Daily Times

The situation is very bleak for mentally challenged prisoners in Pakistan. They are victims of a prison system that aims to maltreat inmates with no consideration of their mental health requirements. This is compounded by the fact that those that are incarcerated are two to four times more likely to suffer from depression and serious illnesses, such as bipolar disorders, schizophrenia etc. in contrast to the general public, according to a study conducted by the LAO on Mental Health in Prisons. These mental disorders are not always prevalent from the onset; in fact, prisoners may develop them during their incarceration.

According to the WHO information sheet on Mental Health and Prisons, multiple factors prevalent in prisons have negative effects on mental health, including, but not limited to overcrowding, various forms of violence, enforced solitude or conversely, lack of privacy, lack of meaningful activity, isolation from social networks, insecurity about future prospects (work, relationships, etc.), and inadequate health services, especially mental health services, in prisons. The impact of the accruement of all these issues is corroborated by the increased suicide rates in prisons.

To understand this further, we can focus on the province of Sindh specifically. As of 2018, there are 25 operational prisons in Sindh, with a population of 17,425 out of which 13,216 are under trial. Out these 25 prisons, 4 have drug treatment facilities, one of which is located at the largest prison facility in the province, Central Prison Karachi, which is currently home to 4735 prisoners in total. Currently serviced by 12 doctors and only 1 psychiatrist that visits once a week, the prison is lamentable in its provision of these crucial services, inevitably causing an ever-widening rift between demand and supply. The issue is exacerbated by the fact that the longer an inmate stays in prison, the more likely are his mental faculties to be affected by such factors.

On the global front, according to a study conducted by the Prison Reform Trust (UK), 70 percent of people who died from self-inflicted means whilst in prison had already been identified as having mental health needs. Furthermore, 40 percent of prisons inspected in 2016-17 had inadequate or no training for prison officers to know when to refer a person for mental health support.

According to a study conducted by the Prison Reform Trust , 70 percent of people who died from self-inflicted means whilst in prison had already been identified as having mental health needs

It is reasonable to conclude that the outlook is not pleasant for mental health patients in prisons in First-World countries as well. Despite the progressiveness of society in such countries, the mentally affected are still not prioritised enough, showing that there is still much to be achieved if the stigma around such individuals is to be broken, which puts the situation of a country like Pakistan into perspective.

This raises the question of what is being done to improve the situation? Unfortunately, the legal framework in prisons can be traced back to the era under the British yoke, resulting inevitably in an outdated ideology that fails to treat prison inmates in a way that is acceptable in the modern era. An example of this is seen in Rule #433 of the Pakistan Prison Rules, which refers to a mental health patient as an “idiot”. Prison manuals still include derogatory remarks regarding mental health patients as well, dehumanising them, and as a result, taking away their basic human rights. These rules date back to the Lunacy Act 1912, making them redundant by default, especially while dealing with non-criminal mental health patients; in contrast, the Indian Supreme Court deemed incarcerating non-criminal mental health patients as illegal in 1993. In addition to this, rules that require the segregation of mental health patients seem to be aimed towards the protection of others from these patients while safeguarding the rights of the patient takes a backseat.

Non-implementation of laws is another significant problem; Sindh is the only province that has integrated the Criminal Justice System and mental health; however, the mental health authority has yet to be constituted, the visiting board needs to be notified, and no separate special security forensic psychiatric facility for transferring under trial prisoners has been established. In a significant step forward, however, the Government of Sindh introduced the Sindh Mental Health Act, that primarily aimed to relieve blasphemers who were languishing in Sindh’s prisons. It was estimated that most of them were already handicapped or outright psychotic, and so, in order to prevent further misdirected punishment, it was made compulsory for any blasphemer that attempted suicide to be assessed by a psychiatrist, and to be dealt with accordingly after his evaluation. By the introduction of this law, the government of Sindh has shown to be actively looking towards more adequate solutions to issues. However, there is still a long way to go in terms of implementation, as it was only in 2017 that the Sindh Mental Health Authority was formed.

In today’s day and age, with greater inclusivity in the recognition of human rights than ever before, such as that of the transgender community, for whom Pakistan has relatively progressive legislation, it is imperative that Pakistan also takes initiatives for the mental health of prisoners, similar to that in the Sindh Mental Health Act. These measures will have the benefit of streamlining the process of helping the mentally ill in coping with their issues, as well as making legal proceedings less arduous

Prison systems can incorporate the following steps as well, to improve conditions. They can appoint full time mental health doctors and nurses, train prison staff to recognise and prevent suicidal prisoners, and bring ministries together to address mental health issues of prisoners.

Our system is retribution and deterrence oriented as opposed to being rehabilitation oriented, and as a result, is inappropriate for mental health patients, especially those imprisoned for non-criminal activity. In order to improve the current system for prisoners with mental health illness, changes that may seem insignificant may set in motion the waves that wash away the shackles of cultural stigmas and societal taboos. It is imperative that barriers to these changes, that stem from these stigmas, are removed in order to not hinder the progress of these steps. When combined, these procedures will help in reducing intolerance in society as well as improving living standards for those who are otherwise shunned.

The writer is an intern at the Legal Aid Society

Published in Daily Times, August 26^th 2018.