What is FORENSIC MENTAL HEALTH

The mental health system is the network of people and services that care for people with mental illness. 

The criminal justice system includes the courts, the institutions and the professionals that deal with people accused or convicted. 

If people who have a mental illness come into contact with the law, they could become involved with the forensic mental health system. Here, “forensic” means “connected to the law or the courts.” forensic mental health is still one of the most misunderstood and stigmatized aspects of the health care system. 

Prevalence

There are more than 100 prisons in Pakistan out of which 22 in NWFP, 32 in Punjab, 22 in Sindh and the remaining in Baluchistan. These prisons are categorized as Central Prison, District Prison, and prison for Women, Prison for Juvenile, Sub-Jails and Judicial Lockup, and Open Jails. According to the Law and Justice Commission of Pakistan these prisons have authorized capacity of 45,210 but there are 80169 prisoners with massive overcrowding. For instance, the central Jail Karachi has the capacity to house 2500 prisoners, while currently it houses 5000-6000 inmates.

Our Contribution in the field of Forensic Mental Health

• Introduction to Psychological First Aid, A Training Program for Prison department

Pakistan Institute of Living and learning (PILL) in collaboration with Sindh Prison department took initiative and successfully completed its first training program for paramedical staff on “An Introduction to Psychological First-Aid” in Men, Women And Juvenile Central Jail Karachi. This program consist of 10 sessions including Depression, Anxiety, Bereavement, Obsessive Compulsive disorder (OCD), Schizophrenia, Post-Traumatic Stress disorder, Substance Abuse disorder, Bipolar disorder, self-harm and suicide and basic counseling skills. A total of 30 participants attended this training program. In each session pre and post assessments were conducted including all the staff was also trained in screening common and severe mental illnesses using culturaly adapted assessment tools. The prison department appreciated this much needed training program including the entire participants found the program extremely useful with active participation.

• Eye Movement Desensitization and Reprocessing (EMDR) for Stress, Psychological Trauma and Suicidal Ideation in Police Personnel: A feasibility study

Pakistan Institute of Living and Learning (PILL) is doing a trial to investigate the feasibility of EMDR as an intervention to reduce psychological trauma and stress amongst police personnel in Pakistan and to test whether reduction in stress and psychological trauma lead towards reduction in suicidal ideation in police personals.

• An adapted self-harm monitoring and case management approach into Karachi prisons

The central aim of the project is to assess the feasibility of introducing an adapted ACCT case management system into Karachi prisons to examine the personal psychological and custodial characteristics of those who self- harm in Karachi prison and with a view to enabling the development of an effectiveness cluster randomised controlled trial (RCT).

• Cognitive Behavioral Therapy for Suicidal Ideation among Male Prisoners

The purpose of the study is to determine the Feasibility and acceptability of the culturally adapted Manual Assisted brief Psychological intervention (C-MAP) on the outcome and to examine the significant decrease in the suicidal ideation in prison settings

• Systematic Reviews in Forensic Mental health

> Prevalence and risk factors of self-harm, suicidal ideation & suicide among prisoners in Low-and-lower-middle-income countries (LLMICs): A Systematic Review and Meta-Analysis

> Prevalence and risk factors of self-harm, suicidal ideation & suicide among police force in Low-and-lower-middle-income countries (LLMICs): A Systematic Review and Meta-Analysis

• Forensic Mental Health: A practical approach towards disruptive behavior (Curriculum Course)

The Forensic Mental Health Program is first of its kind in Pakistan to create awareness on basic concepts related to criminal offences, law, psychopathology and its management.  This program will provide in-depth training in forensic mental health to deal with the individuals suffering in mental health problems. The purpose is to provide specialized levels of expertise in the clinical and legal aspects of Law and Forensic Mental Health to an emerging skilled multidisciplinary workforce. Practical experience helped to enhance the practical experience as well.