Dear Reader,
I hope this overview provides you with a helpful understanding of the current status and development of forensic psychiatry in Pakistan.
Forensic psychiatry in Pakistan is still a relatively new field. Compared to more developed nations, there is a noticeable absence of formal training programmes, dedicated departments, and specialized professionals in this area.
The legal framework in Pakistan concerning mental illness has evolved from the British colonial-era Lunacy Act of 1912 to the Mental Health Ordinance of 2001, further influenced by the 18th constitutional amendment in 2010, which devolved health to the provinces. Despite these changes, the consistent implementation of mental health legislation across different provinces remains inconsistent and often insufficient. It’s important to note that the Pakistan Penal Code (PPC) and the Code of Criminal Procedure (CrPC) address the criminal responsibility of individuals with “unsound mind” and the related assessment and management procedures. Additionally, the Qanun-e-Shahadat Order 1984 (QSO) outlines the role of expert witnesses, including psychiatrists, in legal proceedings.
A significant challenge is the critical shortage of qualified forensic psychiatrists, psychiatric nurses, psychologists, and social workers. This lack of specialized expertise often results in individuals with mental illness within the justice system not receiving the necessary evaluations, treatment, and appropriate court decisions.
Furthermore, the considerable cultural stigma and socioeconomic barriers surrounding mental health in Pakistan impede access to care and understanding, particularly within the legal system.
Despite these challenges, research indicates a substantial volume of forensic cases, highlighting a clear need for specialized forensic psychiatric services. These cases are frequently referred by courts, public hospitals, and government departments, with common diagnoses including schizophrenia, depression, and intellectual disability. The lack of adequate mental health support within prisons and forensic facilities is also a significant concern, posing risks to both inmates and public safety. The intersection of Pakistan’s blasphemy laws with mental illness is another critical and sensitive area, where psychiatric evaluations play a crucial role in informing the court about an individual’s mental state.
However, there have been encouraging recent developments. A significant Supreme Court judgment in February 2021 criticized the lack of forensic psychiatry expertise and mandated the development of services and training programs. This ruling has served as a major impetus for progress. Collaborative efforts with international organizations, such as the School of Forensic Mental Health / The State Hospital Carstairs Scotland and Khyber Teaching Hospital and Sir Cowasjee Jehangir Institute of Psychiatry/Behavioural Sciences Pakistan, have developed curricula and certificate courses to train mental health and legal professionals within Pakistan. Currently the first cohort of 16 candidates are undertaking this course.
Furthermore, provinces, have enacted their own mental health acts that include provisions for inspecting mentally disordered prisoners and providing forensic psychiatric services.
Ongoing research and audits are also crucial, as they help to assess the scale of forensic cases, the types of psychiatric disorders encountered, and the sources of referrals, providing essential data for future planning and development.
In conclusion, while forensic psychiatry in Pakistan faces significant hurdles related to limited resources, training opportunities, and systemic integration, the increasing recognition of its importance, coupled with proactive efforts partly driven by legal directives, indicates a positive trajectory for the strengthening of this vital field.
Best regards,
Khuram Khan, MRCPsych
30/05/2025