Introduction: Historical Context and Legal Evolution
In the year 1947, when Pakistan came into being because of the Partition of India, Pakistan also continued to abide by the Lunacy Act of 1912 which had its origin in British India. The objective of the Act was to maintain people in confinement rather than assisting them in rehabilitation. With new treatments, like psychotropic medicines, a new law was needed. After the 1970s, mental health advocates worked on psychiatric laws, and the government of Pakistan drafted new legislation on mental health laws in 1992. The draft law was shared with all psychiatrists for their feedback. However, it wasn’t used until 2001, when the Lunacy Act of 1912 replaced the Mental Health Ordinance of 2001. That year, the draft was also discussed at the Pakistan Psychiatric Society’s conference in Islamabad. UK and Pakistani psychiatrists worked together to improve it. Many Pakistani psychiatrists were trained in the UK, and many British Pakistani psychiatrists remain involved in psychiatry in Pakistan.[1].
“Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear“.[2]
After the 18th amendment, health became a provincial responsibility, and each province had to create its mental health laws. So far, only Sindh and Punjab have mental health acts, leaving the situation uneven. Other provinces urgently need similar laws to protect people with mental illnesses. Under the Mental Health Ordinance, 2001, “approved psychiatrist” means a medical practitioner possessing a recognized postgraduate qualification, registered with the Pakistan Medical and Dental Council and approved by the ‘’Authority’’ [means the Punjab Mental Health Authority constituted under section 3]. “Mental disorder” means mental illness, including mental impairment, severe personality disorder, severe mental impairment, and any other disorder or disability of the mind [3].
The Mental Health Ordinance 2001 was in the form of a presidential order and set out to:
‘Amend the law relating to the treatment and care of mentally disordered persons, to make better provision for their care, treatment, management of properties and affairs and to encourage community care and further to provide for the promotion of mental health and prevention of mental disorder.’ (Government of Pakistan, 2001) [3].
Pakistan is the sixth most populous country in the world. However, most people in Pakistan, including its legal system, do not know about the repeal. The WHO has stressed the need for public awareness and education campaigns to inform mental health professionals, police officers, religious leaders, and the general public. For a total population of 200 + million, there are only 500 psychiatrists available, with only 11 psychiatric hospitals and 100 clinical psychologists. This ratio creates a large treatment gap, leaving approximately 90% of people with mental illness untreated, and the primary reason being financial barriers, social stigma, and lack of education on mental health issues [4]. Psychiatry is a type of medicine that deals with finding, treating, and preventing problems with mental health, emotions, and behavior. According to the latest report, over 15 million people in Pakistan are suffering from some form of mental illness. But for a population of 220 million, only 400 trained psychiatrists exist with few state-run psychiatric hospitals and a small number of psychiatric units in teaching and general hospital [5].
On World Mental Health Day observed every year on 10 October, the World Health Organization (WHO) Pakistan marked the day with the support of psychosocial volunteers from the United Nations Critical Incident Stress Management Unit (CISMU) [6]. It’s crucial to celebrate these types of awareness days. Still, on the other hand, it’s also essential to go to urban areas and provide basic knowledge about psychotic issues and laws that the Legislation makes. I observed so many patients when I visited the rehabilitation center (Fountain Houses) in Lahore. Some people experienced direct harm, while others were affected indirectly. One person felt intense emotional distress from heartbreak. This kind of mental health issue caused by such events is often called psychiatric injury, which used to be referred to in courts as “nervous shock.” What is nervous shock? About the types of claims which are recognized by tort, Lord Ackner said the following:
‘Shock’, in the context of this cause of action, involves the sudden appreciation by sight or sound of a horrifying event, which violently agitates the mind. It has yet to include psychiatric illness caused by the accumulation of more gradual assaults on the nervous system [7].
Case Studies and Legal Precedents
According to the definition of shock, a person who is involved in an accident where they suffer no physical injury but develop psychiatric injury because of their fear is a primary victim. As I mentioned, above heartbreak damage is very serious psychiatric damage because it affects your love and affection with someone. In this way, the case of Dulieu v White (1901) shows us that a person is eligible for damages if they are worried about the impact the accident may have on them. In White (1901), Justice Kennedy stated that “The shock, where it operates through the mind, must be a shock which arises from a reasonable fear of immediate personal injury to oneself’’ [8].
A person who may victim an accident to others and suffers from psychiatric injury as a result of fear for another safety is the secondary victim. Darnell might be seen as a secondary victim, so he would need to meet the rules set in the Alcock case to succeed with his claim. Comparing Darnell’s situation to the case of Dooley v Camel Laird (1951) [9], Darnell might have a strong case because he was afraid for his wife’s safety, similar to how the claimant in Cammell Laird feared for a co-worker’s safety. Since Darnell has a “close relationship” with the injured person, as mentioned by Lords Ackner, Keith, and Oliver, this could be enough to support his claim in especially terrible accidents.
In the case of Abdul Rehman v Chairman M/s. Mari Gas Co. Limited and two others through Mr. Khaleeq Ahmed, Advocate (2010), the plaintiff claimed a sum of Rs.5,00,00,000/- as compensation for such mental torture and harassment. The Plaintiff has with strong evidence established that he has suffered mental stress and agony on account of the conduct of the Defendants. Based on the findings on issues, the court decrees that the Defendants are jointly and individually responsible for paying Rs. 20,00,000/- (Twenty Lacs) as compensation, along with 10% interest from the date of the decree until the payment is made. The Defendants will also bear the cost of the suit [10].
Imdad’s case (2002) gained attention in 2016 when the Supreme Court dismissed his appeal, stating that “schizophrenia is a curable disease” and not a mental illness. After public backlash, a new petition from his lawyers, and a review filed by the Punjab government, his third execution warrant was stopped. In April 2018, the Supreme Court took notice of another mentally ill prisoner, Kanizan Bibi, and combined her case with Imdad’s. The court ordered new medical examinations for both prisoners and stated that this case would set a precedent for mentally ill prisoners on death row. During the proceedings, Chief Justice Mian Saqib Nisar remarked that it is neither reasonable nor humane to execute mentally ill or disabled individuals, pointing out that international laws forbid such executions. A five-member bench resumed hearings in September 2020 after nearly two years and reserved its judgment on January 7, 2021. This case is expected to set an important precedent to protect mentally ill prisoners in Pakistan. After the trial, Imdad Ali was convicted by the trial Court under section 302 of the Pakistan Penal Code, 1860 (P.P.C.) on 29.07.2002 and sentenced to death. The appeal filed by him was dismissed by a Division Bench of the learned Lahore High Court, Multan Bench, Multan on 07.11.2008 and the murder reference was answered in the affirmative and his sentence of death was confirmed. The Pakistani Supreme Court has also rejected Imdad Ali’s appeal previously in 2015, ruling that there was no evidence of his mental disability. However, the Supreme Court’s judgment shows that Imdad Ali’s lawyer had not included the 2012 medical report diagnosing him with paranoid schizophrenia as evidence. This oversight raises fair trial concerns [11].
After the 16 December 2014 Taliban attack on a Peshawar school, killing 149 people (including 132 children), Pakistan lifted its six-year ban on executions for terrorism cases. By March 2015, the government extended this to all capital crimes, threatening to execute up to 1,000 prisoners. Over 400 executions have occurred since. Amnesty International condemned the attack and called for fair trials without the death penalty. However, Pakistan amended its constitution to shift terrorism trials to military courts, raising concerns about fair trial rights. Many death sentences in Pakistan result from unfair trials, including a lack of proper legal representation and the use of evidence obtained through torture. At the end of 2015, 7,000 people were on death row, with Pakistan allowing the death penalty for 27 crimes, including non-lethal offenses. In 2012 the UN Special Rapporteur on extrajudicial, summary, or arbitrary executions concluded that military or other special jurisdictions should not have the authority to impose the death penalty. Amnesty opposes the death penalty as it violates the right to life, offers no proven deterrence, and is a cruel punishment [13]. After that incident, the families of the victims suffer a very huge amount of nervous shock as a secondary victim.
Similarly, in Muhammad Iqbal v. State, the defendant was convicted of the murder of his wife and sentenced to death. In defense, the learned counsel argued that he was suffering from schizophrenia and was administered electric shock treatment to calm him down. The Court quashed his conviction by placing reliance on the case of Abdullah v. State which held: If the accused can prove substantial impairment to his mental responsibility due to even partial or borderline insanity to affect his knowledge as provided in section 84 P.P.C. he would tie entitled to a favorable verdict on the plea of insanity. As to how he is to establish the above requirement, the answer is that the fact need not be proved as scientifically certain but can be established on the balance of probabilities and proper resolution of doubts. The plethora of cases cited takes the view of the instant case in supporting the verdict and reducing the death sentence to life imprisonment on account of the accused suffering from a mental condition [14].
The World Health Organization’s AIMS report (2009) for Pakistan highlights that, regarding mental health activities in the criminal justice system, only a small proportion of prisons (1–20%) have at least one prisoner per month in treatment contact with a mental health professional. As for training, a few (1–20%) police officers and no judges and lawyers have participated in educational activities on mental health in the past 5 years. An appropriate legislative framework is required to improve the human rights situation of those with mental disorders, and this must be developed following consultation with all the stakeholders to ensure that, when implemented, it is effective in achieving its goals [15].
Implementation Issues and Challenges
Comparing mental health laws between countries can be difficult because each law is shaped by its unique social, legal, political, and economic situation. Developing countries like Pakistan face different challenges than developed ones, especially in implementing mental health laws. Delays in approving or enforcing laws often happen due to disagreements among stakeholders, leaving people with mental illnesses vulnerable to abuse and rights violations. To improve, reforms must address both the laws and the resources needed for better services.
Recommendations for Reform and Policy Action
Update Laws: Bring mental health laws in line with international standards, like the UN Convention on the Rights of Persons with Disabilities (CRPD). Enforce the Rules: Set up monitoring bodies to ensure mental health laws are followed properly. Better Facilities: Build more psychiatric hospitals, train more professionals, and provide services in rural areas. Raise Awareness: Run campaigns to educate people and reduce the stigma around mental health issues. Protect Patients: Clearly define the rights of mental health patients and ensure fair rules for involuntary treatment. Train Legal Experts: Teach judges, lawyers, and police how to handle cases involving mental health issues. Help Young People: Make special rules and services for children and teens to address their mental health needs.
Conclusion:
Recently, psychiatrists, mental health professionals, and voluntary organizations have been working to raise public awareness about mental illness. They emphasize the importance of proper treatment, the rights of patients, the responsibilities of families, and the role of the government and society. Efforts to reduce the stigma around mental illness include publishing articles, organizing seminars and discussion groups, and sharing informational materials to educate families and society. Malik and Bokharey (2001) highlighted how organized efforts can improve both the clinical care and human rights of people with mental disorders. A strong legislative framework is essential to support these initiatives. Progress in Sindh offers hope and could inspire other provinces to develop mental health laws and ensure their implementation. To achieve this, patients’ advocacy groups, families, and mental health professionals need to work together to push for effective mental health legislation. However, experience shows that drafting, approving, and implementing such laws often takes a long time.
References:
[1] Amina Tareen, Khalida Ijaz Tareen, ‘Mental health law in Pakistan’ (2016), < https://pmc.ncbi.nlm.nih.gov/articles/PMC5618880/ > (Accessed 1st Aug ,2016)
[2] C.S. Lewis, You’re Not Alone: International Mental Health Day Quotes (2021) <https://batonrougebehavioral.com/mental-health-day-quotes >, (Accessed 7TH Oct 2021)
[3] THE MENTAL HEALTH ORDINANCE, 2001
[4] Komal Dayani, Mekaiel Zia, Onaiza Qureshi, Maria Baig & Taha Sabri International Journal of Mental Health Systems volume, ‘Evaluating Pakistan’s mental healthcare system using World Health Organization’s assessment instrument for mental health system (WHO-AIMS)’ <https://ijmhs.biomedcentral.com/articles> (Accessed 23rd October 2024)
[5] S. Karim, K. Saeed, M. H. Rana, M. Mubbashar, Rachel Jenkins, ’Pakistan mental health country profile’<https://www.semanticscholar.org/paper/Pakistan-mental-health-country> (Accessed 1st February 2004)
[6] WHO Pakistan celebrates World Mental Health Day <https://www.emro.who.int/pak/pakistan-news/who-pakistan- >
[7] [1992] 1 AC 310 at 398. See also at 401 (per Lord Ackner) and at 411 (per Lord Oliver).
[8] Dulieu v White [1901] 2 KB 669 Justice Kennedy: Dulieu v White [1901] 2 KB 669 J Cooke, Law of Tort (13th Edn. Pearson Education Limited 2017)
[9] Dooley v Cammell Laird & Co Ltd [1951] 1 Lloyd’s Rep 271
[10] Abdul Rehman v Chairman M/s. Mari Gas Co. Limited and two others through Mr. Khaleeq Ahmed, Advocate (2010),
[11] Imdad’s case (2002) and Kanizan Bibi case
[12] Amnesty International, ’URGENT ACTION STOP EXECUTION OF MAN WITH MENTAL DISABILITY, (2016) <https://www.amnesty.org/en/ > (Accessed 21st October 2016)
[13] Amnesty International, ’URGENT ACTION STOP EXECUTION OF MAN WITH MENTAL DISABILITY, (2016) <https://www.amnesty.org/en/ > (Accessed 21st October 2016)
[14] Muhammad Umer Ali Ranjha, Ariba Fatima,’ The Death Penalty and Mental Illness in Pakistan’s Courts: A Critical Analysis’, < https://sahsol.lums.edu.pk/node/11452 >
[15] World Health Organization (2009) Mental Health System in Pakistan: Report of the Assessment of the Mental Health System in Pakistan Using the World Health Organization Assessment Instrument for Mental Health Systems. WHO. Available at <http:// www.who.int/mental_health/pakistan_who_aims_report.pdf> (accessed April 2014).
[16] Dr Fawad Kaiser, ‘Challenges to mental health law in Pakistan’ (2020), <https://asiatimes.com/2020/02/challenges-to-mental-health-law-in-pakistan/> (Accessed 24th FEBRUARY 2020)