Dr. S.Ali Wasif talks about the state of mentally ill in prisons in Pakistan.

Prisons are in their true essence, institutions which perform conflicting tasks of punishment to those offending laws of the country; and providing for their rehabilitation during their stay in prisons.

If we take a glance at Prisons Reforms Report 1997, it shows there were 79 jails in Pakistan with a capacity of 34,226 inmates but today the existing population is 80,795 out of which total Convicts are 16,905 and Under trial prisoners 63, 890, need less to comment on the system of justice and its short comings.

This is an international phenomenon and Pakistan is by no means an exception from this; overcrowding of jails and lethargic legal system has attracted attention all over the world. It would not be wrong to say that as long as society emphasizes imprisonment as a weapon against crime, it operates as a dominant factor on account of which jail population gets swelled unnoticeably.

Jails and prisons hold many people that society on the other hand does not want to have around and it would be wise to keep them there, despite the fact that the legal and correctional system have failed to bring any positive changes in them despite keeping them behind the walls. As long as we keep working on our faulty approaches there would be no change to the social system and rehabilitation of the offenders.

There are seventeen prisons in Sindh and around 19,000 prisoners are currently inmates and out of which around 16,000 are under trial and over 2,000 were convicts. The prisons are heavily overcrowded, which worsens the mental health of the inmates and the care providers as it increased mental stress and overall psychological morbidity.

There is, another sizeable group of prisoners for which imprisonment is even less appropriate: the mentally ill. Prisoners with mental illness frequently endure violence, exploitation and extortion at the hands of other inmates, and neglect and mistreatment by prison staff. Not only is the experience of imprisonment counter-therapeutic for such prisoners, many mental health experts believes that it dramatically increases their chances of psychiatric breakdown.

The prevalence of psychiatric morbidity among people in prisons was much higher than the people living outside as according to a local study about one third of the sentenced prisoners had psychiatric disorders and about 20 out of 1,000 had psychosis. Despite good reasons to limit the incarceration of the mentally ill, the number of mentally ill people behind bars continues to grow because of the prevailing circumstances. The mental disorders affecting these prisoners include such serious illnesses as schizophrenia, bipolar disorder, and major depression. Unfortunately there are no national data on historical rates of mental illness among prisoners, but common knowledge suggests that the proportion of mentally ill prisoners has grown significantly.

A study conducted on 5,000 inmates of Karachi Central Prison showed that nearly 73 per cent suffered from psychiatric morbidity - comprising depressive illness (42 per cent); schizophrenia (11 per cent); stress / adjustment disorder (6.6 per cent); phobic anxiety disorder (3.5 per cent); bipolar affective disorder (3.3 per cent); depression with psychiatric features (2.4 per cent); drug dependency (1.3 per cent); obsessive compulsive disorder (1.3 per cent); and epilepsy (0.8 percent).

According to American Psychiatric Association, a study published in 2000, concluded that as many as one in five prisoners were seriously mentally ill, with up to 5 percent being actively psychotic at any given moment. It also estimated that over 700,000 mentally ill people were processed through prison or jail each year.

Few prisons or jails have sufficient numbers of trained staff to accommodate prisoners but hardly any one capable of handling mental health needs and psychiatric patients. There is only one part time psychiatrist deputed at the central prison Karachi and one medical office to address the issue of health of prisoners, as a result, many mentally ill prisoners go untreated, or receive treatment that is extremely limited in both quantity and quality.

They are taunted "CHARYA" mentally ill prisoners, deliberately provoked, physically mistreated; force is used against them maliciously, or are turned a blind eye to abuses against them by others and kept in the cells called charya ward. It is learned that once people having mental disorders were kept without clothes at night in Karachi prison, as one of the prisoners had committed suicide. To preempt such an act, the prisoners were forced to remain without clothes at night despite providing them with adequate treatment of their ailments and disorders.
The mentally ill are vulnerable to violence, assault, sexual abuse, exploitation, and extortion. Security staff frequently dismisses their symptoms as faking or manipulation; they face physical abuse and mental harassment.

The immeasurable human suffering of the mentally ill is not only inhumane, it is also unnecessary. Extensive trainings for mental health workers and Security staff of jail should be carried out to improve the quality of services.

There is immense need to reduce the number of mentally ill patients by either referring them to the existing psychiatric units with there limitations or to create a new segment of therapeutic community for the correction of their maladaptive behavior and offenders. This would reduce the burden on the security and medical staff of jail, by reducing the overall number of mentally ill prisoners, and would also free up resources that could be used to remedy the generally low quality of prison health care.

There is also a need for allocation of funding to improve the quality of prison and jail mental health services, and to establish discharge programs for mentally ill prisoners who are released.

It is a national shame that our prisons and jails serve as a tool of derogatory instrument in the form of CHARYA wards, degrading the entire humanity and preaching of Islam. It reflects a lack of planning, a failure of public commitment, and a single-minded focus on punishment. The existing Mental Health Ordinance 2001 had been slightly improved as compared to its earlier version, the Lunacy Act 1912, but the ordinance still needs a saner and more compassionate approach to address the issues of mental health.

The author is a Practicing Psychiatrist and can be reached at Mental Health Clinic, 90-A, Depot Lines, Behind Prince Cinema, Sadder, Karachi. Tel # 7217245, 7232423 Cell#0300 2125446

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