Diminished responsibility

In recent days, the case of Imdad Ali has brought the issue of mental health within Pakistan’s criminal justice system to the forefront. Ali has been diagnosed with schizophrenia, a severe mental illness in which a patient loses touch with reality and suffers from delusions. But despite this he has been issued a death sentence.

This case highlights the lack of protections and care afforded to the mentally ill in Pakistan’s criminal justice system. In light of this, it is important to have a national conversation about improving the treatment of mentally ill prisoners.

Severely mentally ill individuals all suffer from a chemical imbalance in their brains which renders them incapable of being fully in control of their actions or recognising their implications. This inherently inhibited capacity for rational decision-making means that mentally disabled individuals have what is now known as ‘diminished responsibility’. The onus is on society to treat them with compassion and make sure they get the best care so that their mental illness can be improved.

This principle can only be achieved if Pakistan’s federal and provincial governments, legal system, police forces and public are on the same page regarding the importance of protecting and helping the mentally ill. Legislation that reflects an understanding of mental illnesses based on modern medical research and practices is needed. The lack of awareness of the causes, symptoms and treatment for mental health illnesses needs to be countered while successive governments need to develop more adequate facilities.

The Imdad Ali case perfectly encapsulates how lack of awareness regarding mental health issues can snowball into a tragedy perpetuated by the Pakistani state. According to the available evidence, Imdad’s schizophrenia is genetic; his father had the same disease. But despite this, his family didn’t notice the onset of symptoms and he went years without any medical intervention.

The same ignorance of mental illnesses was to be found among the local police, lawyers and the lower judiciary as Imdad’s condition went undetected or ignored. The upshot was a conviction and a sentence of capital punishment. In fact, the first time he came in contact with a psychiatrist was in jail but as our laws currently stand by then it was deemed too late.

For a majority of Pakistan’s existence, the colonial-inherited Lunacy Act of 1912 was in place. This largely ceremonial law remained unchanged until efforts by civil society resulted in the passage of the first Pakistan Mental Health Act of 2001. However, the framework of its implementation was not developed properly. After the 18th Amendment, this federal framework became redundant altogether and now the power to legislate on mental health issues lies with the provinces. Thus there is no Pakistan-wide law that protects mentally ill people.

In Sindh, active advocacy has thoroughly amended the Mental Health Ordinance from 2001 to form the Sindh Mental Health Act 2013. But this act will only be operative when the Sindh Mental Health Authority and Board of Visitors are formed by the health department

This problem becomes particularly exaggerated when a mentally ill person is at the mercy of criminal justice institutions – police stations and prisons. As Imdad’s case shows, mentally ill individuals are prone to be abused and tortured and made to sign confessions by the police. The basic dignity and fundamental rights of mentally ill patients are thus regularly violated. A lot of mentally ill people go undiagnosed throughout their detention and trials, and get severe sentences for crimes they cannot be held responsible for.

Sindh is the first province to legislate on mental health, based on input from the Pakistan Association for Mental Health. This bill can be a model for other provinces to adapt. In particular, the bill has provisions for the treatment of mentally ill prisoners.

The law calls for an integration of psychiatric care system with the criminal justice system. If there is suspicion or complaint of an individual being mentally ill, the police have to conduct a psychiatric assessment, and if a mental disorder is confirmed the individual has to be admitted to a psychiatric facility. The law also gives courts the authority to forgo punishment in favour of rehabilitation if there is suspicion that a crime was committed due to an underlying mental disorder.

While the bill remains a landmark, the legal requirement for building psychiatric care facilities in prisons and police stations remain unfulfilled. Abuse and wrongful punishment of individuals accused of crimes will continue unabated unless the governments of the provinces utilize the resources at their disposal to build the required facilities for treatment, and invest in the education sector so more psychiatrists and mental health medics can be trained.

The World Mental Health Association has adopted ‘Dignity in Mental Health’ as its theme this year for World Health Day, to be observed next month. Not punishing the mentally ill, the most marginalised and misunderstood people in our society, would be an excellent start.

The writer is the founder and head of the Pakistan Mental Health Association, which led the campaign to pass the Sindh Mental Health Act in 2013.