The Prime Minister’s Strategic Reforms Initiative has launched a mobile/web-based application for the mental wellbeing of citizens, named Humraaz along with an integrated helpline, which can be reached at 1166. This has been developed in collaboration with the Ministry of Health Services, Regulations and Coordination, the World Health Organisation (WHO), the National Information Technology Board (NITB) and the Federal Directorate of Immunisation.

Since the pandemic, mental health applications and resources have seen a big boom. While initially there were some fears about technology replacing traditional methods of psychotherapy, this discussion died down once “Zoom fatigue” set in, which is the exhaustion, worry or burnout associated with overusing virtual platforms of communication.

Still, mental health applications are here to stay due to their greater convenience, the lack of travelling costs, their anonymity, their immediate and constant support and the high engagement rates for people who might not be willing to go to a mental health clinic because of stigma, anxiety or any other reason.

Research done on the efficacy of mental health apps shows that virtual assistance can never replace the human element involved in traditional psychotherapy. However, they have been shown to be very successful when used in conjunction with therapy, through regular check-ins, symptom and mood trackers, reminders, interactive exercises and community features to set goals and chart progress.

A new mental health app launched by the government is a laudable initiative in a country with a burgeoning demand and inadequate supply for mental health support. But there are some critical weaknesses in the app which need immediate attention

THE PROMISE OF VIRTUAL

In a struggling economy such as Pakistan’s, virtual mental health initiatives bridge the gap between the burgeoning demand and inadequate supply for mental health support. It makes quality mental health accessible to people from rural or low-income areas. In that vein, a national mental health app and helpline is a significant milestone.

The webpage of Humraaz boasts that more than 150 registered doctors and psychologists are available on their panel. The key features of the Humraaz mobile application are calorie- and mood-tracking, psycho-educational videos and 24/7 access to mental health service providers, who can provide counselling and psychotherapy sessions. It also has a chatbot, a self-assessment mental health screening tool and support groups for people with similar lived experiences. Urgent support can be received by dialling the 1166 hotline.

As soon as we log into the application, the welcome page inquires “How are you feeling today?” which can be answered by choosing from an array of emojis depicting various moods. Now emojis can be a useful non-verbal measure to use in a population like Pakistan’s where the literacy level is low. Conventional self-reporting assessment tools (questionnaires, rating scales) are rendered useless for this group since illiteracy can result in the content of scales being misunderstood.

Emojis provide an accessible and universal alternative to limiting self-reporting scales. However, the shortcoming of this method is that it is subjective and, hence, there is no empirical way of testing or comparing this. Additionally, the screening tool the app uses to assess the level of mental health distress is not validated for the Pakistani sample and is quite rudimentary.

ISSUES WITH THE APP

A national mental health initiative is a much-needed endeavour in Pakistan, since it can help in regulating and standardising practices in a field populated by quacks and phonies. However, in order to achieve that, certain things would have to be rectified.

Firstly, the current screening process for selecting mental health professionals is questionable, with there being little check and balance on this process. From an academic point of view, a clinical psychologist should at least have a MS/MPhil in a relevant field of psychology in order to practise.

Ms H* is one of the ‘psychologists’ listed on the portal, even though she holds only a Masters in Social Sciences with a major in Psychology, which technically makes her ineligible to practise. “They did not even ask me my credentials or if I had a supervisor to guide me, due to my lack of experience,” she says.

Another grave concern is that private numbers of all the mental health professionals are shared on the app, with users being able to contact them at any time, which is a serious violation of their privacy. Ms T* was inundated with strangers calling and texting her the day the app launched. Unbeknownst to her, her private number, which was included in her resume which she had sent to the team, had been listed on the app without her consent.

An email chain running between the Humraaz team and all the recruited professionals shows several female psychologists expressed reservations about the fact that their private numbers had been made public.

“I volunteered for this initiative as we already have a dearth of mental health professionals, but we all want our safety and well-being too,” shares Dr Z*, who has been fielding random calls on her number. The team behind the application must take this into notice and ensure the privacy and safety of everyone on their panel.

Another psychologist registered on the app shared, “I did not sign up for the app, but it created an account using my contact details and identified me as a psychiatrist, even though I am actually a psychologist.”

This technical glitch, where many psychologists are incorrectly labelled as psychiatrists and vice versa, is concerning, since it can inadvertently encourage malpractice in mental healthcare, which defeats the purpose of this initiative. There also seems to be a lot of confusion regarding the nature of the job, with some assuming it to be volunteer work, while others are inclined towards charging clients for consultations.

As a user, the application interface is engaging and seems geared towards the holistic wellness of young adults. Users can chart their fitness progress by tracking their steps, calorie count and distance covered. Videos depict experienced doctors breaking down mental illness issues in simple terms. Manuals and guides are also available for people dealing with specific mental health conditions.

But to sign up on the application, the user is required to provide their CNIC number, which might discourage those experiencing stigma from seeking support and desiring anonymity. It may serve as a security risk as well. One reason for the CNIC requirement is to make sure

people do not sign up with fake accounts, but perhaps phone numbers would be a better alternative.

While Humraaz is a breakthrough initiative, major structural changes are required, such as a rigorous vetting of mental health professionals and valid screening tools, for it to be effective for the general public.

**Name has been withheld to protect privacy*

The writer is an associate clinical psychologist and freelance journalist writing for international publications

Published in Dawn, EOS, April 16th, 2023