Every 40 seconds one person is lost to suicide. Mental health issues have been invisible for too long.
In a recent judicial conference on Mental Health and Mens Rea, Honourable Supreme Court Justice Umar Ata Bandial stated, “One of the strongest forces evolving in Pakistan is the civil society. It can change the direction of the law.” He continued, “Subjective opinion by one psychiatrist shrouded with technical language is not very helpful.” Law and psychiatry do indeed need to develop a common language and improve their understanding of the other.
In Japan, a prisoner named Hakamada remained in prison for 50 years, 30 of which were in solitary confinement. He was set free when DNA tests proved his innocence. Executing prisoners with active mental illness and not considering solitary confinement as ‘psychological torture’ are other sore points in our chain of death.
The Indian Supreme Court commuted the death sentences of three individuals convicted of the 1991 assassination of former Prime Minister Rajiv Gandhi. The court reasoned that the unreasonable delay in considering the inmates’ mercy petitions, a delay of more than 11 years, warranted a commutation of their death sentences. In Pakistan, a prisoner will spend an average of 11.41 years on death row before the sentence is actually carried out. Many of them suffer from mental illnesses, and are destroyed by their long wait to the walk to the gallows.
The medical evaluation of Imdad Ali carried by a select three-member team of psychiatrists is expected at any time now. His now infamous case surfaced when he was sentenced to death despite continuously showing florid psychosis.
Florid psychosis is a condition where the person loses insight to his illness. This means he is oblivious to what is happening to him and why he is being punished. The minimum health requirement for a prisoner to be hanged is that at least he should be mentally stable. The fitness of the death row prisoner is so critical that in the last 72 hours of his life, he is fed nothing but biscuits and water (to prevent any stomach problems arising). Psychosis is a broad term which includes several disorders, of which schizophrenia is a classic representative.
This case garnered much international attention when through the court judgment, schizophrenia was characterized as a routine and treatable psychiatric disorder. In Imdad’s case, the government was able to extract 15 years of data from the prison which had rightly diagnosed the patient. Yet, there is no success in the management of the disorder. This was truly shocking as it revealed a grave truth and highlighted a spectrum of shortcomings in our handling of the mentally ill.
It was indeed a blessing in disguise because what followed was unprecedented. The Punjab government took up the case itself, making the plea that its Mental Health Act was interpreted marginally. The irrevocable vision of Prof Aftab Asif and Prof Nasar Sayeed Khan made it possible to formulate and submit changes to the current Punjab Mental Health Act. The recent announcement of assembling the Punjab Mental Health Authority and its members is very encouraging. Its first meeting is expected to push things forward.
This May, an international panel of experts from the US – including attorneys, a retired Supreme Court judge and a forensic psychiatrist – visited Pakistan. There was just one goal: to initiate a dialogue with their counterparts here by sharing their experiences and work. The justice in particular, was astonished to learn the amount of power a judge wields in Pakistan. Here, a judge is not dependent upon the two parties. In fact, they may call for as much evidence or technical help to resolve the case to his satisfaction.
The typical forensic report furnished at the Punjab Institute of Mental Health (PIMH) is a 7-10-line paragraph, mostly identifying the patient, a brief introduction and conclusion. Robert McGlasson, an American attorney, shared that such assessments are also frequently seen in the US, and are grimly referred to as ‘drive-by judgments’. However, this is a gross shrinkage of a person to few words. When I compared it to ‘Sammy’s Report’, a seminal forensic report by Dr George Washington Woods, there were many lessons to learn – starting with the development of forensic psychiatry as a field in Pakistan.
Abraham Lincoln said, “I have always found that mercy bears richer fruits than strict justice.” Getting Imdad the treatment that he so badly needs and which he was too poor to obtain on his own is the first step towards a criminal justice system that upholds the rights of these vulnerable members of our society.
The writer is an assistant professor at King Edward Medical University.