Justice Bulletin: Punishing The Mentally Ill

The Justice Bulletin is an initiative of the Justice Project Pakistan (JPP) to shed light on some of Pakistan’s most pressing criminal justice failures.

This special edition of the Justice Bulletin focuses on the case of Imdad Ali, a schizophrenic on death row for over 14 years. Imdad’s case encapsulates the many failures of the Pakistani criminal justice system in safeguarding the rights of mentally ill prisoners.

The PDF of the e-bulletin is available here: Justice Bulletin: Punishing the Mentally Ill and here (yumpu).

To read more about Imdad Ali’s case, click here

To read more about the death penalty for the mentally ill under international law, click here

To gain more understanding of mental illnesses and schizophrenia, click here

“A Cruel and Inhuman Punishment”: Execution for the Mentally Ill Under International Law

The Principled Prohibition of Executing the Mentally Ill

Under customary international law and international human rights norms, the imposition of death penalty on people suffering from any form of severe mental illness is considered cruel and inhuman punishment and, as such, it is prohibited. The UN Commission on Human Rights has adopted several resolutions urging all states not to execute any person “suffering from any form of mental disorder.” Similarly, two fundamental articles of the International Covenant on Civil and Political Rights (ICCPR) have been interpreted to prohibit the punishment of the mentally ill:

Article 6 (I): Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life

Article 7: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment

The UN Human Rights Committee – the monitoring body for the ICCPR – unequivocally stated in the cases of Sahadath v. Trinidad and Tobago (2002) and Francis v. Jamaica (1995) that the issuance of an execution warrant in the case of mentally ill prisoners violates Article 7 of the ICCPR. The UN Special Rapporteur on extrajudicial, summary or arbitrary executions has repeatedly criticised the practice of imposing the death penalty on mentally ill offenders.

The principle to prohibit the execution of the mentally ill applies irrespective of whether the accused was mentally ill at the time of the crime or if he or she  developed the condition afterwards.

Precedent from Comparative Jurisdictions

Countries all over the world that still practice the death penalty limit it in the case of mentally ill prisoners.

The Supreme Court of India in the landmark judgment of Shatrughan Chauhan & Anr v. Union Of India (2014) unequivocally stated that death convicts suffering from schizophrenia cannot be hanged. This decision was also upheld by a decision of a 5 member bench in the case of Navneet Kaur v. State of Delhi (2014).

The Supreme Court of the United States of America has decided that the executions of mentally ill prisoners amount to “cruel, in human and degrading punishment” under the Eighth Amendment of the Constitution of the United States of America as they fail to meet either the retributive or the deterrent purposes of capital punishment. The Supreme Court has also emphasized that there is a greater threat of wrongful convictions in cases of persons with mental illness. Relevant cases include Ford v. Wainwright (1986) and Atkins v. Virginia (2002).

The Privy Council has ruled that mental disorders (such as schizophrenia) are mitigating factors in sentenced and has struck down death sentences for mentally ill prisoners. In Robinson v. The State (Trinidad and Tobago), the appellant, a 39-year old man diagnosed with schizophrenia, was convicted of murder and sentenced to death. Concluding that evidence of the appellant’s mental illness was not properly presented to the jury at the appellant’s trial, the Council  quashed the death sentence as well as the murder conviction, and substituted a manslaughter verdict on the grounds of diminished responsibility.

In Franics v. Jamaica (1994), the HRC held that the incarceration on “death row” and execution of a prisoner whose mental health had “seriously deteriorated” amounted to a cruel, inhuman, and degrading treatment.

Pakistan and International Law

Pakistan is a dualist country with regards to its application of its international law obligations. This means that in order for Courts to rely directly upon international treaty obligations they must be given effect in domestic legislation. However, the Government of Pakistan has maintained consistently in UN human rights treaty body reviews that Pakistan’s domestic legislation adequately encompasses the breadth of its international human rights obligations. Additionally, authoritative precedent of the Supreme Court establishes in cases such as PLD 1958 SC 138 that domestic provisions of law must be interpreted so as not to be inconsistent with international legal obligations. As a result, a decision of the Honourable Court that conforms to Pakistan’s international obligations must honour the prohibition on the executions of mentally ill prisoners enshrined in international law.

To read the full issue, click here

 

Understanding Schizophrenia

What are mental illnesses?

Mental illnesses or mental disorders are broad, largely interchangeable, terms used to describe a variety of conditions that effect a person’s mood, thinking and behavior. As mental illnesses can encompass a wide range of symptoms and severity, an all encompassing definition that adequately specifies boundaries of “mental illness” remains elusive.

Definitions and diagnostic criteria for specific mental illnesses are listed in medical manuals like the DSM and ICD that are used by mental health professionals worldwide. Different types of mental illnesses include depression, bi-polar disorder, anxiety disorders, obsessive-compulsive disorders, personality disorders and schizophrenia.

Mental disorders are usually considered distinct from intellectual disability or from neurological diseases like dementia.

Psychosis and Mood Disorders

Mental illnesses can be crudely divided between mood disorders and psychotic disorders. Mood disorders, like depression and anxiety, greatly inhibit a person’s well being and vigor, while psychosis is characterized by the twin symptoms of hallucinations and delusions. Hallucinations entail a person experiencing what isn’t there (hearing voices, seeing visions), while delusions are false beliefs. In other words, sufferers of psychotic disorders lose their sense of reality, while sufferers of mood disorder can remain cognizant of their surroundings.

What is Schizophrenia?

Schizophrenia is a chronic and severe mental illness of the psychotic variety. As is typical of psychosis, schizophrenia results in a distortion of thought and perception. Patients with schizophrenia most commonly hear voices that are often critical of the person or compel them to act inappropriately. They are also afflicted with delusions of persecution, i.e. that someone is out to harm them, and delusions of grandeur, e.g. believing that they are supernaturally gifted. Other symptoms can include incoherent speech, lack of self care and a numbing of emotions.

Treating Schizophrenia

The psychotic symptoms of schizophrenia usually emerge in early adulthood, and the onset can be sudden or gradual. There is no consensus on the causes of schizophrenia and treatment usually focuses on addressing individual symptoms. While it is possible in some cases to manage the symptoms of schizophrenia, according to the DSM-V only about 20% of schizophrenia patients respond favorably to treatment and “many remain chronically ill, with exacerbation and remissions of active symptoms, while others have a course of progressive deterioration”.

To read the full issue, click here

The Imdad Ali Case

A Schizophrenic’s Plight

Imdad Ali is a 50 year old diagnosed paranoid schizophrenic who has been languishing on death row in Vehari for the past 14 years.  Imdad, who has been issued multiple black warrants, received an unprecedented new lease of life on 31st October when the Supreme Court of Pakistan decided to review its own prior ruling against Imdad. 

Previously, on 27th September, Imdad’s case generated outrage among the international psychiatric and legal community when the august Court ruled that Imdad’s schizophrenia was not a “mental illness” but a “recoverable disease”, hence  making him eligible to be executed. That ruling demonstrated a widespread lack of awareness regarding mental illnesses in the Pakistani criminal justice system and effectively condemned hundreds of other  mentally ill individuals  on death row.

The Supreme Court’s review now represents a critical juncture in Pakistan’s human rights record and an opportunity to demonstrate Pakistan’s commitments to its international legal obligations.

Pakistan Criminal Justice’s Troubling Relationship with Mental Illness

Whatever the result of the Supreme Court review, the case of Imdad is particularly instructive in understanding the failure of the criminal justice system to protect the vulnerable segments of society. The media coverage of Imdad’s case has prompted a valid question among many: How can a mentally ill person come so close to the gallows?

Sadly, Imdad’s case is far from an aberration.

Mentally ill people repeatedly slip through the cracks in Pakistan’s criminal justice system.  The lack of mental health treatment and training in the criminal justice system, as well as in Pakistan generally, means that many individuals never even get diagnosed. In fact for many mentally ill people, their first contact with a mental health professional is in jail.

The dearth in procedural safeguards upon arrest and in the course of trial results in the sentencing to death of many mentally ill persons.

Imdad was convicted for murdering his mentor and spiritual leader in 2001. According to eye witnesses, he accused the deceased of plotting against him and standing in the way of his spiritual knowledge immediately prior to the murder; the nature of his rambling rant was consistent with symptoms of delusions of being persecuted, irrational anger and violence that are associated with paranoid schizophrenia. Anyone with a passing familiarity with mental health problems could have instantly concluded that not all was well with him. But despite Imdad’s wife raising the issue of his mental health in the trial court and subsequent appeals, the judges have so far dismissed this aspect based on archaic understanding of mental health in judicial precedent: i.e. the fact that he escaped the scene of the crime is seen as proof that he maintained his lucidity.

This is despite that Imdad has been treated with anti-psychosis medication in the district Vehari jail since 2004. This is despite a 2012 medical examination conducted on the request of Vehari jail’s superintendent, where the head of psychiatry of the Nishtar Hospital formally diagnosed Imdad with paranoid schizophrenia, and commented on his total lack of awareness of his circumstances. This is despite sworn affidavits from multiple neighbours and family members of Ali where they testify on his erratic behaviour and delusionary beliefs over the years. Despite all evidence to the contrary, and even despite the jail authorities being sympathetic to Ali’s case, at every appellate step his plea for mercy on humanitarian grounds has been rejected simply because the legal system has an insufficient conception of mental illness.

To read the full issue, click here