SHAHZAD has been sitting on a bench outside the emergency ward of the Punjab Institute of Mental Health (PIMH) for hours, occasionally lying down on the well-maintained grassy lawn, while his father is treated inside. He and his mother have been bringing the father to PIMH, also known as the Mental Hospital, for 25 years.

“The patient was a drug addict, would cut his own hair, act violent and hyper, break things, walk around naked, which is why we initially brought him here. He was kept for over two months, administered injections and medicines and sent home when he was stable. After a few days back at home, he started skipping medicines and began smoking again because of which he suffered a relapse. We then brought him back to the hospital and since then we have been doing the same each time he skips medicines,” said the weary, evidently sleepless young man.

The century-old PIMH, spread over as many as 54 acres, is the only facility in Punjab, public or private, that treats patients with mental illnesses. Located in the busy Shadman area of Lahore, the hospital is literally a town in itself, secluded from the rest of the city with its high, thick walls shielding the lives of its denizens and an arched gateway with minarets on either side — reminiscent of a fort — leading inside.

The mission statement affixed to the right side of the gate talks about the provision of “state-of-the-art” facilities to the mentally sick people to enable them to “become socially acceptable, useful and productive members” not only of their families, but the society also.

A 10-point “Hamara Paigham (Our Message)” aims to create awareness about mental health in the most relatable terms and language: mental illnesses are treatable; psychiatric diseases aren’t caused by magic, but chemical changes in the brain; don’t treat mentally challenged people as a burden; not every mentally ill person needs to be admitted to a mental health facility, they could be treated with their families’ support and prescribed medicines; marriage is not the solution to a mental illness, instead mentally ill people could lead a happy married life once they’re treated; a mentally challenged child can be taught various skills; love and attention can prove helpful in treating such people; proper treatment can control epilepsy; and hate the drug, not the addict.

From the looks of it, the facility does look like a mental health-friendly place: blooming flowers, plants, big shady trees, huge manicured lawns, a small zoo, daycare centre, and blocks named after Sufi poets.

Additional Medical Superintendent (AMS) Dr Mohsin Shaukat says the 1,510-bed facility almost always has at least 1,100 patients admitted — mostly men and only 400 to 450 women. “These can include people who are violent, threaten their kids with taking their lives, randomly cast doubts over their wives, drug addicts. Some are brought in by their families, others with no relatives are picked up by police and the court then issues their guardianship orders to the institute; so they’re owned by the state.”

These patients could be suffering from mood disorders — such as depression and schizophrenia — drug addiction, epilepsy or a mental disability, but, the AMS claims, they are only treated with a variety of medicines — anti-psychotics, anti-depressants, mood elevators, mood stabilisers and tranquillisers — and psychotherapy and group sessions. “The only treatment is lifelong medication and patients are called in for follow-ups also. Mostly, patients are admitted for 15 days to a month and then sent back home with instructions on medication. More than a patient, his/her family needs education and awareness about an illness,” says Dr Shaukat.

However, not every patient is fortunate enough to return to his/her family. If the illness and treatment take their toll, what possibly damages their mind further is the abandonment they face. “This is our biggest problem: patients whose families get them admitted to the hospital, often refuse to take them back. They give incorrect addresses and phone numbers. If we take the patient to their homes, families don’t open doors and make excuses. So we bring such people back, take their responsibility, teach them some skills and they become gardeners, carpenters, cooks. They then live and die here and are even buried in the hospital’s own graveyard,” laments AMS Shaukat.

Coronavirus that ravaged the world failed to affect the institute, as the AMS claims they have not had to report even a single case of Covid-19 among their patients since the pandemic broke out. “This is because we closed admissions as soon as the first Covid-19 case in the city was reported, stopped visits by families and relatives or even government officials and just shut down any movement from the outside.”

While medicines are free and Shahzad, the patient’s attendant mentioned earlier, appears satisfied with the facilities at PIMH, renowned psychiatrist Dr Sa’ad Malik has a sordid tale to tell — of corruption, mismanagement, pilferage, apathy, lack of interest among doctors, and much more. “They have 250 doctors, out of whom only a couple are interested in psychiatry, while the others are into cardiology, pathology, gynaecology, etc. Nurses have no concept of psychiatric nursing, which is different from common nursing. The wards are locked at night and the attendants, nurses, doctors all go to sleep. What happens to the patients at night can’t be described because most are either stable or are new admissions, who are very aggressive. So clubbing them together is very dangerous,” he says.

“There’s pilferage in food and medicines; patients are beaten, the kind of psychiatry practised there is obsolete, there’s over-medication.”

Dr Malik has been part of a supervisory committee formed in 2018 by then health secretary on the order of the Supreme Court to formulate recommendations for running PIMH. “I’ve been trying to change things at the hospital for 30 years. The committee worked for two months and prepared recommendations, but former chief justice of Pakistan Saqib Nisar retired and the report never saw the light of the day. The hospital is located in the heart of Lahore but if you go inside, you feel you’ve gone back 500 years,” says the visibly dissatisfied veteran.

He feels the reason behind the hospital’s failure to move ahead with time is the general lack of apathy among the psychiatrists, the workers, members of the bureaucracy and officials of the health department. About what he thinks needs to be done, he says: “I gave many recommendations as part of the committee, but the one I think should be implemented immediately is to form a supervisory committee comprising psychiatrists, psychologists, journalists, lawyers and some others who feel for humanity. They should visit the facility once a week, have the powers to fire and hire and the hospital will improve within a month. The empty grounds can have hostels and homes for mental patients and wards for acute patients.”

Dr Malik says the concept of asylum is now obsolete in the western world. “They believe, and rightly so, that patients should be kept in community in small mental health centres. But that’s a long shot from our situation.”

With awareness about mental health increasing the world over, AMS Shaukat says in Pakistan too, TV and social media have helped alert people to the problem. Yet, a dearth of hospitals and health facilities across the country hampers the mitigation of mental health issues. “Mental hospitals or smaller institutes should penetrate among the other cities, communities and backward areas so people don’t have to contemplate before coming to Lahore from far-flung areas.”

Published in Dawn, May 3rd, 2021