Many orphanages house children who are not true orphans but are placed in institutional care due to poverty and inadequate family support
[Author’s note: This article highlights that in Pakistan, thousands of children grow up in institutional care due to poverty, family breakdowns, or loss of parents. While these institutions provide shelter and basic needs, mental health and emotional well-being remain largely neglected. As a child protection professional, I have identified critical gaps, including a lack of family-based care alternatives, mental health resources, and trained professionals. Institutionalized children face higher risks of depression, PTSD, and attachment disorders, impacting their development. To address this, Pakistan must integrate mental health services into orphanages, promote family-based care, and enforce child protection standards.]
Amir Murtaza
In years of working as a child protection professional, the challenges faced by institutionalized children in Pakistan have been closely observed. Thousands of children grow up in institutional care, often as a result of poverty, the loss of parents, or family breakdowns. While these institutions provide shelter and necessities, the mental health and emotional well-being of children in such environments often remain largely overlooked. The lack of structured mental health support in orphanages has long-term consequences on their development and future opportunities.
Several critical issues contributing to this crisis have been identified through work and analysis of this sector. Many orphanages house children who are not true orphans but are placed in institutional care due to poverty and inadequate family support. Cases have been encountered where family-based care options—such as foster care or kinship care—could have provided a more nurturing environment, but these remain scarce. Families often lack financial or social support systems, leaving institutionalization as their only option.
As discussed in the paper, The Evolution of Alternative Care in Pakistan over the Last Decade and Way Forward, the transition from institutional to family-based care is critical. Institutions in Pakistan often fail to provide the emotional and psychological support needed for children’s development, a gap highlighted in the research paper. The need for integrated mental health services in these institutions is paramount, as children in such environments are at an increased risk of developing behavioral and emotional disorders.
During work with care institutions, many fail to meet minimum care standards. Poor living conditions, neglect, and insufficient emotional and psychological support can have a devastating impact on a child’s well-being. Weak enforcement of child protection policies exacerbates these challenges, as the quality of care varies widely across institutions. There is also a concerning lack of awareness about the negative impacts of institutional care and the benefits of family-based alternatives. These gaps affect public perception and hinder effective policy development and implementation.
Like many developing countries, Pakistan struggles with economic, social, and geopolitical issues. Priorities often focus on immediate needs, such as access to clean water, sanitation, and immunization. However, research and professional observations argue that mental health—particularly child mental health—deserves far greater attention.
Read – Kinship Care in Pakistan: A Vital but Neglected Child Protection Pillar
Research and professional observations highlight a high prevalence of mental health challenges among institutionalized children. Many suffer from depression, anxiety, and post-traumatic stress disorder (PTSD), often stemming from the trauma of family separation, neglect, or abuse before entering care. A 2020 study conducted in Sri Lanka found institutionalized children exhibited significant emotional and behavioral problems compared to their peers in family-based care settings. This aligns with broader evidence showing that children in institutional care face a much higher risk of developing mental health challenges, such as depression, anxiety, and attachment disorders, due to a lack of nurturing and stable relationships.
A key barrier, often observed, is the acute shortage of trained mental health professionals
A common issue encountered is attachment disorder, where children struggle to form healthy emotional bonds due to a lack of stable, nurturing relationships. This challenge is compounded by societal stigma that isolates these children and diminishes their self-worth.
Despite the clear need, most orphanages lack adequate mental health resources. Psychological counseling and therapy remain unavailable or poorly integrated into the care system. Institutions often focus on physical needs—food, shelter, and education—while emotional and psychological care is neglected.
A key barrier, often observed, is the acute shortage of trained mental health professionals. According to WHO data Pakistan has only 0.19 psychiatrists per 100,000 inhabitants, leaving institutionalized children—one of the most vulnerable groups—without the specialized care they deserve. Additionally, the absence of regular mental health screenings means that challenges often go undiagnosed and untreated.
While the situation is concerning, promising efforts have been seen. Various government departments, INGOs, and NGOs are working to provide psychosocial support and train caregivers in child psychology. However, these initiatives are often fragmented and lack the scale needed to address the issue nationwide.
I strongly advocate for integrating mental health services into the standard care framework of orphanages. Employing trained counselors, conducting regular mental health assessments, and building caregiver awareness of emotional well-being can create safer, healthier spaces for institutionalized children. I believe that community-based networks and partnerships with mental health organizations are vital for bridging the gap.
Institutionalized children in Pakistan deserve far more than basic survival.
Deinstitutionalization—the transition from orphanages to family-based care systems—offers a sustainable solution. I have followed global examples, such as Rwanda and Bulgaria, where reforms have successfully created emotionally nurturing environments for children. Pakistan has much to learn from these experiences as we move toward family-based care.
Read: What is institutional care?
The government must play a central role in addressing these challenges. I urge policymakers to allocate funds for mental health services in care institutions, implement minimum care standards for emotional well-being, and enforce regulations to ensure compliance. Raising public awareness about the psychological needs of institutionalized children is also essential for reducing stigma and fostering an inclusive, child-centered approach.
As someone who has spent years working in this sector, I firmly believe that institutionalized children in Pakistan deserve far more than basic survival. They need opportunities to heal, thrive, and build hopeful futures. Addressing their mental health challenges is not only a moral obligation but also an investment in Pakistan’s social and economic progress.
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Amir Murtaza is a development sector consultant and researcher. He can be reached at amirmurtaza1@hotmail.com
