A rape survivor has allegedly been sexually assaulted in the Pakistan Institute of Medical Sciences Islamabad (PIMS) where she had been taken for treatment. The unnamed 22-year-old alleged that she was raped by a male nurse; she is said to be in a critical condition, too unwell to even record her statement. Public hospitals in Pakistan are frequently crowded and understaffed with lax security. The case has drawn national attention to the plight of women, and many have demanded harsher punishments for rapists. The First Information Report (FIR) was registered but no case of negligence was registered against hospital authorities. Even more alarming is the revelation that this was not the first time vulnerable women had been raped and sexually assaulted in PIMS, and the alleged sex offender has a history of sex-offences in the PIMS A&E department over the last few years.
Sexual violence is defined as any sexual act forced upon a person who did not give his or her consent. In cases of rape, the law says the anguish caused by the fear of pregnancy shall be presumed to constitute a grave injury to the mental health of the woman. I do not think lack of resources can be used as the measure to define why potentially dangerous people are on the streets and why vulnerable citizens sometimes have to live in fear and isolation while their perpetrators walk the streets. I think not to increase resources and involving experts in the forensic psychiatry field is short-sighted and the consequences can be disastrous.
It is inexcusable that a disabled 22-year-old female patient was allegedly raped in the Intensive Care Unit (ICU) of PIMS. CADD State Minister Dr Tariq Fazal Chaudhry has so far done what every incumbent state minister is expected to do: he has immediately formed a committee that would submit an enquiry report when and where required. Having done that, the minister may think he has done his job but, unfortunately, the incidences of sexual assault has increased over the past decade and the risk of sexual violence and behavioural patterns of sex offenders is now being fervently debated in our society. Sexual victimisation is routinely prosecuted, but sex offenders have a high rate of recidivism and are up to 10 times more likely to be re-arrested for another violent sexual assault than individuals convicted of other crimes.
With hardly any practising state legislatures to allow for civil commitment of sexual offenders to mental health facilities and the creation of sex offender registries, psychiatrists have found themselves thrust into this nexus of society and the legal system. Forensic psychiatrists are often asked to evaluate individuals accused or convicted of sexual offences for a variety of purposes, including the assessment of dangerousness, risk for recidivism, involuntary commitment, and inclusion in a state’s sex offender registry, competency, and criminal responsibility. But in Pakistan there is little knowledge of forensic psychiatry, although a promising glimpse of forensic psychiatry practice was seen in the first Forensic Psychiatric conference recently held in Lahore, which carried out workshops and plenary sessions on prevention of sex offences and the rehabilitation of victims of sex offences.
Like most other forensic evaluations, the assessment of sexual offenders involves performing a comprehensive psychiatric evaluation, reviewing available police reports and criminal history, and contacting available collateral sources of information to verify information provided by the defendant. In addition, the accurate assessment of individuals involved in sexual crimes requires a detailed sexual history and careful evaluation for deviant sexual arousal patterns. Sexual assessment questionnaires are often used as a guide to aid in the clinical assessment of sexual history and behavioural patterns. Because effective control and treatment of deviant sexual behaviours depends on identification and understanding of the underlying dysfunction, assessment techniques that provide insight into the aetiology of behaviour are critical to reducing sexual predator crimes. It may have happened last week, last month, 10 years ago or decades may have gone by, but some victims of sexual assault would finally get their day in court. I am not sure why the avenues to solving this type of crime have been left on the wayside, but I believe it would be prudent to provide even more forensic expertise to ensure that cases of sex offenders and victims are analysed in a timely fashion.
The rationale is to outline how the publicity of a high profile sexual offence can increase the understanding of relationships among sexual violence, paraphilia, and mental illness. I will also question whether more is required from the case study of this civilly committed sex offender who is being examined in custody. Specifically, the question is whether such standards and practices are efficient and necessary given the issue of increased cases of rape and sexual molestation by health practitioners in hospitals and clinics.
The vicious and alleged brutal rape of physically disabled female in an ICU at PIMS has drawn national attention, and concerns on how to prevent such tragedies from happening in the future. Attention has also been focused on this case, as well as the term ‘sexual predator’,” and various pieces of legislation would have to be considered to prevent further similar occurrences. More specifically, issues of sexual predator registration, community notification and sexual predator civil commitment laws have to be topics of discussion.
Individuals who are sexually deviant pose a higher risk. Contrary to public belief, not all sex offenders qualify for sexually deviant psychiatric disorders. If one is labelled a sexual predator, he or she would be a high risk for sexual recidivism and as a result, would be mandated to be registered in the community as a sexual predator for community notification and safety purposes. While community notification and registration of sex offenders are two significant pieces of sex offender legislation, I would argue that government should initiate legislation requiring civil commitment of violent sexual predators.
Provinces should be granted the authority to enact civil commitment statutes to control violent sexual predators. This authority should be a provincial right and should be excluded from the federal domain. However, the provinces should consider initiating sex offender treatment while the defendant is in prison as part of his attempted rehabilitation. Furthermore, the provinces should impose harsher sentences and consecutive, rather than concurrent, sentences in some situations for serious sex offenders who have committed sexually violent acts. These steps may eliminate the need for civil commitment of sex offenders and conserve provincial government resources.
The writer is a professor of psychiatry and consultant forensic psychiatrist in the UK. He can be contacted at [email protected]