Prof. Iqbal Afridi lauds Judicial directives to visit public places including shrines


Identification of Mentally ill patients
Prof. Iqbal Afridi lauds Judicial directives 
to visit public places including shrines

KARACHI: Prof. Muhammad Iqbal Afridi, President Pakistan Psychiatric Society (PPS) has lauded the directives by Justice Salahuddin Panhwar of Sindh High Court against the petition filed by Ms. Erum Shaheen, issued to all the commissioners and the senior superintendents of police to constitute special committees to visit public places including shrines and graveyards across the province for finding patients with mental health issues, and referring them to the Sindh Mental Health Authority for proper care and treatment. These public places are considered sanctuaries and feasible alternative treatment for impoverished families of the mentally ill individuals, as most mental illness often remain unacknowledged and commonly ridiculed and stigmatized by the society. Most of the patients found in such places are suffering from diagnosable and treatable mental conditions.

He further stated that the judicious directive of SHC would serve as a landmark throughout the country as provision of health and mental health facility (with its specified purpose) is a fundamental right and the responsibility of the state. Justice Panhwa’s observation that Chapter IX (Section 54) of the Sindh Mental Health Act also provided for the inspection of prisoners with mental disorder and ordered all the district and sessions` judges to ensure during their visits to prisons that all such inmates to be referred to the authority is highly significant, as imprisonment harms mental health. Overcrowding (a serious problem, e.g. Landhi Prison capacity for 1700 but holding 5000+ prisoners), various forms of violence, enforced solitude, lack of privacy, lack of meaningful activity, isolation from social networks, insecurity about future prospects (work, relationships, etc.), and inadequate health services, especially mental health services, harm mental health. The prevalence of poor mental health and substance use among prisoners is considerably higher than in the community, and studies worldwide have shown that suicide rates in prisons are up to 10 times higher than those in the general population. Nevertheless, prisoners are also less likely to have their mental health needs recognized and to receive psychiatric help or treatment. They are most susceptible during the remand period. The ground reality is that even the largest prison in Karachi does not have a proper psychiatric team (comprising of psychiatrist, psychologist, social worker, occupational therapist and trained psychiatric nurse) in public capacity. Based on international data, the prevalence of mental disorder in prisons is over 40% if not closer to 60-70%.

He was of the view that the court order stated that since `place of safety and `psychiatric facility`, as defined in the Act, was specific and meant for the special purpose, but the same purpose could not be achieved by the authority unless the details were available. Thus, the court’s direction to all the commissioners as well as the Director General and the Secretary Health to provide details of the facilities with regard to mental health, including the hospitals, centers, homes in the public or private sectors, for the mentally challenged persons is crucial to the improvement of mental health in the province.

He stressed that mental healthcare must be delivered at the community level. More non-specialists, such as Primary-care Physicians/General practitioners should be trained to deliver basic care to those who need it. Building on the strength of communities to provide mental health in the patient’s immediate environment would sustainably improve lives. (PR)