Up till 2001, the Lunacy Act of 1912 regulated both the medical treatment meted out to psychiatric patients in Pakistan and the rehabilitation centres—both in private and public sector—came under its purview. It took 54 years to replace the outdated, colonial-era legislation with Mental Health Ordinance 2001 that aimed to bring about the necessary changes that took place in the mental health practice over a century.
The new legislation was applicable on all of Pakistan and carried provisions related to mental healthcare, voluntary treatment for mental illnesses, and dealt in detail with the installation and outs of involuntary admission in severe cases. Furthermore, provisions related to appeal against involuntary detention was also provided which was, however, rarely used.
Not at all a flawless piece of legislation, Mental Health Ordinance 2001 still aimed to cover the competency, capacity and guardianship issues for mentally ill; also delineated the offences against persons with mental disorders, ill-treatment or neglect of a patient by the staff of a psychiatric facility, and other inhumane acts committed against mentally ill.
With the passage of 18th Amendment in 2010, the subject of health devolved to the provinces and the Mental Health Ordinance 2001 lapsed. Since then, the legislatures of Punjab and Sindh have passed Punjab Mental Health Act 2014 and Sindh Mental Health Ordinance 2013, respectively. However, the implementation of the laws lags behind in various ways, including the absence of provincial authority responsible for overseeing and keeping check and balances on the rehabilitation centres.
The state of affairs in KP and Balochistan are such that both provinces have yet to pass mental health regulating acts, even after a lapse of seven years since the 18th Amendment.
In a story published in this newspaper back in January this year, the condition of many rehabilitation centres was documented at length. Opened in small, rented houses in suburban areas, these rehabilitation centres provide services to both psychiatric patients and drug addicts at exorbitant prices. The staff hired at most of these rehabilitation centres, located mainly in Bani Gala, Khana Pul, l Ghori Town, Chaklala, and middle-class sectors of Islamabad, are under-qualified and poorly paid.
The most worrying aspect of all is that aforementioned rehabilitation centres that offer in-patient facilities are neither registered with the social welfare agency or health directorates in their respective provinces.
“The situation of mental health is dire in Pakistan. There is already scant awareness about various mental ailments. The social stigma and ostracism that follows a diagnosis exact a huge cost on an individual. There is a need for awareness and acceptance. Proper laws, their legislation and, most importantly, their implementation will improve things for mentally ill individuals and society as a whole,” said CDA Hospital Islamabad’s Psychiatry Head Dr Anwaar-ul-Haque.
