactive approach. We hold stress management seminars and other activities to help our students. We also have an in-house team of therapists and psychiatrist and another one who is not from the faculty to give students a safe space,” he said.

BNU’s Zaeem Yaqoob claimed that in early 2017,  BNU  established a counselling center under the title 'Center for Counseling and Psychological Well-being' whereby there is a full-time counsellor available on campus.

“The process for referral to the counsellor is simply either by faculty recommendation or when a student approaches the counsellor directly. In the case of former, the relevant  BNU  School approaches the parents of the student to seek their consent to refer the student to the on-campus counsellor (in case of some students the issue is already in the knowledge of the parent and they are seeking help elsewhere).

The counsellor also maintains a longish list of external specialised counselling experts and practitioners that can be shared with students, staff and parents,” he said.

“As per established standards of counselling practice, all counselling sessions and their details are kept strictly private and confidential and the only authorized person to have access to these is the counsellor.  

Besides, we have an Institute of Psychology (IP) that offers undergrad, graduate and post-graduate degrees (PhD) both in specialised and applied areas of psychology and is also in the forefront of a number of research activities undertaken at  BNU  under the able leadership of long-time and renowned academic in the area of psychology, Dr Ruhi Khalid,” he added.

Talking about how the university dealt with M's case, Mr Yaqoob said: “In the aftermath of the incident, the Vice Chancellor held a town hall with faculty and stressed the need for being more vigilant in identifying emotional challenges of students and their referral to the counsellor, since in this particular case, nothing had been reported by faculty and neither had the student sought any help from the counsellor.

Group grievance counselling sessions were held for the immediate affectees of the incident, her class-fellows and friends as well as for staff separately. Individualised sessions were also facilitated for those who sought individual help.”

He added, “A regular feature in the annual calendar of our co-curricular activities is the Mental Health Day featuring Inter University Poster and Quiz Competitions, Psychometric Assessment Services and Mental Health Carnival to engage students from within and outside  BNU  to overcome taboos associated with mental health in innovative ways.

The proceeds from these activities are donated to different non-profits working for equitable access to mental health facilities for the underprivileged persons.” 

A parent’s input

Azfar Naqvi, a parent who lost his child last year to  suicide  said: “As parents, we have to work very hard to have an equation with your child – what I am telling you, is something my wife and I did with our kids and yet we lost a child. Kids will talk to friends, cousins, not parents. You need to create a safe space. It is important to have a secure family life. Especially during their teen years and if your child doesn’t talk, then you need to come up with activities to engage them.

After my son’s death, I have started taking interest in my younger son’s activities. We walk together, we watch football together or play badminton.  He won't talk once, he won't talk twice, eventually he'll open up.

He reiterated that parents need their children to know that they will always be there for them: "Parents take more credits for their kids achievements here; there is immense social pressure. It is so lethal, the duress that puts on a child."

Names have been changed to protect individuals' identities.

This article was originally published on 17 July, 2019.