Pakistan stands at a quiet but profound turning point. The seasons we once knew no longer behave as they used to. Winters pass too quickly and too dry, heatwaves linger like uninvited guests, and monsoons—once predictable and life-giving—now arrive heavier, longer, and far less forgiving. What once nourished fields increasingly washes them away. Crops fail or flood, livelihoods fray, food prices rise, and families already stretched by inflation and poverty feel the pressure tighten further.
These shifts do not remain confined to weather charts or policy documents. They seep into daily life, reshaping how people plan, worry, and hope.
Beneath the visible damage runs a quieter, deeper current: climate anxiety. It rarely announces itself, yet it is everywhere. It lives in the questions young people ask themselves about whether there will be enough water for their land, or work for their hands. It sits with parents counting each rupee, wondering how they will protect their families when the next shock comes. It strains households, deepens silences, and leaves those displaced by floods or landslides feeling unmoored from the people and places that once gave them stability.
Dr Khalid Mufti, a psychiatrist working on flood-affected communities in Khyber Pakhtunkhwa, has observed how environmental shocks can affect mental health long after the waters recede. As he notes, “Climate change is not just an environmental or weather-related issue; it is also a serious mental health challenge.”
That challenge weighs heaviest on those already carrying the most: women holding households together amid scarcity, children absorbing their parents’ quiet fear, the elderly watching social support networks dissolve, and rural communities far from Pakistan’s limited mental health services. With roughly one psychiatrist for every 360,000 people, most of them based in cities, the distance between suffering and support remains vast, widened further by stigma and silence.
Weak governance and persistent fiscal strain sharpen this anxiety. Devolution has left local systems unevenly prepared, district disaster management units under-resourced, and national policies slow to translate into protection on the ground. Tight public finances further constrain the state’s ability to meet basic needs—health, housing, livelihoods—leaving vulnerable populations exposed even in normal times.
Economic pressures compound this sense of exposure. Inflation may have eased, but poverty still grips roughly a fifth of the population, more so in rural areas. Growth remains modest, jobs scarce, subsidies thin. Each climate shock—a lost harvest, a damaged home, rising food costs—pushes families closer to the edge. What begins as worry about the climate quickly becomes fear about survival. Over time, this erodes hope and adapts feel like an impossible luxury.
If mental health systems remain weak, the psychological toll of the next disaster could be as devastating as the physical one
These gaps are now fuelling a deepening mental health crisis: national estimates suggest that one in four Pakistanis, over 50 million people, experience some form of mental health condition, with depression and anxiety among the most widespread, yet the vast majority receive no formal care.
Climate stress is magnifying this burden. Repeated floods, heatwaves, displacement, and economic shocks push already fragile households into chronic uncertainty, turning distress into long-term anxiety and trauma. Yet this growing need unfolds amid a severe shortage of care. Fewer than 600 psychiatrists serve a population exceeding 240 million, most concentrated in major cities; clinical psychologists, psychiatric nurses, and trained trauma counsellors remain similarly scarce.
At the district level, functional mental health units are rare, and in many climate-affected areas, there is simply no accessible clinical facility or trained professional to support people once emergency relief fades.
Recent disasters have made these costs impossible to ignore. The floods of 2022 affected more than 33 million people, claimed over 1,700 lives, and left behind a heavy psychological toll—widespread depression, anxiety, and post-traumatic stress that continues to surface years later. The monsoons of 2025 reopened those wounds, particularly in Khyber Pakhtunkhwa, where cloudbursts, landslides, and flash floods killed more than a thousand people, many of them children, and displaced millions.
Survivors speak of fear that returns with every dark cloud, of guilt for those who did not survive, of nights spent awake reliving the sound of rushing water. Dr Mufti, drawing on years of frontline work, notes with quiet urgency: “Extreme heat, floods, droughts, and other natural disasters cause fear, anxiety, depression, and in some cases, Post-Traumatic Stress Disorder.”
In the immediate aftermath of such crises, timely mental health support matters. Horizon and its partners have shown how community-based counselling, mobile psychosocial teams, and trauma-informed care can help people steady themselves—giving language to grief, restoring routine, and slowly rebuilding trust in life.
But the deeper lesson is longer-term. As Dr Mufti reminds us, “Strong mental health is not only essential for individual well-being but also strengthens community resilience, fosters mutual support, and reduces the long-term impact of disasters. When minds are not safe, society itself cannot remain safe.”
Pakistan’s policy framework already hints at this understanding. The National Climate Change Policy acknowledges psychological impacts, the National Disaster Risk Reduction Strategy includes mental health and psychosocial support as part of recovery, and recent emergency responses have leaned on humanitarian partners for screening and referrals. These are important beginnings—but they are not yet enough.
What is now required is faster, more deliberate action. Mental health must be woven into climate planning, not added as an afterthought once damage is done. Disaster protocols should routinely include psychological first aid. Lady Health Workers and community responders should be trained to recognise distress early.
Rural services must be expanded, stigma addressed through schools, mosques, and media, and economic support delivered quickly enough to prevent anxiety from hardening into despair.
Horizon’s telepsychiatry initiative in Bajur illustrates how targeted services can reach remote communities, with a dedicated team equipped with medicines, essential equipment and arrangements to transfer patients needing advanced care to Peshawar. Such models point to the kind of integrated approach the government could adopt to embed mental health into climate planning.
This urgency is not theoretical. NDMA projections warn that the coming monsoon may arrive earlier and bring significantly heavier rainfall than last year, raising the risk of glacial lake outburst floods, flash flooding, and landslides across already vulnerable regions. If mental health systems remain weak, the psychological toll of the next disaster could be as devastating as the physical one.
By listening to voices like Dr Mufti’s, grounded in years of care, research, and compassion and by acting now rather than later, Pakistan can meet a changing climate with steadier minds and stronger communities. In the face of what lies ahead, that human-centred shift may prove not just wise, but essential.