KARACHI: “The criminal justice system does not understand the severity of mental illnesses as deeply as the psychiatric community does,’’ said the chief psychiatrist at Sindh Health Department, Dr Ajmal Mughal, while talking to Dawn recently.

Stressing the need for proper mental health assessment and regulation in prisons, he said: “It is imperative on the government to authorise an official team of certified psychiatrists to access patients admitted to forensic psychiatric settings to assess their mental stability for rightful legal judgement.’’

The Supreme Court’s recent decision that ruled schizophrenia outside the legal jurisdiction of mental disorders as per the Mental Health Ordinance 2001 has brought the condemnable situation of mental health in prisons in Pakistan to the forefront. Despite suffering from genetic paranoid schizophrenia, Imdad Ali, 50, was introduced to a psychiatrist for the first time in jail in 2012 after he had committed the murder. Due to the lack of awareness and empathy towards mental illnesses in Pakistan, most mentally ill convicts face the same fate.

“Psychosis is the most common illness suffered by prisoners; schizophrenia, clinical depression, personality disorders and addiction are dominant behind bars. These disorders require frequent check-ups and take time to cure,’’ said Dr Ajmal.

He pointed out how a majority of mentally ill prisoners went undiagnosed throughout detention and trials by the criminal justice system and were awarded harsh punishments for crimes they committed because of mental instability. “At present, we are invited for weekly visits for the patients referred by the jail authority at the central prison. This leaves the jail in-charge with more discretion regarding the patient’s health than the psychiatric consultant,’’ he said.

With the exception of the Central Prison Karachi, other prisons, including the Landhi jail, female and juvenile prisons, are deprived of a separate psychiatric ward and are yet to be assigned a consultant for regular visits.

A country where about 50 million people are suffering from mental disorders, Sindh happens to be the only province to have passed a legislative act that integrates psychiatric health with the criminal justice system. “The stigmatisation of mental illness is rampant in society and is in dire need of a law that protects mental health on a federal level,’’ said Dr Haroon Ahmed, senior psychiatrist heading the Pakistan Association for Mental Health.

Although the Sindh Mental Health Act was passed three years ago to ensure proper care for mentally ill convicts and a court of protection to offer legal assistance to psychiatric patients in jail, no progress has been made in terms of implementation of the law. “We have sent 15 to 20 names shortlisted for the Mental Health Authority and Board of Visitors to the government, including the legal forms required for the provision of health facilities to the prisoners,’’ said Dr Ahmed. Urging the provincial authorities to take notice of the aggravating situation, he said: “Without the government’s support in establishing psychiatric care facilities in prisons and police stations, mentally ill offenders will continue to face abuse and injustice.’’

Expressing disappointment over the slow progress of the law, the recommended chairman for the mental health authority, retired Justice Dr Ghous Mohammad, demanded urgent issue of licences to mental asylums and institutions concerned to carry out inspection of mentally ill prisoners as per the law. “The government is requested to notify the authority as soon as possible given the worsening plight of mentally ill prisoners,’’ he said.

Published in Dawn October 23rd, 2016