Mental Health Malpractice in Islamabad, Pakistan: A Phenomenological Study of Clients’ Experiences and Perspectives

Abstract

In Pakistan, a complex environment has emerged for individuals seeking psychological services due to challenges such as stigmatization, lack of awareness, absence of regulatory bodies, and the increasing burden of psychological issues stemming from societal and economic disruptions. Any deviation from standards of care in this context could have profound consequences, perpetuating the cycle of suffering and worsening the existing mental health crisis in the country. This study aims to explore instances of mental health malpractice by examining the experiences of clients who have utilized mental health services. Grounded within a Human Rights-based Approach, the study also aims to uncover the intricate intersectionality between mental health malpractice and human rights violations. Employing a qualitative approach, the research utilized an exploratory design and conducted in-depth semi-structured interviews with 15 clients and 4 key informants, chosen through purposive and snowball sampling. Thematic analysis of the data revealed five major themes surrounding multifaceted malpractice, barriers to seeking recourse, and the psychosocial repercussions of malpractice. Many clients reported boundary transgressions characterized by compromised confidentiality, inappropriate social interactions, and attempts to leverage personal connections, leading to a breakdown of trust between practitioners and clients. Moreover, instances of inadequate and unsuitable treatment were highlighted, where practitioners failed to provide interventions tailored to clients’ needs and conditions. Various problematic behaviors were identified, ranging from dismissive and non-empathetic attitudes to verbal and emotional misconduct, representing another facet of malpractice. The failure to adhere to ethical standards adversely affected clients' psychological well-being by exacerbating symptoms and fostering negative cognitions. Despite experiencing psychological harm, clients were hesitant to report malpractice due to fears of stigma in public disclosure and the absence of robust regulatory mechanisms. These findings underscore the importance of establishing ethical and legislative frameworks in mental healthcare to uphold the dignity, integrity, and well-being of clients.