KARACHI, June 19: The government has failed to remove anomalies from the Mental Health Ordinance 2001 which replaced the archaic Lunacy Act 1912 last year.

Psychiatrists told Dawn that while the promulgation of a new ordinance on mental health was a welcome step, the government should have ensured that the ordinance was properly implemented. “The fact that a large number of measures envisaged in the ordinance have not been implemented at all proves that legislation without strengthening of the country’s health-care infrastructure is futile.”

This view of the psychiatrists is echoed in the latest report of the Human Right Commission of Pakistan, titled ‘State of Human Rights in 2001’, which says: “In an important step forward, a Mental Health Ordinance was introduced during the year. This indicated some improvement over the 1912 law. Implementation of the law’s provisions regarding the care of the millions suffering from mental illness and their institutionalization, when this became necessary, were however extremely poor.”

Senior psychiatrist Dr S. Haroon Ahmed, who is president of the Pakistan Association for Mental Health, said: “Let’s first look at the number of mental health patients in Pakistan. According to a World Health Organization report, in most developing countries, including Pakistan, the minimum number of people needing psychiatric attention is about 10 per cent of the total population. If psychosomatic disorders and epilepsy are included, this figure rises to over 35 per cent. Now compare this figure with the number of psychiatrists in the country. At the very most, there are 350 trained psychiatrists in Pakistan.”

Dr Haroon added that the health-care infrastructure from mental health patients had not improved adequately over the years. “At the time of the partition of the subcontinent there were 40 mental hospitals in India. Pakistan inherited two of them — the Lahore mental hospital established in 1840 has 1,400 beds and the other at Hyderabad was set up in 1850 with 450 beds which is now called Sir C.J. Institute of Psychiatry. In Peshawar the sick ward in prison grew into Government Mental Hospital with 140 beds. The only mental hospital added after partition was at Dudhial, Mansehra, 1964 with 100 beds.”

He said that there would have been no anomalies in the Mental Health Ordinance 2001 had the government consulted the psychiatrists and other stakeholders.

The government came under fire over Section 19 of the Mental Health Ordinance 2001 which gives a lot of arbitrary powers to the police.

Section 19 of the Mental Health 2001 reads: “If an officer in charge of a police station finds in a place to which the public have access, a person whom he has reason to believe, is suffering from a mental disorder and to be in immediate need of care or control the said officer may, if he thinks it necessary to do so in the interest of that person or for the protection other person, remove that person to a place of safety, which means only a government-run health facility, a government-run psychiatry facility, or hand him over to any suitable relative who is willing to temporarily receive the patient.

“A person removed to a place of safety under this section may be detained there for a period not exceeding 72 hours for the purpose of enabling him to be examined by a psychiatrist or his nominated medical officer and for making any necessary arrangements for his treatment or care.”

In a report, the Pakistan Association for Mental Health poured scorn on this section of the ordinance. It said: “Through this section, discretionary and unfettered powers are given to an SHO to arrest anyone. The arrested person may be detained for a period of 72 hours. This power can be misused by the police for political or other purposes. Even the repealed Lunacy Act 1912 (under Section 13) required an SHO to forthwith produce a suspected ‘lunatic’ before the magistrate. Even in the case of the most heinous crimes, an accused is required to be produced before the magistrate within 24 hours.”

Psychiatrist Dr S. Ali Wasif of the Institute of Behavioural Sciences said he wondered how an SHO could find out if a person was suffering from mental illness or not. “This section of the Mental Health Ordinance 2001 could be used as a tool for oppression by the police in connivance with judicial magistrates, especially in rural areas.”

The Sindh chapter chief of the Pakistan Psychiatry Society, Dr Amin A. Gadet, also deplored that the government had not deemed it fit to seek recommendations from practising psychiatrists before promulgating the Mental Health Ordinance 2001.

“It is about time the government laid down a mental health policy which integrates primary health with the health-care system.”

Anaesthesiologist Dr Salamat Kamal said Section 56 of the Mental Health Ordinance needed to be rewritten.

Part 2 of Section 56 reads: “All electroconvulsive shall preferably be administered under general anaesthesia.”

Dr Salamat explained that electrovulsant therapy was a form of treatment in psychiatry introduced in the 1930s in which an electric current was passed through the brain to produce loss of consciousness accompanied by convulsions.

“Being based on the theory that epilepsy and schizophrenia were antagonistic conditions, and that one could not exist in the presence of the other, it was originally used in cases of schizophrenia, but later it was found to be effective in cases of depression, and continued in use until the range of modern antidepressant drugs were introduced.”

He added that in Section 56 the word “preferably” should be replaced with “compulsorily”.