The true measure of implementation science isn’t just in the design of an intervention, but in how it breathes and adapts when it reaches the ground.
As part of our implementation evaluation research study on Problem Management Plus (PM+), we have had the privilege of training mental health specialists across five different regions of Pakistan. Every region brings its own unique context, strengths, and challenges. Yet, our recent 4-day Training of Trainers (ToT) in Skardu, Gilgit-Baltistan (GB), was an experience that stood entirely on its own.
Capacity Meets Readiness: The Skardu Cohort
Over the course of four intensive days, we had the honour of training and interacting with 17 dedicated mental health specialists representing various institutes across the Skardu region.
In implementation research, we often talk about “readiness for change.” What struck me most about this group wasn’t just their clinical backgrounds, but their unparalleled passion for learning and a deeply rooted enthusiasm for bringing scalable mental health support to their communities.
While there is an undeniably pressing need for community-based psychological support in Gilgit-Baltistan, this training highlighted something even more vital: there is an incredible capacity and willingness to provide that care. In fact, the level of readiness we witnessed here felt more profound than in almost any other region we have touched so far. Every session was marked by high engagement, thoughtful contextual discussions, and a shared vision for sustainable impact.
Diverse Sectors, Shared Vision
What made this cohort uniquely strong was its composition and dedication. These 17 mental health specialists joined the training on their own initiative, traveling from various districts of the Skardu region as well as from Gilgit, purely driven by their passion to learn and bring PM+ back to their communities.
Their close contact with the grassroots population is arguably the greatest asset of this cohort. They represented a vast cross-section of the region’s infrastructure, hailing from:
- Special education and traditional schools
- Higher education colleges
- Community counseling centers
- Government hospitals
- Private clinics
Crucially, their unit heads nominated them with a formal promise: that they will cascade this training to others within their respective institutes. This institutional buy-in is exactly how we ensure a scalable, sustainable psychosocial intervention.
The Power of Scalable Interventions
PM+ is engineered to bridge gaps in resource-constrained settings, but its ultimate success rests on the frontline supervisors and trainers who sustain it. Seeing this remarkable group grasp the fine nuances of the program fills me with immense optimism.
As these 17 newly trained specialists’ step into their roles, the potential for the PM+ project to scale up and weave into the wider community is massive. They are no longer just participants; they are the architects of a more resilient mental health infrastructure across GB.
Collaboration, Community, and Context
An initiative of this scale is never a solo journey. It requires deep institutional support, local champions, and a welcoming environment to thrive:
Local Facilitation: A heartfelt thank you to Dr Shahida Batool for her seamless facilitation and unwavering support throughout this initiative.
Institutional Leadership: We extend our deepest gratitude to the Director of the Health Department, Dr Syed Sadiq Shah, for the incredibly warm welcome and unmatched hospitality extended to our team during our stay amid the breathtaking landscapes of Gilgit-Baltistan.
Global Support: This work would not be possible without the trust and vision of the Centre for IMPACT and the NIHR (National Institute for Health and Care Research) (NIHR203248). Thank you for providing the opportunity to witness and drive this vital mental health initiative forward.
Looking Ahead
Moving the needle on mental health equity requires moving beyond urban centers and investing heavily in regional workforce optimization. Skardu has proven that when you pair an evidence-based framework with passionate local experts and institutional commitment, the potential for sustainable health systems strengthening is limitless.
Together, we are taking meaningful, evidence-driven steps toward a more resilient and supported community.
This article was written by Maham Abid (IoP), Project Manager PM+ Pakistan. Edited by Harriet Evans Tang (UoY), KEDI Co-Lead.
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