Imagine being inflicted by a severe and progressive psychiatric illness called schizophrenia, and you kill an old friend under the effect of a delusion. Do you wonder which laws are in place to safeguard our interests? A delusion is a thought disturbance existing in a patient’s mind as the truth. Mentally ill prisoner, Imdad Ali’s delusion was that his spiritual growth was hampered by a friend, the victim.

The Supreme Court not only rejected the jail notes by visiting psychiatrist but also Nishtar Medical College’s psychiatry department’s diagnosis of ‘paranoid schizophrenia’. A board of most experienced psychiatrists is now going to re-assess the prisoner.

Mental health assessment records are missing around the time of Imdad’s trial. Jail personnel are being pushed to share them. However, the Punjab government was able to access the available jail records which date two years after the trial.

Imdad’s fate is sealed with a diagnosis of treatment resistant schizophrenia and absence of a forensic setting. Discovery of the drug clozapine for resistant schizophrenia is being denied to him; this reminds me of the infamous Tuskegee syphilis study where African Americans suffering from syphilis were denied the available treatment of penicillin. Their excuse was to study the full spectrum of syphilis. What is our excuse?

Compare Mrs Farhat case, 64-year-old patient of schizophrenia who is better with treatment but remained confined at Punjab Institute of Mental Health (PIMH). She was held against her will for 5 years. Now she has filed corruption charges on the authorities.

Mental health laws speak of having an all-powerful body called Punjab mental health authority and a board of visitors to evaluate the authority’s performance independently. The only problem is in reality, there is neither an authority nor a board. It’s like a state-of-the-art design of a building with an imaginary address.

The Mental Health Ordinance 2001 reads, ‘Any patient, not being a mentally disordered prisoner, may make an application to the Magistrate for his discharge from the psychiatric facility’. And ‘the magistrate may after making such inquiry as he may deem fit, pass an order discharging the person or dismiss the application’.

It envisages a ‘board of visitors’ lead by a retired judge to inspect and evaluate the standards of treatment at government and private facilities: Mrs Farhat would have been visited and released, once she had recovered.

The non-existent ‘Punjab Mental Health Authority’, is responsible for supervising promotion of mental health, establishing standards of care, creating centres for children, psycho-geriatric, forensic, the learning disability and community based services. Also establishing crises centres, registration protocols, research and registering psychiatrists and facilities is important.

Special courts are also proposed, where lawyers and judges will attend an orientation in handling mental illness related cases. An another distant fantasy.

The overwhelming majority of the private set ups are not being run by psychiatrists in Pakistan, rather unqualified people are running such facilities. Since its grossly unregulated, there is no check and balance. The above mentioned non-existent ‘Punjab Mental Health Authority’, was assigned the powers to register and monitor the private institutes. The public has a right to be safeguarded against such places. The law makes it mandatory that a ‘psychiatrist’ is a must to run such a facility.

The recent need is being addressed by the psychiatric community on an emergency basis – last week, recommendations to the mental health act were submitted and are currently underway. Once it is approved, further rules and regulations will be created for its practical operation in society and prisons.

The fact that the first psychiatric hospital ward was founded in Baghdad in 705, and insane asylums were built in Fes in 8th century Cairo in 800 and in Damascus and Aleppo in 1270, and the scholars who wrote on mental disorders such as Al-Balkhi, Al-Razi, Ibn-Sina and Al-Farabi were Muslims, it gives our society an impetus to strike a balance between empathy and justice.

With this I conclude, one’s rights although apparent and constitutionally secured, do not automatically implement themselves.