Mental Health and Crime – The Legal Chasms

Mental Health and Crime – The Legal Chasms

Over the past few years, there has been a growing trend in the discussion of mental health in Pakistan with people feeling more confident to speak openly and freely about the emotional and psychological issues they have been facing. Recent years have seen a miraculous shift among people who previously felt uncomfortable approaching psychiatrists and psychologists or even openly discussing mental disorders due to fear of stigma. Lately, seminars have been taking place on mental health awareness, more people have been opting for counseling, mental health has become a popular topic on social media and individuals have started feeling more comfortable in admitting the type of mental disorders they may be suffering from. Moreover, we also have the Sindh Mental Health Act of 2013 which primarily focuses on the rules for admission and detention in a psychiatric facility and the management of property for persons with mental disorders.

While all these developments are positive, there is a massive legal chasm in the area of mental health and crime. It is pertinent for lawmakers to highlight the connection between serious mental illnesses and crime and the methods of tackling this unfortunate cause and effect.

To illustrate my point without referring to books written on the history of psychiatry and madness a few decades ago, I will instead focus on the recent Hollywood success, The Joker.

Without going into the details of the plot — The Joker depicts how a man from an underprivileged background, who is bullied at work and elsewhere, suffers from a serious mental illness which goes unnoticed by society. The mask he wears of a clown on the surface aims to make people laugh, but in fact conceals his own inward emotional and psychological pain and angst. As we watch the movie we understand that ‘Arthur’ (i.e. the Joker) has recently been released from a psychiatric hospital and is receiving counseling. He reiterates that the counselor does not listen to him — in fact no one does. Due to a lack of funding the counselor ultimately informs Arthur that she can no longer see him. No one, therefore, supervises as to whether or not he takes his medication (which he eventually abandons).

Furthermore, we discover that Arthur’s foster mother suffers from narcissistic personality disorder as well as a psychotic disorder, which may be a factor leading to her grandiose thinking (of having an affair with the Mayor of Gotham i.e. Thomas Wayne and Arthur being their lovechild). Often when one person suffers from a serious psychotic disorder, the other person living with them acquires what is called ‘shared psychoses’. It is possible that Arthur may have acquired his mental illness from his foster mother as we are oblivious to the identity of his biological parents (mental illnesses can be hereditary too). Moreover, Arthur suffers from disorganized thinking and delusions. When provoked, he succumbs to a string of cold-blooded murders, terrorism and anarchy and shows a lack of remorse or empathy. While the movie does not pinpoint any particular mental disorders that Arthur suffers from, it is implied that he may have a combination of schizophrenia and severe personality disorder (he has the requisite symptoms). In fact, society at large is depicted to be responsible for Arthur’s criminal actions, including his dysfunctional family and childhood abuse, bullying at the workplace, withdrawal of state funding for counseling sessions, getting mocked by peers and strangers for an abnormal ‘laughing’ condition and being rejected by the society for his idiosyncrasies.

This is, in effect, the link between mental health and crime. It is fundamentally where a mental illness goes so unnoticed or untreated that a people eventually succumb to the ‘voices in their heads’ so to speak.

According to the World Health Organisation, 1 in 4 people suffer from a mental disorder. By 2020, ‘depression’ will become one of the leading causes of death. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists around 300 mental disorders but the Act of 2013 defines a mental patient very narrowly as “…a mentally ill person who is in need of treatment by reason of any disorder of the mind other than mental impairment and severe personality disorder.” The definition is, to put it quite bluntly, very slim and devoid of the real issues involved in the world of mental disorders. One has to browse through the DSM to understand the intricacies of depression, bipolar disorder, schizophrenia and various personality disorders such as anti-social personality disorder, borderline personality disorder and narcissistic personality disorder.

As unfortunate as it may seem, schizophrenia is a serious mental illness which may lead to the commission of a crime. According to the American Medical Association, 27.6% of the people who were convicted of at least one violent crime (between 1973–2006) suffered from schizophrenia with substance abuse disorder. Schizophrenics have an abnormal perception of reality which results in paranoia, hallucinations, delusions, disordered thinking and behaviours that impair daily functioning. They usually have a false belief system (combined with paranoia) and may believe they are being watched possibly by a government agency or fear that there is a political conspiracy against them. In most cases, sufferers of schizophrenia hear audible voices and these hallucinations may prompt them to commit what potentially becomes a crime. Take David Berkowitz for example, the notorious serial killer also known as the ‘Son of Sam’ who killed six people in the 1970s and claimed that his neighbour’s dog had told him to do so – he was diagnosed with paranoia schizophrenia. Another serial killer, Richard Chase known as the ‘Vampire of Sacramento’ killed six people in California and drank their blood – he too was diagnosed with the same.

Our local laws on mental health should clearly define the symptoms of serious mental disorders which unfortunately they presently do not. The 2013 Act also defines a ‘mentally disordered prisoner’ as: “a person, who is a prisoner for whose detention in or removal to a psychiatric facility or other place of safety, an order has been made in accordance with the provisions of sections…” – followed by a list of never-ending statutes. My point is, this is merely rhetoric. In reality, do criminals get diagnosed by psychiatrists? Do they receive counseling? Are they dealt with accordingly in jails? Are the police competent to deal with a mentally ill criminal? Are advocates competent to deal with them and defend their clients fairly? Do judges take a person’s mental health as a mitigating factor when reaching a verdict?

My answer is a bold ‘no’. In Pakistan, with a few exceptions, there is a massive gap in understanding and taking into account a prisoner’s mental health background and the sentence or treatment he or she receives. Personally, I am not aware of any high security psychiatric prison in Pakistan, like Broadmoor Hospital in England which is essentially a jail but one exclusively for criminals diagnosed with serious psychotic disorders. As per the M’Naghten rule, if a person charged with murder is found guilty by reason of insanity, he or she is not guilty of murder (rather manslaughter) and gets shifted to psychiatric facilities rather than confined to jails for common criminals. But in Pakistan, this is yet to be seen.

According to section 19(1) of the Sindh Act:

If an officer in charge of a police station finds in a place to which the public have access, a person whom he has reason to believe, is suffering from a mental disorder

  • and is in immediate need of care or control,

  • the said officer may, if he thinks it necessary to do so in the interest of that person or for the protection of other persons,

  • remove that person to a place of safety,

  • which means only a government run health facility, or

  • government run psychiatric facility,

  • or hand him over to a suitable relative, who is willing to temporarily receive the patient.”

My question is: are police officers competent to deal with a person suffering from a mental illness? Do they even understand what a mental illness is? In reality, do they treat sufferers of mental illness leniently and gently? The mystery behind the tragic death of Salahuddin (the ATM thief) proves otherwise. To a layperson, he appeared to have some form of a mental disability. Should such a man have been put behind bars or should he have been immediately sent to a psychiatric facility? Was he in fact a criminal or a victim? The answer is of course before our eyes.

The state of affairs is quite tragic in Pakistan. Our thoughts and aims are only limited to words, whereas what we need is proactive training for the police, advocates and even judges in understanding what mental illnesses are and how to justly and equitably handle the offenders suffering from a mental illness. It is the state’s responsibility to establish more psychiatric facilities, especially those for convicted criminals, and to provide funding, encourage the study of psychiatry and promote counselors and psychiatrists. On the other hand, the society at large is morally responsible for removing the stigma behind mental illness due to which sufferers sink into a bottomless abyss.

My advice to a layperson reading this article is that if you see someone who:

  • was receiving treatment but has stopped medication, counseling or psychotherapy,
  • may have a previous history of violence or mental illness,
  • may be misusing alcohol or other drugs,
  • is experiencing active psychotic symptoms such as hallucinations or delusions,
  • constantly shows lack of remorse and disregard for others’ feelings and is in constant violation of other’s rights, or
  • has abnormal mood swings

– please help them. Talk to their families. Suggest psychiatric help. Take some action before it’s too late. Please let your conscience take over for once!


The views expressed in this article are those of the author and do not necessarily represent the views of or any other organization with which she might be associated.

Sana Pirzada

Author: Sana Pirzada

The writer is a qualified Barrister from the UK. She has studied Law from King’s College, London and specialised in Criminology for her LLM from the London School of Economics. She offers legal consultancy services in Karachi and alongside pursues her passion of fiction writing. Her debut novel ‘The Rose Within – A Gothic Romance’ has been published in the UK.