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 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 • 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Mental health law in Pakistan • 2001 – Lunacy Act repealed and replaced by Mental Health Ordinance 2001 (MHO 2001) • Drew heavily on Indian Mental Health Act 1987 • Used more humane and relatively updated terminology •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 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 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 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 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… • 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?? • Current scenario • Sindh Government has drafted a Provincial Mental Health Bill • Currently in Provincial Assembly
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… • Need for advocacy for the enforcement of mental health law • Advocacy for improving upon the clauses • Inclusion and active participation of all stakeholders
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.