The black warrant for Imdad Ali and the dismissal of blasphemy accused Humayun’s medical plea has a common thread. The first is a confirmed case of schizophrenia. The symptoms are active, and the mercy plea claiming he is unfit for execution is still pending with the president of Pakistan. Ali’s father suffered from the same illness, and was run over by a train. The second case has a history of mental disorder, and has prescriptions to support the claim. His condition demands a scientific opinion. Humayun would have qualified for a psychiatric assessment by law if he was in Sindh under the Sindh Mental Health Act 2014. In the United States (US) the chances of getting a death sentence are four times higher if the offender is African-American. Capital punishments reached a hiatus in 1972 in the US when ‘super due process’ was formulated to safeguard that the sentencing was proportional to the crime. It included an automatic appeal and careful state review of all capital cases. In 1986, in Ford vs Oklahoma, the Supreme Court, while addressing the issue of a prisoner who went insane on death row, gave the ruling that to be eligible for execution the offender must be able to understand the punishment and the reason for its application. In another landmark case, Atkin vs Virginia, the court in consideration of its evolving standards of decency, along with 18 other states, reversed its earlier decision and banned the execution of mentally handicapped individuals. The federal executions, however, did take place in cases such as Tim McVeigh from the Oklahoma bombings and Juan Raul Garza under the Drug Kingpin Law.? Mental health laws in Punjab are far from implementation. The amendments in 2014 just changed the term ‘federal government’ to ‘government’. The required Punjab Mental Health Authority is a fiction waiting to be actualised. Forensic cases are currently being supervised by a board of certification that includes a team of psychiatrists, neurologists and psychologists, who evaluate the cases with utmost diligence. However, unless the law is truly implemented, the rights cannot be effectively defended in the court. Clive Stafford Smith, founder of the international charity, Reprieve, on his visit to Mayo Hospital’s Psychiatry Department, shared: “I asked a group of eight US judges how sure they have to be about the guilt of an offender before ordering the death penalty. The answer was in the range of 60-70 percent.” When a life is at stake, have we developed a system where an innocent person gets a fair chance? The recent acquittal of two brothers from Bahawalpur after they were executed, and an earlier similar case from Sadiqabad repudiate this notion completely. Let us admit our system is currently far from being error-free. In Pakistan, only three percent of health seeking is managed by primary health care. In economic terms, consequences of mental illnesses are enormous, as mental health contributes 35 percent productivity losses of all non-communicable diseases. A recent study at the Aga Khan University confirmed that mental illnesses have a disproportionately higher impact on productivity than medical costs.Courts have their standard procedures. According to the 2009 AIMS report of the World Health Organisation, despite a large number of mentally ill prisoners in the criminal justice system, only a small proportion (1-20 percent) have at least one prisoner per month treatment contact with a mental health professional. Similarly, a few (1-20 percent) police officers, and no judges and lawyers have participated in educational activities on mental health in the past five years. A meeting this week comprising government representatives, psychiatrists and NGOs concluded that there is a dire need to consider mental health challenges on priority basis. From effects of psychological trauma due to terrorism, an urgent need for mental health legislation was fully acknowledged. Mental health gap (mhGAP) training in five districts was announced, and the planning commission decided to make a task force. The initiative if followed with the same zeal forward is expected to bring a good change. Efforts to expedite the usual delays in drafting, presenting and implementation are expected. Rt Hon Lord Bradley in his landmark report on mental health problems in criminal justice system concluded: “Convergence between mental health and criminal justice tends to happen most at the latter part of the criminal justice system, in the courts at the point of sentencing. Yet interventions at the earliest opportunity are crucial if diversion is to be most effective. Achieving this means reconfiguring the way that health services work with police, and helping police officers change the way that they engage and respond to people with mental health problems.’ The writer is an assistant professor of Psychiatry at the King Edward Medical University, Lahore