KARACHI: Despite being the first province to legislate on mental health and replace the century-old lunacy act in the country, the Sindh government is yet to take some basic steps required to implement the mental health law enacted two years ago, experts told Dawn on Friday as the country marks the World Mental Health Day today (Oct 10).

The theme for this year is ‘Dignity in mental health’.

Regretting the pathetically slow official progress on the law, the experts said the delay in establishing institutions to protect the rights of psychiatric patients meant that the government allowed continued exploitation, physical and emotional abuse of these vulnerable people in the community as well as at health facilities (due to lack of experts and a system of accountability).

The government, they emphasised, must set up the much-awaited mental health authority, a visitors’ board for inspecting institutions offering care services to the mentally ill and a ‘court of protection’ to deal with cases pertaining to psychiatric patients.

“The rules and forms (needed by caregivers for patients’ admission, discharge, leave etc) suggested by experts have been notified by the government, but they can’t be implemented and adopted till the government constitutes a mental health authority, a visitors’ board and a court specifically dealing with cases of the mentally ill,” said Dr Haroon Ahmed, senior psychiatrist heading the Pakistan Association for Mental Health.

Non-governmental organisations working for people with mental health conditions, he said, had formed an alliance to speed up the process of implementing the mental health act and were also seeking media’s help to support the cause.

Though disappointed over the official delay in the law enforcement, Dr Ahmed termed the recent amendment to the act passed by the Sindh Assembly a landmark achievement according to which a person attempting suicide or is accused of blasphemy should be examined by a psychiatrist and given treatment under the provisions of the act (Chapter VII, Clause 49), if he or she is found suffering from a mental disorder.

“We couldn’t introduce this clause earlier in the law as it was a sensitive issue,” he said in reply to a question.

Endless struggle

The struggle for appropriate legislation for the rights of people with mental health conditions is spread over decades with little success, reflecting the indifference of successive governments towards one of the most marginalised sections of society.

With complete lack of awareness about causes, symptoms and treatment for mental health illnesses, governments contributed to stigmatising mental illness by delaying the enactment of an updated mental health law and its implementation.

The century-old Lunacy Act of 1912 with glaring flaws was finally replaced on the pressure of NGOs by Mental Health Ordinance in 2001 but that remained without implementation for more than a decade and then the health sector was devolved to provinces. “The ordinance had flaws that we have tried to remove through the new law. There are many facilities mentioned in the law that we don’t currently have. So, once the mental health authority is set up, infrastructure will also come up,” noted Dr Ahmed.

According to the Sindh Mental Health Act 2013, the 14-member mental health authority will include a retired high court judge, health secretary, director general, Hyderabad, medical superintendents of teaching hospitals, six eminent psychiatrists and a psychologist with 10 years of experience to be appointed by the government for four years.

Its functions among other things include advising the government on all matters relating to promotion of mental health.

It would also develop and establish new standards for care and treatment of patients, recommend measures to improve existing mental health services.

The authority is also required to set up a board of visitors (in consultation with the government) to carry out inspection and monitoring of psychiatric facilities to ensure proper care to patients.

The law calls upon the government to establish psychiatric facilities for persons who are above the age of 18 years, children and adolescent and the elderly as well as for persons who have been convicted of any offence and are mentally disordered for whom special security measures are required.

“We are all first citizens of the country and it’s the state’s responsibility to ensure our protection. In the absence of a law, a mentally ill person is at the mercy of his or her family and there is no legal cover available for medical intervention,” says Dr Ajmal Kazmi, heading Karwan-i-Hayat, a treatment and rehab facility for people with mental health conditions.

He added that the present laws comprehensively addressed both these issues. “Now a legal cover is available for intervention and a patient can be admitted for treatment against family’s will. But we can’t exercise this authority unless a mental health authority is set up and the government provides us with forms for admission, discharge, leave etc of a patient,” he said.

Published in Dawn, October 10th, 2015

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