Co-Creating Stakeholders Informed Theory of Change (ToC) Roadmap for Child and Youth Mental Health Services in Pakistan

Abstract

Child and adolescent mental health conditions are a major contributor to the global disease burden with a greater impact in low- and middle-income countries (LMICs) such as Pakistan. Despite high need, access to services remain limited due to stigma, storage of trained professionals, fragmented system, and financial barriers. Theory of Change (ToC) approaches have shown potential in developing scalable and contextually appropriate mental health interventions in low resource settings. This qualitative health system study used a participatory theory of change framework through multisectoral stakeholders round table involving 26 participants from education, health, social care, community leadership, youth advocacy and policy sectors. Data was collected through facilitated discussions, ToC mapping, and consensus building activities. Stakeholders co-developed a ToC road-map outlining five interconnected pathways for scaling child and youth mental health services. (1) reducing stigma through community and school base approaches, (2) Strengthening parent and caregiver engagement (3) promoting youth-led advocacy and peer support (4) building capacity though task sharing model and (5) integrating metal health services into existing health, education and social welfare systems. These pathways linked key problems with interventions, challenges, solution, and expected outcomes. A Stakeholder informed Theory of Change provides a practical and contextually relevant road-map for scaling child and youth mental health services in Pakistan. Strengthening community ownership, integrating services within schools, investing in front line workforce capacity, and improving coordination across sectors are essential to reduce the child mental health treatment gaps.