Comparison of lunacy Act 1912 with Mental Health Ordinance (MHO) 2001

I am accustomed to sleep and in my dreams to imagine the same things that lunatics imagine when awake.

Rene Descartes

Before 1912 no comprehensive law was present in India for mentally ill individuals then called Lunatics. At about the same time (1913) almost same law was promulgated in England. It served well for many decades but major changes were not done to keep pace with new concepts and developments in psychiatry both in India and Pakistan. India acted a bit earlier and promulgated new law in 1987 replacing the old one. In Pakistan MHO replaced the old law in 2001. It is still far behind the laws of the developed world.

Following is the comparison of Lunacy Act 1912 with the Mental Health Ordinance 2001 to highlight the major differences.

Sr. No

LA 1912 MHO 2001

1 Archaic, imprecise and often undefined terms were used. ‘Lunatic’ is the classic example and defined as ‘idiot or unsound mind’ (Sec 4). This is inhumane and derogatory and obsolete. Same is ‘criminal lunatics’ (An oxymoron as it is given in the existing law that ‘lunatics’ cannot be held responsible for their acts).

Here ‘Mental health; is used as part of its title and then defined ‘mental disorder as mental illness, mental impairment, sever mental impairment, sever personality disorder or disability of mind’ (Sec 2 (1) (m).

2 No further definitions were present in it

For all categories comprehensive definitions are provided.

3 ‘Criminal lunatic’ was used and it shows the tone of the law makers.

‘Mentally disordered prisoner’ is used giving a sympathetic and rational approach to old user.

4 ‘Asylum’ was the word for place where patients were kept.

‘Health facility, psychiatric facility’ replaced the old name.

5 No concept for informed consent Informed consent is the law binding procedure to treat and keep the patients in the said facilities.

6 It is well recognized fact that terminology shows the mood of its users. This act showed the attitude of summery dismissal.

More Scientific, appropriate, precise and humane terms are used showing more rational and sympathetic approach towards the patient.

7 No separate body was here to look after the individuals.

A federal body (FMHA) in constituted comprising. 7 eminent psychiatrists and 7 other members largely beurocates to incorporate the knowledge with state authority to facilitate the function of the authority.

8 The combined effect of the law (Sec 13-16) was to detain the alleged lunatics’ for 10 days, extendable to 30 days by the permission of magistrate, and absolutely lay man in psychiatry. After the lapse of 10 or 30 days as the case may be, an actual inquiry was held to establish the detainee’s mental status. This provision gives immense powers to police. In most of the cases this power was misused and rather abused by the stake holders in connivance of the police.

It restricts the powers of police to detain or arrest Sec 19 (2) limits the forced detention up to 72 hours, and during that period it is mandatory that the detainee must be examined by and approved psychiatrist or his nominated medical officer. During this detention period necessary arrangements for care and treatment must be made.

9 Human right concept was there in a general sense.

Human rights protection is a very strong part and chapter VII consists of laws to protect these e.g. ‘No patient shall be published nor his identity disclosed to the public through press or media unless such person chooses to publicize his own condition.

10

Though some punishment was there to deal with the individuals who make wrong statements to detain others by reporting them as lunatics, but these were not enough.

Sec 52 chapter VII describes the punishment for extravagance like false statements to discredit a person as mentally ill, mismanagement of the property and estate of the mentally ill individual. It also describes the punishment of practice of microcephaly and ill treatment etc.

11

No specific punishment for doctors or staff of a mental hospital or asylum was described in this act.

The doctrine ‘no one is above law’ is prevalent here. Punishment for doctors or staff of the health facilities also stipulated. Any one who misuses the MHO will be held responsible (Sec 56 chapter XI)

12 No control of treatment whatsoever.

Very stringent control has been placed on the practice of psychosurgery and giving electric shock treatment.

13 Community involvement is at minimum level.

It involves and encourages the community in taking card, treatment and rehabilitation of the patients.

14 There is no specific roll of the psychiatrists.

Psychiatrists have been charged with major role at all stages.

15 Restriction of the rights of mentally ill was not properly monitored.

Restriction of basic human rights is Stringently monitored.

It is worth noting that we are still far behind the Universal Declaration of Human Rights and its extension with regard to the individuals who are mentally disabled. The Declaration of the Rights of the Mentally Retarded is a useful guide. This in brief gives grantees to mentally disordered.

1. Equal right to the maximum degree of feasibility.2. Proper education, care and treatment for self development. 3. Rights to economic security and a decent standard of living. 4. The right to live with one’s owns family or the closest possible

alternative. 5. The right to qualified guardian, if necessary. 6. Protection form exploitation, abuse and degrading treatment, and

restricted civil and criminal liability. 7. That the right that any restriction of rights must be legally

monitored, must not be arbitrary, and must be subject to appeal and periodic review. although all the recommendations are not met in present law but MHO comes closer to these. Pakistan is not a signatory to this convention so there is no binding to adopt all but we must strive to achieve the goal.