Taskeen Mental Health Initiative

Taha Sabri is a doctor working in public health in Pakistan. He got his medical degree from Aga Khan University Hospital in Karachi in 2014. When he was a student, he volunteered as a relief worker in communities affected by disasters. This, along with personal experiences of mental illness, helped him see the immense burden of mental health problems in Pakistan and inspired him to co-found Taskeen in 2015. He now serves as its Chief Operating Officer and consults for other mental health organizations in Pakistan. He was granted a Fulbright scholarship to study Global Health at the University of Washington in 2016 followed by the Acumen fellowship in 2019. He is passionate about developing scalable and sustainable programs that can ease the suffering of those affected by mental health problems. Aside from work he enjoys exploring poetry, philosophy, water sports and the performing arts.

1. Modern human societies tend to define health in mostly physical terms, with psychological well-being not being given its due importance. Cultural forces, like materialism and toxic masculinity, are making people focus on physical gratification, resulting in the neglect of our psychological needs. This is manifesting in the form of the lack of awareness about mental health, and unavailability of mental health services for sufferers, leading to a surge of mental health problems, substance abuse and suicides globally, and particularly in Pakistan.  

2. Taskeen (Urdu: to comfort) focuses on bringing about health behavior change by equipping people with the knowledge, skills, and support to take care of their mental health, so they can live happier and healthier lives.

3. We believe that if human beings can develop resilience against distress and cultivate healthier minds, they can achieve holistic well-being leading to more fulfilling relationships and a happier society. 

Psychological illnesses have become a significant global health problem due to their increasing burden around the world. Depression has been estimated to be the leading cause of disability globally. In Pakistan, estimates before the COVID crisis indicated that 25% of the population was affected; approximately 50 million people. A recent study that we conducted during the COVID crisis revealed that 60% of respondents reported experiencing psychological distress, meaning now potentially 120 million people may be at risk.

Some major causes of mental illness in Pakistan are the patriarchal nature of society and female oppression, leading to women being the worst affected. Toxic masculinity discourages men from expressing their distress in a healthy manner, causing them to adopt harmful behaviors and develop mental health problems. This then leads to unhealthy parenting of children, who go on to participate in this cycle of suffering. In addition, those suffering from mental health problems do not get the help that they need due to lack of awareness about the importance of mental health, stigma against mental illness, and lack of adequate mental health services. All of this results in tremendous suffering for people affected by mental health problems, and their families.

Our vision is a Pakistan in which everyone can manage their distress effectively, and those affected by mental illness can get the help that they need. Our objectives are to:

1.) Become pioneers in the promotion of mental health and prevention of mental illness by:
a. Raising awareness about the importance of mental health and reducing the stigma against mental illness.
b. Educating people about the causes, signs, symptoms, and management of mental health problems.
c. Encouraging healthy expression to help people build their resilience and prevent mental illness
d. Promoting healthy communication between people so they can live in harmony.

2.) Become advocates for mental health by:
a. Establishing the importance of mental health at par with physical health among the key stakeholders in the country
b. Lobbying the government to sufficiently address mental health in the national healthcare policy and allocate substantial funds for it.

For objective 1, our activities include producing digital content that is distributed through social media, mass media, and community-based mediums. For objective 2, we are conducting national mental health studies and forming a national mental health coalition to help us successfully lobby the government for policy change and investment in mental health.

Our project serves those at risk of developing mental health problems, and those living with mental illness. Since mental health problems do not discriminate, our target population is the entire nation.

Anyone can develop mental health problems if the intensity of the distress they experience overwhelms their resilience; the ability to cope with stressors in a healthy manner. We help those at risk by educating them about ways of managing distress and strengthening their resilience, so that they can prevent the onset, or worsening, of mental illness. 

Those who are suffering from mental health problems often do not seek help because of stigma and lack of awareness. We conduct public mental health information campaigns, to give hope to those who are suffering and encourage them to seek help. We also have a mental health helpline that people can reach out to for support. 

Over the past 5 years we have conducted anthropological research to understand the cultural conceptualizations about mental illness, enabling us to develop culturally relevant content. In addition, most of our employees are either caregivers or those with lived experience of mental illness, and we feel the inclusion of this perspective is critical for developing effective content.

Mental health is a global issue and, along with climate change, is considered to be one of the wicked problems humanity has to contend with in the 21st century. Our project is focusing on increasing mental health awareness and embarking on advocacy efforts to drive action to address the gaps. As a result, it aligns very well with the second dimension of the prize.

In 2013, while in medical school, I was involved in relief efforts at a bomb blast site in Karachi. 3 weeks after the bomb blast, while working at a medical camp, I met a 7-year-old girl who had not spoken since the day of the blast even though she had no physical trauma of any kind. Upon inquiry it was revealed that she had identified her father’s remains through a ring on a charred finger, which was all that was left of him. It was evident that it was a psychological problem, but we were not equipped to deal with it. When we referred her to a mental health professional, the family refused since they were cynical about the utility of the service, and they were afraid their daughter would get labelled as “crazy”. This incident helped me realize the hidden burden of mental health problems in our society, the lack of services to address them and, most importantly, how stigma prevented sufferers from accessing services.

After graduating from medical college, I met like minded professionals, sufferers and caregivers who also felt that mental health was not properly addressed in Pakistan. In January 2015, we decided to launch Taskeen.

In early 2012, I was admitted to the psychiatry ward of my medical college after having struggled for years with depression, hyperactivity and addiction which culminated in an overdose on prescription medications. I was diagnosed with bipolar disorder and started on treatment. The journey of recovery was difficult, but during its course I was able to understand the challenges that sufferers face, including the tremendous stigma against mental illness in Pakistani society and the exploitation in the mental health industry. However, I was still lucky since, due to my medical background, I was able to access opportunities because of which I was able to recover.

Further research into the field and other experiences helped me see that mental health is an uncharted territory globally, and humanity’s understanding of it is still in the embryonic stages. My personal experiences, along with the tremendous need, fueled a fire within me to take action to address the social injustices and inequities that people with mental health problems experience. I hope that through my efforts, those who are suffering will not have to experience the challenges I experienced and are able to avail the opportunities that helped me get better.

I feel that the most important quality that makes me uniquely positioned to work in this field is my lived experience. I really value the suffering I underwent since it seems to have prepared me for this role. Therefore, my loyalties lie first and foremost with the sufferers and not with an industry with a history of exploitation of those it serves. 

My medical background provides me with the technical expertise regarding the clinical aspects of mental health problems. In addition, I completed a MPH in Global Health with a specialization in Global Mental Health from the University of Washington in Seattle. This experience enabled me to understand population level aspects of mental health including the societal determinants of mental health and the root causes of mental illnesses in our societies. It also enabled me to develop essential organizational management and policy development skills which are proving invaluable in the work I am currently doing. 

Over the past 7 years I have worked with 8 mental health organizations (some often simultaneously) in Pakistan. Through this I have gained experience in the primary, secondary, and tertiary levels of mental health care. This includes mental health awareness and stigma reduction campaigns, mental health integration into primary care, disaster response mental health interventions and psychiatric rehabilitation. 
For all these reasons, I feel that I am uniquely poised to make a huge impact in the mental health field and alleviate the suffering of those experiencing mental health problems.

When I initially conceived of Taskeen as a survivor led movement, I approached the top psychiatrists of the country for support. After hearing about it they were not convinced, stating that mental health awareness was the domain of clinicians only. They also considered those with lived experience to be unstable and incapable of working effectively on this.

While initially demoralizing, this experience helped me understand that mental health stigma was present even in the clinicians, and further strengthened my resolve of involving those who had suffered to further the cause. Fortunately, I was able to meet other survivors, caregivers and professionals who had faith in the cause and together we were able to build Taskeen into one of the most important voices in mental health in Pakistan, today.

Through our efforts, we have also earned the respect of the skeptical psychiatrists, who now not only assist us with our efforts, but are also regularly praising us publicly. I learnt from this experience that in the face of resistance, sometimes it is better to be steadfast and let your work speak for itself. And perhaps you may, eventually, even win over your fiercest critics. 

When the COVID crisis began in December 2020 most people thought that it won’t affect Pakistan. After seeing the trajectory of the pandemic internationally, it was clear to me that Pakistan would also be severely affected with the socio-economic complications of the lock down causing an increase in mental health problems. Therefore, Taskeen began developing a COVID mental health strategy. When the first lock down took place in March, it left the entire country in chaos. The mental health industry was not spared, and all the community level services stopped, thrusting everyone into confusion. At this point Taskeen started its COVID mental health information campaign. I then approached other mental health organizations and convinced them that COVID was here to stay and we must pivot our activities accordingly. This led to the creation of the Pakistan COVID Mental Health Response: a coalition of organizations offering free of cost mental health services to the public through digital means including awareness campaigns, mental health helpline, online workshops and tele-mental health consultations. In addition, we also convinced our international partners, the global “Speak Your Mind” campaign, to use COVID as an opportunity and adapt advocacy efforts accordingly. 

Most contemporary approaches towards mental health are based on a reductionistic biomedical model, that focus on the manifestations of the problems and not on the root causes. Our model of holistic well-being seeks not just to identify and treat illness, but to promote wellness by bringing about behavior change to address the root causes of suffering in our society. By focusing on the upstream causes, we are more likely to have a more sustainable and wide-ranging impact than a narrow focus on downstream manifestations.

It is difficult for a purely clinical approach to do justice to a phenomenon as abstract and profound as human consciousness. Therefore, we feel that in addition to professional expertise, learning from those with lived experience is critical for us to develop interventions that do justice to our beneficiaries. All the members in our leadership team are those with lived experience of suffering or providing care to sufferers, and so their perspectives have been invaluable in helping us achieve our success. 

While some aspects of the human experience are universal, there are others which are determined by the cultures we have been exposed to. Mental illness is an aspect that is culturally determined, and therefore understanding indigenous conceptualizations of mental health and illness is essential to develop culturally relevant programs. We recognized this early on and conducted anthropological research which has proven extremely useful in helping us develop effective content. 
All these innovations have helped us create a new dimension of performance.

Currently: 100,000

One year: 500,000

5 years: 5 million

Taskeen is still a young organization since even though it has existed for 5 years, it was legally registered in October 2019. Our vision is to develop Taskeen into an institution of excellence so that it can continue to make an impact long after the founders are gone. That is why we are cognizant of the fact that we must build the organization up slowly but surely. For the next year, Taskeen’s goals are:

1.) Scale up our public mental health information campaigns on social and mass media.
2.) Develop and pilot our mental health helpline.
3.) Start development of the AI powered mental health BOT.
4.) Conducting nationwide studies to ascertain the true burden of mental health problems.
5.) Establish the Pakistan Mental Health Coalition and being engaging relevant stakeholders. 
6.) Establish the South Asian Union for Mental Health: a regional coalition of mental health organizations. 

The goals for the next 5 years include:

1.) Continuing to scale up our public mental health information campaigns.
2.) Scale up our mental health helpline and facilitate more people.
3.) Launch the AI powered mental health BOT and continue to fine tune it.
4.) Work with the national coalition to develop a “National Charter for Mental Health”.
5.) Use the research data, “National Charter for Mental Health”, and partner stakeholders to lobby the government to bring about policy change and increased investment in mental health.
6.) Work with the regional coalition for sharing of mental health resources, joint fundraising, and joint advocacy efforts. 

The problem we are addressing is quite challenging since its root causes are multi-dimensional and are reinforced by structural and cultural pressures. We foresee the following potential barriers that we may face and are currently facing:

1.) Financial: mental health is not given the importance it should, and so funding opportunities are limited from both national and international sources. Potential funders are usually more interested in investing in curative solutions rather than the preventive work that we are doing. 
2.) Technical: some of the programs we have envisioned, such as the AI bot, may require technical expertise that may not be accessible in Pakistan. In addition, getting expertise for monitoring and evaluation of public mental health information campaigns is difficult since these types of interventions are new for Pakistan. 
3.) Legal: the legal processes in Pakistan are quite slow; it took us almost 2 years to get our organization registered. Due to international pressures such as the FATF non-profits, particularly those receiving foreign funding, have come under increased scrutiny by the state. This entails increased paperwork and getting clearances from multiple state agencies which makes work very tedious. 
4.) Cultural: the stigma against mental health has been reinforced by centuries of cultural attitudes and practices such as patriarchy and misinterpretation of suffering from a religious perspective. These attitudes will not be easy to change and there may also be resistance to change in the shape of a public backlash against our organization. 

1.) Financial: through our advocacy program we are conducting nationwide research and conducting lobbying activities to make government and civil society stakeholders understand the importance of investing in mental health. We hope that through these efforts, there will be increased funding sources in the future through government funds, corporate CSR funds, Zakaat (Islamic annual wealth tax) and other sources.

2.) Technical: to overcome potential technical challenges, we may experience, we are planning to commission a feasibility study pertaining to the AI BOT that we are developing. Through this study, we will understand whether the technology we require exists within the country or will have to be sourced internationally.

3.) Legal: to overcome legal challenges we have hired one of the best law firms in the country who are providing their services at a subsidized cost. We are also looking to establish relationships within the state apparatus that will help us overcome any roadblocks that we may encounter. We have also instituted organizational processes and policies to ensure excellence and transparency in governance so that we will not face any problems in the future.

4.) Cultural: to prevent a backlash from society we aim to get religious institutions onboard and support us with their credibility. This will decrease the risks associated with resistance to our content due to religious misinterpretation. In addition, we will ensure that the content we create is sensitive and tries to address problems in a culturally respectful manner, to make it more palatable for the masses.

1. Mental health service providers; organizations that provide mental health services to the beneficiaries that we refer to them:

• Aga Khan University
• Sehat Kahani
• Saaya Health
• Interactive Research and Development 

2. Mass media partners; mass media channels that partner with us to conduct weekly segments on mental health on television

• Dawn TV
• SAMA TV

3. Social media partners; social media channels that partner with us to help us distribute our content on social media:

• Newsline
• School of leadership

4. Research agencies; research consultants who partner with us to conduct nationwide mental health studies:

• IPSOS International

5. Community based organizations; organizations working on the grassroots who partner with us to distribute our content to low income communities:

• Interactive Research and Development
• Sehat Kahani
• TAF Foundation
• Development in Literacy
• Zindagi Trust
• Orangetree Foundation

6.) Content production; production companies that partner with us to produce our content at a subsidized cost:

• Social Junction
• Radical
• Qaumi Coup

7. Advocacy partners: organizations that assist with our advocacy efforts on the international front.

• Speak Your Mind
• United for Global Mental Health

Since we don’t charge for any services, our projected major sources of revenue during the initial years are grants and donations. This includes grants from international institutions, local corporations, and donations from wealthy philanthropists and our board of directors. For future financial sustainability we are currently working to develop a paid corporate mental health program through which we hope to sustain some of our activities. This includes developing an innovative technological platform to deliver individualized mental health care to employees of companies. In addition, we hope that our advocacy efforts will be successful in making the state allocate substantial funding for mental health and that can be a potential future source of funds.

1.) Philanthropists (Zakaat/Donation): $ 9,417

2.) Local corporations (Donation): $ 26,012

3.) Taskeen Board (Donation): $ 18,828

4.) International institutions (Grant): $ 29,940

5.) Total: $ 84,196

Due to the nature of our work, we conduct financial planning on an annual basis. At the moment, we have enough funds to cover our activities for the next 6 months. For the rest of the year we are currently in talks with international funding institutions and seek to raise around $50,000 to cover our costs. Apart from this year, we are also looking to raise funds for the future. 

1.) Human Resource (Core team costs): $ 44,551

2.) Admin (Legal, finance, overheads): $ 12,575

3.) Program (Content production, research, AI BOT): $ 69,665

4.) Total Cost: $ 126,790

There is great alignment between my vision and the vision of the elevate prize; to work for the psycho-spiritual evolution of human beings. However, I feel that currently I do not have the intellectual and financial resources to realize my vision. This is what I hope that The Elevate Prize can help me with. The financial aspect of the prize can help relieve the pressure of fundraising and enable me to focus on program development and implementation. Access to world renowned scholars, mentors and institutions can help me develop technical skills, particularly with regards to the technology platform that we hope to build and evaluation of the impact of our programs. Learning best practices regarding organizational management can help us develop an efficient organizational structure that can help us navigate through the legal challenges we are experiencing. If I get selected, then I am looking forward to learning from my peers about similar socio-cultural challenges they face in their work and the strategies that can be used to mitigate them. 

1.) Funding: to develop a business model that can help us sustain the core work that we are doing for years to come.

2.) Mentorship: to learn skills to help me navigate through the socio-cultural challenges I may experience due to my work.

3.) Legal: to learn more about organizational management to develop an efficient organizational structure

4.) Monitoring and evaluation: to get technical support for monitoring the impact of our programs.

5.) Marketing and media: to facilitate increased exposure of our work so we can reach more people and have a bigger impact.

While there are numerous organizations that can benefit us, some organizations that we would like to partner with are mentioned below. 

1. MIT: to provide us with the technical expertise to build and improve our technology platforms.
2. Netflix: to develop films/TV series on mental health and well being.
3. Youtube: to increase the reach of our content and services.
4. Facebook: to increase the reach of our content and services.
5. Instagram: to increase the reach of our content and services.
6. TikTok: to increase the reach of our content and services.
7. Linkedin: to increase the reach of our content and services.