Tyranny of the mind

At one point during his time in prison, Khizer Hayat thought the world was coming to an end. He believed that the Americans landing on the moon was having a dire effect on the planet. He also believed the solutions to the world’s problems could be found in the toilet in his cell, which had a direct connection with the Earth.

The world did eventually come to an end. But only for Khizer Hayat, who had already spent 16 years on death row. It wasn’t the gallows that took him. It was his own mind. A mind so fraught with debilitating illness that in his last years Khizer was unable to even bathe and feed himself. He would wear soiled clothes or disrobe completely, throwing food and faeces out of his cell.

In 2009, Hayat was shifted to a public hospital in Lahore for severe head injuries. Cooped up 24 hours a day in a cell with a delusional and confused person, his fellow inmates had violently attacked him. His lawyers often found him injured during their visits. By 2012, the attacks had become so frequent and severe that he was transferred to an isolated cell in the jail hospital, effectively living in solitary confinement till his death in March this year – a death that came to Khizer as he lay shackled to a hospital bed.

Though it shouldn’t take Khizar’s demise to stir Pakistan’s criminal justice system from slumber, one hopes it does. A paranoid schizophrenic person should never have been handed capital punishment and four subsequent death warrants for his execution. A patient on powerful anti-psychotic medication should not have been exposed to the wrath of other inmates. But that is exactly what happened – despite judges voicing their concerns, both publicly and privately, about the treatment of mentally ill prisoners and the punishments meted out to them. India’s Supreme Court recently ruled that even post-conviction mental illness is a mitigating factor while considering appeals of prisoners on death row. Pakistan, though, has some ways to go.

A consultative dialogue recently held in Islamabad on mental healthcare facilities in detention shed light on some of the obstacles and limitations in providing adequate diagnosis and treatment to prisoners suffering from mental disorders. The participants – lawyers, psychiatrists, IG prisons and superintendents – all agreed there is much left to be desired as far as caring for the mentally ill in Pakistan’s prisons is concerned. Particularly vulnerable are women and children. Children in detention often suffer from mental disorders as a consequence of confinement and abuse. Still, it is the sheer number of men in the prisons of Pakistan that calls for urgent attention of their mental healthcare needs.

Psychiatrists at the conference underscored the need to develop a mechanism to identify prisoners who are at risk of developing disorders or are already mentally ill when they enter detention facilities. A lot of prisoners may not have mental disorders but rather learning disabilities. Many of these can be treated by non-specialists. Putting them in solitary confinement, however, further aggravates their condition and puts them at risk of harming themselves.

Prison authorities at the conference admitted there were huge gaps in the mental healthcare framework and underlined the need for capacity building and training. Since medical officers are not equipped to deal with mentally ill prisoners, they sedate the detainees for prolonged periods or tie them up to restrict their movement – sometimes both together. This is an inhumane practice and a violation of prisoners’ rights.

It is not just the judiciary or the government that failed Khizer. It’s our collective understanding, or rather the lack of it, about mental illnesses that has led us to shun those whose minds cannot fathom what it means to lie in wait of death for a crime they either do not remember committing or do not fully understand the implications of. While it is too late to save Khizer, there are others like Kanizan Bibi and Imdad Ali who remain on death row despite being diagnosed with paranoid schizophrenia.

Kanizan has spent nearly 30 years on death row. Her mental health has deteriorated so much that she has stopped talking. The hospital staff has confirmed that she has not spoken a single word in eight years. Imdad, on the other hand, talks too much. He sometimes says provocative things that have resulted in physical abuse from fellow inmates. The last time his death warrant was issued, Imdad was unable to comprehend why his family members were weeping inconsolably.

It is unfortunate that for many mentally ill patients, their first interaction with a mental health professional is in prison. In a lot of cases, the patients have been abandoned by their families. It is, however, crucial to understand the culpability of those suffering from mental disorders. Mentally ill people are not as criminally responsible for their crimes. They lack criminal responsibility because the element of intention is not necessarily there or at least not to the extent of a person with a sound mind. We need to ensure that imprisonment does not push an already broken individual over the edge.

The writer is the executive director of the Justice Project Pakistan.