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A review of Mental Health Law in Pakistan. Presentation by Rubeena Kidwai, Ph.D. Consultant Clinical Psychologist Hubert H. Humphrey Fellow 2010-2011. History of mental health law in Pakistan. 1912 - Mental health law introduced in Indo-Pak subcontinent (then India) – Lunacy Act 1912

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A review of mental health law in pakistan

A review of Mental Health Law in Pakistan

Presentation by

Rubeena Kidwai, Ph.D.

Consultant Clinical Psychologist

Hubert H. Humphrey Fellow 2010-2011


History of mental health law in pakistan
History of mental health law in Pakistan

  • 1912 - Mental health law introduced in Indo-Pak subcontinent (then India) – Lunacy Act 1912

    • Referred to persons with mental illness as “Lunatics” or “idiots of unsound mind”

    • Main emphasis was on

      • removing persons with mental illness away from mainstream society and keeping them under custodial care or “asylums”

      • ‘Protecting’ the society from persons with mental illness


Mental health law in pakistan
Mental health law in Pakistan

  • 2001 – Lunacy Act repealed and replaced by Mental Health Ordinance 2001 (MHO 2001)

    • Drew heavily on Indian Mental Health Act 1987

    • Used more humane and relatively updated terminology

      • e.g. “mental illness”, “psychiatric facility”, “care in the community”

    • Addressed human and civil rights of persons with mental illness

      • Informed consent

      • Right and privilege to confidentiality

      • Right to protection of property and assets

      • Punitive measures against abusive treatment


Mental health law in pakistan1
Mental health law in Pakistan

  • 2001 - Federal Mental Health Authority (FMHA) formed whose task it was to:

    • Form rules and regulations to make the Ordinance enforceable

    • Advise government regarding matters of mental health – prevention and promotion

    • Advise on setting up on mental health services and on improving existing mental health services

    • Prescribe code of practice for mental health service providers


Mental health law in pakistan2
Mental health law in Pakistan

  • 2001 MHO introduced and FMHA formed

  • 2003 Member of FMHA reported they were working on creating forms and procedures in line with MHO

    • No additional news of any meetings or activities about FMHA

  • 2001 onwards – PAMH, HRCP and other stakeholders involved in:

    • Awareness raising about the MHO

    • Consultations regarding suggested amendments

    • Advocacy for the implementation of MHO


  • Mental health law in pakistan3
    Mental health law in Pakistan

    • 2005 – Tenure of members of FMHA ended

      • FMHA lapsed

  • 2007 - Board of Visitors (BoV) formed was in Sindh

    • Due to lapse of FMHA the BoV did not have a valid presence

  • PAMH contacted the Federal Ministry of Health numerous times to

    • Urge the FMHA to convene and begin its tasks

    • To reconstitute and activate the FMHA


  • Mental health law in pakistan4
    Mental health law in Pakistan

    • 2007 – PAMH filed a petition with Sindh High Court asking for reconstitution of the FMHA

    • 2008 (Oct) – Sind High Court ordered Federal Ministry of Health to reconstitute FMHA

    • 2009 (Dec) – FMHA reconstituted - but did not meet

    • 2010 Jan- Jun - PAMH initiated a signature drive petitioning the FMHA and the Supreme Court to take steps to implement the MHO

    • 2010 (Jun) – Chief Justice took note of the issue and directed the issue to Human Rights Cell which in turn issued a directive for the FMHA to convene

    • 2010 (Dec) meeting of FMHA


    However
    However…

    • 2010 April – 18th Amendment Bill was passed

    • Process of devolution of power and greater power to provinces

    • Federal legislative list vs. Concurrent legislative list

    • MHO becomes a casualty of 18th Amendment

      • FMHA dissolved

      • MHO does not have force


    Problem or opportunity
    Problem or opportunity??

    • Current scenario

      • Sindh Government has drafted a Provincial Mental Health Bill

      • Currently in Provincial Assembly


    Loopholes and lacunae
    Loopholes and lacunae

    • Definition of mental illness

    • Exclusion of other mental health service providers and mental health facilities

    • Power to police

    • Absence of psychiatrists in many areas

    • Does not address civil or criminal liability of a person suffering from mental illness


    The way forward
    The way forward…

    • Need for advocacy for the enforcement of mental health law

    • Advocacy for improving upon the clauses

    • Inclusion and active participation of all stakeholders


    References
    References

    Mental Health Ordinance, full text, retrieved on November 28, 2011, at http://www.emro.who.int/MNH/WHD/Pakistan-Ordinance.pdf

    • Gilani, A.I., Gilani, U. I., Kasi, P. M., & Khan, M. M. (2005) Psychiatric Health Laws in Pakistan:From Lunacy to Mental Health. PLoS Med 2(11): e317

      doi:10.1371/journal.pmed.0020317.



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