PAKISTAN is grappling with the stigma surrounding mental health. A social fabric steeped in tradition often finds itself at odds with the critical need for progressive mental healthcare solutions.

This clash is exacerbated by misguided reliance on shamans and archaic spiritual rituals, propelled by misinterpreted religious doctrines, rather than scientific psychiatric intervention. This dependence on traditional healers, especially in impoverished areas, perpetuates the stigma.

Child sexual abuse in Pakistan, with its dismal conviction rates, casts a long shadow over our human rights record. Chilling statistics from organisations like Sahil, reveal thousands of cases with a conviction rate of less than two per cent.

Despite initiatives like the Zainab Alert Bill and national sex offender registries, the acute scarcity of child psychiatrists and underdevelopment of specialised branches, such as forensic and community psychiatry, are a glaring oversight in addressing mental health after abuse.

Pakistan faces a dire human rights challenge, as detailed by the Human Rights Commission of Pakistan. A woman is raped every two hours — a statistic that is potentially more frequent, with claims of such incidents occurring every 20 minutes by groups such as Pakistan Men Against Rape.

The distressingly low rate of cases being reported and even fewer convictions exposes deep flaws within the justice system. A number of high-profile rape cases, including the Zainab Ansari incident and a mother abused sexually in front of her children, necessitates a demand for forensic psychiatric assessments in court proceedings.

Pakistani women are encumbered with a disproportionate share of mental health conditions compared to men. While attention has been drawn to many of the sociocultural practices responsible, including karo kari (‘honour’ killings often seen in Balochistan and Sindh), watta satta and child marriages, the struggles of women in less visible rural and urban slum areas remain largely unacknowledged.

Pakistan’s mental health framework is inadequate.

Despite Pakistan’s pledge to the WHO Comprehensive Mental Health Action Plan (2013-2030), women are brutally punished for perceived immorality. Such barbaric practices inflict fear and profound physical and psychological trauma, often leading to myriad mental health disorders.

This crisis is exacerbated by the lack of adequately trained healthcare providers who can recognise and assist victims and violence — a shortfall highlighted by the Unicef-initiated mental health and psychosocial support services programme in 2021. Medical studies corroborate this gap.

In Pakistan, the intersection of mental health and human rights is brought into sharp relief by the impact of blasphemy laws on the mentally ill. Between 1986 and 2010, an alarming surge in blasphemy accusations resulted in over 50 extrajudicial deaths.

The existing laws, increasingly stringent and far-reaching, ensnare individuals with mental health conditions such as schizophrenia and autism, often misused to conceal abuse against them. There is a critical need for legal reforms that provide robust protections for those with mental health challenges, ensuring that blasphemy laws are not weaponised against them.

Pakistan stands at a critical juncture, with recent legal reforms pointing towards progress in mental health care. The decriminalisation of attempted suicide was a commendable step away from punitive measures, signalling the emerging recognition of mental illness as a public health matter and not a criminal one.

However, the realities of mental health care in Pakistan, as evidenced by high suicide rates juxtaposed with an insufficient number of mental health professionals and facilities, particularly in the rural areas, highlight a landscape in desperate need of reform.

With a budget that fails to adequately address mental health and a medical community yet to fully acknowledge psychiatric subspecialties, Pakistan’s mental health framework is alarmingly inadequate.

Forensic psychiatry in Pakistan is at a pivotal juncture, facing the challenge of reconciling its colonial legacy with contemporary human rights and psychiatric practices. Our legal system, which often places an unreasonable onus on defendants to prove mental illness with insufficient support, calls for urgent modernisation.

Pioneering decisions like the Supreme Court’s ruling in the Safia Bano case are indicative of an increasing awareness of these critical issues and underscore the imperative for systemic legal reforms.

Pakistan’s struggle with mental health stigmatisation and human rights breaches requires a legal overhaul. The justice system, failing to shield vulnerable groups, particularly the mentally ill, highlights the need for incorporating psychiatric evaluation into judicial processes.

The writer is secretary, Pakistan Psychiatric Society, Punjab chapter.

Published in Dawn, December 26th, 2023