Forensic Psychiatry in Pakistan: An Update

Pakistan is a lower-middle income country in South Asia where forensic psychiatry is often not recognized as a distinct subspecialty of psychiatry. Although evolution toward this direction has begun, more development in this field is needed. Before Pakistan’s Mental Health Ordinance of 2001, much of the mental health legislation and institutional infrastructure pertaining to the mentally ill offender can be traced back to the Indian Lunacy Act of 1912. The past two decades have witnessed important legal developments in the role of psychiatry in Pakistan’s criminal justice system. This has been seen through the devolution of health-care provision and by an extension of psychiatric service provision from the federation (federal government) to the four provinces. Despite the sparse resources allocated to psychiatry, competent yet scarce psychiatry residents are graduating from Pakistan’s accredited residency programs with an interest in forensic psychiatry. The objective of this article is to reflect on the past, while examining the current state of existing forensic mental health in Pakistan. This article will also address the future trajectory of forensic psychiatry in Pakistan and supports the establishment of forensic psychiatry as a subspecialty in Pakistan.

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A Review on the Effectiveness of Canadian and American Mental Health Courts

Objective: This systematic review synthesizes mental health court (MHC) research across the United States and Canada. This study reviews and compares the operations and practices of MHCs across both countries, as well as their recidivism rates.

Methods: We gathered from existing literature to present common MHC practices used across the United States. However, in response to the lack of literature about Canadian day-to-day practices, we developed a questionnaire and contacted every Canadian MHC. In total, we contacted 36 Canadian MHCs, and 19 courts filled out a questionnaire. With respect to recidivism rates, we conducted a comprehensive literature search in February and March 2019 in PsycINFO, Google Scholar, Web of Science, and National Criminal Justice Reference Service Abstracts using the keywords mental health court, therapeutic justice, serious mental illness, mentally ill offenders, mental health diversion and problem-solving courts.

Results: Canadian and American MHCs have similar practices. However, American MHC’s have more robust screening measures and typically admit more participants with schizophrenia, bipolar disorder, and major depressive disorder into their programs compared to Canadian MHCs. MHC participants in both countries typically had lower recidivism rates compared to regular docket court participants.

Conclusions: MHC research should inform public policy. Additional research should move in the direction of discovering the predictors for why MHCs reduce recidivism.

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