Draft:Usman Amin Hotiana

The precursor of an important development in Pakistan Mental Health Laws transformation was a simple appeal by an unknown psychiatrist Dr Usman Amin Hotiana while he was stationed at Akhtar Saeed Medical College. (1)

KHIZER HAYAT CASE The saga started with the Case of a death row mentally ill prisoner Khizer Hayat, a convicted prisoner diagnosed with schizophrenia in 2008 after murdering a colleague. He spent his last six years in solitary confinement, experiencing severe hallucinations and delusions without any insight. His case became a pivotal example in the evolution of mental health laws in Pakistan.

In 2013, Dr Hotiana collaborated with the Justice Project Pakistan (JPP) to stop Hayat's execution, garnering significant support from the psychiatric community. Pakistan Psychiatric Society fully supported and large number of psychiatrists signed the appeal and expressed their continuous support over the years. Despite repeated death sentences, their appeals were successful in delaying his execution multiple times until Hayat eventually died in a hospital.

This case highlighted the challenges in assessing mentally ill prisoners within the legal system and emphasized the need for better understanding and cooperation between the legal and psychiatric communities. The persistent efforts led to broader awareness and changes in legal perspectives on mental illness and capital punishment. The story culminates in the landmark Supreme Court judgment in Safia Bano vs Home Department, which banned the death penalty for prisoners with severe mental illnesses, recognizing the unjustness of such punishments when mental illness impairs rationality (2)

This case was significant as it advocated for all prisoners with mental illnesses who were on death row. The executions of these individuals were postponed through appeals filed by the local nonprofit organization, Justice Project Pakistan (3)

'Early Developments' Dr Hotiana had earlier the experience of working at Punjab Institute of Mental Health (PIMH) (4). PIMH was following the lunacy act while it had been replaced by Mental Health Act of 2001 (5)

Dr. Hotiana reviewed Khizer Hayat's medical records and filed an appeal, asserting that Hayat suffered from severe, treatment-resistant schizophrenia, as confirmed by multiple psychiatrists over the years. The court stayed the execution. Dr. Hotiana presented the facts to Justice Umer Ata Bandial, who supported the civil society movement but noted that psychiatric terminology often lacks clarity in courtroom settings (6)

PAKISTAN PSYCHIATRIC SOCIETY Awareness about forensic mental health issues were created all over the country. Through academic workshops at the universities, colleges, courts. It involved lawyers, judges and mental health professionals. Newspaper articles on the plight of Imdad ali and others were highlighted. Awareness through issues of forensic psychiatry were highlighted (7) as well as plights of mentally ill (8) This particular prisoner, failed to have representation till the Supreme court took notice. (9) Along with media awareness, scientific research about the perceptions of schizophrenia were studied. (10)

'Prof Mubasshar Hussain Malik' This movement incoporated Prof Mubasshar Hussain Malik as he met the team at the first forensic conference at University of Health Sciences. Later he became one of the central figures to promote the cause.

INSTITUTE OF PSYCHIATRY 

Prof Fareed Minhas, Head of the Department, Institute of Psychiatry at Benazir Shaheed Hospital invited Dr Usman Amin Hotiana for a Forensic Workshop named ' Forensic Psychiatry & Law: A torrid Love affair". This created a long lasting partnership across the key departments. (11) Prof Aftab Asif KEMU was being headed by Prof Aftab Asif and Prof Ali Hashmi who both had a western experience of Forensic Psychiatry. They introduced and encouraged further development in the Mental Health Laws in form of awareness workshops, lectures, endless brainstorming and motivating other psychiatrists. (11)

DEATH OF KHIZER HAYAT Khizer Hayat died after remaining ill at the Kotlakpath Jail and was brought to Jinnah hospital. His death brought a new spark to the movement. Again with new zest the campaign was initiated. All pending cases were reviewed and public awareness and technical issues were reviewed (12)

SAFIA BANO CASE

This landmark judgement culminated in deeply reviewing all the relevant mental illness related issues surrounding the death sentences of mentally ill prisoners. (13)