Queen’s University Psychiatry Associate Professor Tariq Hassan has seen too many people suffering from mental-health issues ignored by a justice system in Pakistan that is not equipped for basic psychiatry needs.
Many are treated like regular prisoners with no access to treatment and little hope of getting better. It can be dangerous for the person suffering from mental-health issues, other inmates, prison officials, and the general public once the person (if they get no treatment) is released.
“It’s in everyone’s interest that mental-health issues do not go untreated,” says Dr. Hassan, a forensic psychiatrist who was born and raised in Pakistan.
In Canada, forensic psychiatry is an established field and Dr. Hassan is one of many doctors who help the courts decide if a defendant with a mental illness is capable of standing trial or if they are criminally responsible for their actions.
During a trip to Pakistan in 2012, Dr. Hassan discovered that forensic psychiatry was hardly used in the legal process. Since then he has dedicated himself to building the field by collaborating with Pakistani experts to help facilitate systematic changes.
In 2015, Dr. Hassan published one of the first extensive papers on the state of forensic psychiatry in Pakistan, outlining barriers that need to be overcome. Even today, the nation is still in desperate need of more psychiatrists. A 2020 article in the medical journal The Lancet noted there are fewer than 500 psychiatrists in a country of more than 200 million people, leaving more than 90 per cent of Pakistanis suffering from mental disorders with no treatment. Dr. Hassan estimates there are fewer than 20 psychiatrists in Pakistan who are interested in the law and providing expert opinions to the courts.
Over the years, Dr. Hassan recommended and worked with the Pakistan Psychiatric Society to create a forensic branch (which was finally established in 2020) so like-minded individuals can make guidelines, create training programs, and host conferences.
Forensic psychiatrists need to work in partnership with the justice system, so Dr. Hassan also reached out to the Pakistan legal community. In 2019, he gave a talk to judges, lawyers, and police officers at a meeting of the Islamabad High Court Bar Association.
“My talk was very warmly received. It was like they were hearing it for the very first time,” Dr. Hassan said. “They realized (the Pakistan legal community) needs help with education in mental health.”
In February 2021 the Supreme Court of Pakistan made a landmark ruling that is now making forensic psychiatry an important component of the country’s justice system. The court ruled that prisoners on death row with serious mental-health problems who are “unable to comprehend the rationale and reason behind his/her punishment” cannot be executed for their crimes. The ruling also required lawyers and judges be trained in how to assess mental-health issues and the defendant’s ability to stand trial.
“Most developed countries around the world have a landmark ruling that will guide forensic psychiatry for three or four decades, and this is the case in Pakistan,” says Dr. Hassan.
After years of slowly building the field of forensic psychiatry in Pakistan, Dr. Hassan says the Supreme Court ruling is giving him an exciting opportunity to make a major impact.
“I have been advocating for change (in Pakistan) for years and it takes time. It was like moving the Titanic with one tug boat. Now with the Supreme Court judgment, I feel like I have 15 tug boats” says Dr. Hassan.