Promoting Mental Health: Journey of Establishing ‘Saving 9’

In Pakistan, mental disorders account for more than 4% of the total disease burden with an estimated 24 million people in Pakistan in need of support and treatment. According to WHO data, Pakistan has only 0.19 psychiatrists per 100,000 inhabitants, one of the lowest numbers in the WHO Eastern Mediterranean Region, and in the whole world.

Brain child of Usama Mirza, a LUMS BS 2013 Physics graduate, Fulbright Scholar from Columbia University, New York state trained Emergency Medical Technician and Gates Cambridge Scholar for PhD, Saving 9, is a first-of-its-kind initiative in the world that is reshaping emergency response and mental healthcare in Pakistan. Filling the gap in physical and mental training, first aid workshops, and sensitivity training especially on school and university campuses, this initiative, incubated at LUMS, aims to “heal the world, one emergency at a time”. An insightful discussion with Mirza showcases his passion for saving lives and his journey of establishing Saving 9.

Q: What are the core values driving Saving 9’s work, particularly in addressing mental health and first aid literacy?

Answer: At Saving 9, we believe in empowering individuals to save lives within their capacity. Inspired by my time at LUMS EMS, we emphasise the importance of prevention and early intervention. Our recent initiative, Embrace, the mental health ambulance, fills a critical gap in traditional emergency services by providing compassionate support during psychological crises. That is where the idea for the mental health ambulance originated. Upon researching, we discovered that there was no existing model for it worldwide. The world’s first mental health ambulance was established in Sweden, which operates in a vastly different context than Pakistan. The name ‘Saving 9’ derives from the phrase ‘a stitch in time saves nine’, highlighting the importance of prevention over cure. By bringing communities together, much like stitching together a tapestry, we aim to create a caring community, capable of saving lives.

Q: What are some key achievements and milestones of Saving 9 since its inception, particularly in terms of the lives saved and emergencies handled?

Answer: To date, we have responded to over 13,000 cases, ranging from accidents to mental health crises. The recent launch of the mental health ambulance has already addressed 60 cases, demonstrating its critical role in providing timely care. Some of these cases were resolved online, but most were resolved by our team going to the site of the emergency and compassionately negotiating with the patient to receive care and transporting them safely to an appropriate facility.

Q: Did you always have an interest in mental health?

Answer: While at Columbia University, I was introduced to Pakathon, an organisation dedicated to fostering entrepreneurship within the Pakistani community in the USA. Attending their events was truly inspiring and motivated me deeply. Another impactful organisation, Educators Lab, provided invaluable mentoring and encouragement. These experiences ignited the belief that we could also make a difference. Upon returning to Pakistan, I initiated Saving 9 in January 2018, initially, in a very informal capacity. Bringing together individuals from the Fulbright alumni community and LUMS graduates, I began training them as medical first responders. Subsequently, we established an ambulance system in collaboration with the Union Council of Islamabad. One thing led to another, and we evolved into an incorporated private limited organisation and a foundation. These entities now work together as a social enterprise, united in our mission to create meaningful impact.

Q: Could you walk us through the personal journey that led to the founding of Saving 9 and projects like Embrace?

Answer: From 2009 to 2013, while pursuing my Bachelors in Physics, I joined the LUMS Emergency Medical Services (EMS), where I received rigorous training as a medical first responder. I had the responsibility of dealing with over 250 emergencies and in my last year of University, I became the Head of Training and Development. That was a transformational learning experience because I got to deal with so many emergencies, including psychological emergencies. This experience emphasised the need for youth-driven initiatives like LUMS EMS, serving as the frontline for emergencies and directing individuals to appropriate facilities.

Q: How does Saving 9 navigate the cultural taboo surrounding mental health in Pakistan?

Answer: Despite prevailing stigma, societal shifts during COVID-19 have fostered greater openness towards mental health issues, particularly among the youth. To address this, we have partnered with experts to develop culturally sensitive protocols for our Embrace ambulance. The issue lies in the affordability of mental health care. Many individuals, particularly those with elderly parents or grandparents suffering from mental illness, face barriers to seeking help. Some families may conceal the issue, while others acknowledge the need for psychiatric care and medications. However, the cost of treatment and medications can be prohibitive and inaccessible. Discontinuing medication due to financial constraints can exacerbate symptoms significantly. Beyond the stigma surrounding mental health, which remains a significant challenge, there is a misconception that willpower alone can alleviate the issue. While this certainly does play a role, many individuals desperately seek help but struggle to navigate the complexities of accessing reliable and ethical care. Acknowledging cultural norms, we also prioritise female staff to ensure a supportive response for female emergencies.

Q: How do you ensure that your services are effective and culturally sensitive for everyone?

Answer: We have assembled a diverse board of psychologists, psychiatrists, and field experts to tailor our services. We pooled our expertise to develop culturally appropriate standard operating procedures for our Embrace ambulance. This involved ensuring that family members reaching out on behalf of the patient didn’t unilaterally make decisions without the patient’s consent, especially if they were in a sound state of mind. We recognised the importance of keeping family members appropriately informed and involved, which differs from the individualistic culture prevalent in Western societies.

Q: How do technology and innovation enhance Saving 9’s emergency response capabilities, especially in rural areas?

Answer: Leveraging existing technologies like WhatsApp allows for quick response and consultations, particularly in rural areas where access to traditional services may be limited. Utilising an auto-generated response through AI chatbots significantly alleviates the burden on frontline responders like us in handling cases. Additionally, having online telecommunications is crucial, especially when providing field support to patients. It enables constant communication with our mental health officer, who is a trained psychiatrist. The availability of tele-counselling facilitates dynamic communication with a professional, making significant life-saving differences in emergencies.

Q: Do you offer a hotline where individuals can directly speak with a professional?

Answer: Absolutely! We offer an integrated service with two partners. The first is Rubaro, a non-profit that provides free online counselling. How it works is that we provide a public-facing hotline number; when a patient or their caretaker calls this number, a trained psychologist assesses the level of urgency. Depending on the situation, they may receive immediate online counselling or be referred for delayed online counselling. We collaborate with another partner, Mahir-e-Nafsiyat, which offers in-person counselling services. This integrated approach ensures that whether it’s an emergency requiring immediate assistance or long-term care, we have the resources to support individuals effectively, offering a fully integrated service. If there’s an emergency, we can help you and if there is a delayed, long-term care required, we have partners who can make that happen for you as well.

Q: Looking forward, what are Saving 9’s future goals and initiatives?

Answer: Our primary focus is expanding the Embrace mental health ambulance model across Pakistan. It is currently in the stage of evolution of being piloted, growing, and gaining traction. There is a dire need for such a service. We aim to share our insights through research publications, benefiting low- and middle-income countries globally. By advocating for innovative solutions, we strive to make meaningful contributions to mental health worldwide.

Other than the interview of Saving 9 founder, you can also read Correlation between academic performance and mental health