KARACHI, Oct 4: Speakers at a workshop on “Mental Health Ordinance 2001” stressed that the ordinance be reviewed and improved to overcome its lacunas so that it could not be misused and the people suffering from the mental disorders benefited.
The workshop was organized jointly by the Pakistan Association for Mental Health (PAMH) and the Human Rights Commission of Pakistan (HRCP) to mark the Mental Health Week that began on Saturday.
Judge of the Sindh High Court Justice Sabeehuddin Ahmad and senior journalist Saleem Asmi, chaired the two sessions of the workshop. Former governor Kamal Azfar, Prof S. Haroon Ahmad of PAMH, Justice (retd) Rasheed A Rizvi, Husain Naqi of HRCP, Rubeena Kidwai, Ishaq Sarhandi, Kartar Lal Pamnani, S. Ali Wasif, Sheen Farrukh, Justice (retd) Ghaus Mohammad, Iqbal Haider and others spoke at the workshop.
They suggested that rules and regulations should also be formulated so that once the ordinance was reviewed and improved it could be implemented properly and effectively.
They said that the Mental Health Ordinance 2001 had been slightly improved as compared to its earlier version, the Lunacy Act 1912, but as the ordinance had been made in haste by an un-elected government so it contained many shortcomings.
They said that under this ordinance the SHO (police) has been given powers to keep a person, whom he thinks as being mentally disordered, in confinement for 72 hours, as under other laws a detained person is to be produced in a court of law with 24 hours of being taken in custody.
They said that even the police misused these powers under which they could keep a person in confinement for 24 hours, so with giving extended powers to the junior officials of police (SHO) of keeping in confinement for 72 hours could be misused and exploited more.
Referring to another shortcoming of the Ordinance, they said that though the terms “medical practitioner” and “psychiatrist” have been defined in the ordinance, they were not named in Section-30 of the ordinance for conducting an inquiry.
They said that without professional opinions from medical practitioners or psychiatrist, it would be difficult for the Court of Protection to determine whether a person was mentally disordered or not and whether the person was incapable of managing affairs of himself or his property.
They said that the United Nations General Assembly had adopted a resolution No 46/119 on Dec 17, 1991, which had set out the principles for the protection of persons with mental illness and the improvement of mental health care system. They said that the government while formulating the Ordinance should have ensured that the ordinance was in conformity with the principles laid down by the supreme organ of the United Nations.
They said that the ordinance left much to be desired. It appears that though those, who supervised the drafting of this ordinance, were conversant with the UN Resolution, they restricted their exercise to incorporating some of the titles of principles enunciated therein. The soul of these principles remained ignored, they added.
The participants of the workshop said that it seemed as if the main focus of the ordinance was not on all the persons with mental illness, but a minority of those amongst them, who belonged to the propertied elite and the ones lodged in prisons.
They said that most parts of the ordinance had been based on the input from such laws prevailing in the United Kingdom and India without keeping in mind the cultural dissimilarities among the societies of these countries and without taking in consideration the local conditions. They suggested that local conditions be considered while formulating the law so that it might not appear alien to the local people.
Referring to a World Bank report on health and development, they said that the report had identified “neuropsychiatric” disease as the second most important non-communicable cause of disability in the developing world. They urged the World Bank to use its clout for augmenting mental health facilities in the country.
They said that the existing facilities in the country were extremely inadequate. They suggested that hostels should be established at the district level where the people with mental disorders could be provided assistance. Extensive trainings for mental health workers should be carried out to improve the quality of services.
The speakers suggested that steps should be taken to strengthen the undergraduate teaching of psychiatry and behavioural sciences and to link the departments of psychiatry at the teaching hospitals to the community and district level hostels.
They also suggested to re-write the curriculum of Psychology at Bachelors and Masters level, which must be related to local mental health needs, and introduce interaction with patients that was negligible at present.
The prevalence of mental disorder among people in prisons was much higher than the people living outside, they said while referring to a survey, which had shown that about one third of the sentenced prisoners had psychiatric disorders and about 20 out of 1,000 had psychosis.
A report of the study was also presented at the workshop. According to the report, 24 prisoners had sever mental morbidity out of 1,000 prisoners. They said that there were around 19,000 prisoners in 17 prisons in Sindh and out of whom over 16,000 were under trial while over 2,000 were convicts. The prisons were heavily overcrowded, which increased mental stress on prisoners, they added.
It was stated that people having mental disorders were kept without clothes at night in Karachi prison, as one of the prisoners had committed suicide a few months back. To preempt such an act, the prisoners were forced to remain without clothes at night.
A study conducted on 5,000 inmates of Karachi Central Prison showed that nearly 73 per cent suffered from psychiatric morbidity — comprising depressive illness (42 per cent); schizophrenia (11 per cent); stress / adjustment disorder (6.6 per cent); phobic anxiety disorder (3.5 per cent); bipolar affective disorder (3.3 per cent); depression with psychiatric features (2.4 per cent); drug dependency (1.3 per cent); obsessive compulsive disorder (1.3 per cent); and epilepsy (0.8 per cent).
Interestingly, the study showed that there was no information to the jail authorities about this new ordinance, and if they had been informed it had not been properly communicated to the prison functionaries as yet. The patients were still being dealt with the system going on since ages and were still being called charya and kept in the cells called charya ward.
They were of the view that though this ordinance was an improvement over the previous laws, it contained some defects and lacunas that creep in when legislations were made in undue haste without recourse to the elected lawmakers, who could have studied and proposed any apparent defects and lacunas before the law was formulated.
