Some of the most seasoned clinicians in the room chose to give up their weekend for it. That, more than anything else, tells you what kind of training this was.
Our implementation evaluation research on Problem Management Plus (PM+) has now taken us across five regions of Pakistan, each cohort teaching us something new about how a psychosocial intervention lands in a real health system. The 8th Training of Trainers (ToT), held in Abbottabad, Khyber Pakhtunkhwa, 2–5 July, was our first encounter with a cohort made up largely of senior psychiatrists and established mental health professionals, and it reframed, for us, what “readiness” actually looks like.
The 8th PM+ Training of Trainers cohort in Abbottabad, KP
A Room Full of Experience, Still Hungry to Learn
Twenty participants joined this training: psychiatrists, clinical psychologists, and mental health staff from Ayub Teaching Hospital, Ayub International Medical Institute, National Institute of Science and Technology, Comsats University, The Minds, Hira General Hospital, DHQ Mansehra, and DHQ Haripur. Many had spent years, in some cases decades, in clinical practice.
But what stood out wasn’t their expertise. We expected that. It was how little that expertise got in the way of curiosity. Seasoned psychiatrists who have diagnosed and treated for years sat through role play exercises, practiced active listening scripts, and took feedback on their delivery with the same openness we usually see in early career trainees.
There was a consistent question running through the four days: how does a structured, low intensity intervention like PM+ fit alongside what I already do?
From Friction to Flow
Not every cohort finds its rhythm right away, and this one was no exception. On the first day, we noticed a certain professional friction in the room, the kind that can surface when experienced clinicians, each confident in their own way of working, are asked to sit as learners rather than experts. It showed in the pace of discussions and in how cautiously people engaged with each other and with us as facilitators.
What was notable was how quickly that shifted. Day by day, the room opened up. Exchanges became more collaborative, questions became more pointed, and by the midpoint of the training the same clinicians who had been reserved on day one were actively debating case scenarios with each other. That evolution told us as much about the training as any assessment score.
Institutional Weight Behind the Room
A training like this only works when the institutions around it show up too. A special word of gratitude is owed to Prof. Aftab Alam, whose tireless coordination held the training together from the first day to the last. His steady presence, quick problem solving, and genuine investment in the outcome of this training gave the whole cohort a sense that they were supported at every step. That support did not go unnoticed by the participants. This kind of visible institutional backing matters, and we could see its effect directly in this cohort.
Our thanks go as well to Dean, Prof. Irfan Uddin Khattak, the Medical Director, Dr Imran Khan, and the Hospital Director, Lt. Col. Dr Sajjad Ahmad Afridi for the coordination and support extended throughout the training.
The involvement of these prominent figures was, in our assessment, one of the clearest drivers of participant motivation. Their involvement gave a signal to the group that the skills they were building were not a side project, but something their own leadership was invested in carrying forward. That sense of investment came through in how the cohort behaved, not just in how it felt.
Our training team outside Ayub Teaching Hospital, MTI, Abbottabad
A Weekend Given Willingly
Abbottabad, like much of the region, is served by a strikingly small number of mental health professionals relative to the population that needs care. Committing four full days to a training on top of an already stretched clinical schedule was never going to be easy.
Yet the group itself proposed running part of the training over the weekend and held to that commitment with no dropout. They prioritised the work, even when day three ran well beyond its scheduled hours, carried by a stream of questions and discussion that neither the participants nor the facilitators wanted to cut short. That same discipline was reflected in the numbers too. Competency assessments at the close of the training showed strong, consistent scores across the board, earned in sessions that most people would have been reluctant to sit through on a Saturday.
Why the Psychiatrists in the Room Matter for Sustainability
A notable share of the participants were psychiatrists placed in public sector institutions. These are posts that, unlike many psychology roles, tend to be longer term and less prone to turnover. This has direct implications for the sustainability of PM+ as it scales. When the people trained to deliver and supervise the intervention are also the ones most likely to remain within the system for years, the investment in their training compounds rather than erodes over time.
It serves as a reminder that sustainability in implementation research isn’t only about the intervention itself. It is equally about who is trained to carry it, and how long they stay where they can use it.
What This Cohort Teaches Us About Scale
Scaling PM+ is often framed as a question of reaching new geographies or new categories of frontline workers. Abbottabad offered a different lesson: sometimes scale depends on winning over the people who are already deeply embedded in the system. The endorsement of these psychiatrists and senior clinicians shapes how a new approach is received by everyone around them.
When professionals with years of clinical authority choose to learn, practice, and be assessed like anyone else, it lowers the barrier for the rest of their institutions to do the same. That is its own form of scale, quieter, but no less consequential.
Looking Ahead
Eight cohorts in, the throughline across every region has been the same: PM+ succeeds where evidence meets people willing to carry it forward, whatever the cost to their own time. Abbottabad’s cohort carried that cost on a weekend and carried it well.
Written by Hassan Raza Ali (IoP), Research Assistant in the PM+ project. Edited by Harriet Evans Tang (UoY), KEDI Co-Lead.
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