parity of esteem for mental health remains a dream

The plight of Mohammad Asghar, a British citizen and resident of Edinburgh, is surely the stuff of nightmares. He is in a Pakistani jail, sentenced to death because of blasphemy. Recently he was shot in the back whilst in prison, apparently by a member of staff. It has been widely assumed by the British media that his life will be at significant risk when he returns to jail from the hospital in which he has been treated.

Mr Asghar has lived in the UK since he was 16. He is now 70. He has a British born family. He is a successful businessman, a millionaire, who has, amongst other projects, founded a school in Lahore and an orphanage in Rawalpindi. I presume that one of these latter projects was the reason for him to have travelled to Pakistan. Mr Asghar’s family have been pleading with the Foreign Office, with Alex Salmond, and directly with the Prime Minister David Cameron to intervene to secure his release, and pending his release for him to be kept in a properly run and staffed hospital where he can receive treatment. As far as I can tell they have received only platitudinous assurances thus far.

I cannot help wondering whether if this was one of Cameron’s white public school millionaire friends in a Pakistani jail, then rather more action would have been taken to secure his release. Unfortunately for Mr Asghar, not only is he Asian, but he has the great misfortune to suffer with paranoid schizophrenia – that most stigmatised of mental illnesses. In the lay mind schizophrenia remains synonymous with incurable, and sadly, with violent and dangerous. Of course none of these things are true, and although a tiny minority of untreated schizophrenics may commit violent crimes (and hit the headlines) the majority live and work just like everyone else.

Of course it was Mr Asghar’s schizophrenia that was responsible for his blasphemy, but evidently no medical evidence was allowed to be presented in court by his defence. There seems little doubt about the veracity of his diagnosis as he had been hospitalised under the Mental Health Act in Edinburgh some time before he travelled to Pakistan. I presume that he has not had access to medication, or at least not to his normal medication, whilst he has been in prison, and is therefore at risk of speaking or acting in ways that may further aggravate the Pakistani authorities.

Numerous aspects of this case make me angry and despairing.

The impotence of our British government to act firmly in the interests of its own citizens when dealing with other governments is depressing. This is particularly the case when the country concerned belongs to the Commonwealth – a group of countries held together loosely by their allegiance to the Queen. I do not underestimate the delicacy of political negotiation, but I (perhaps foolishly or naively) had expected that if my life were at risk due to the dubious judicial processes of another Commonwealth country, then the British government would work strenuously to secure my safety. This is a completely different situation from hostage taking, where utilitarian arguments are understood by most people (but probably not the family and friends of the hostage).

I feel angry because of the inequalities that I suspect are at play here. I am not completely convinced that there is not a degree of racial discrimination; in other situations I have felt that educational and financial status have been significant factors. But I feel most angry because this case is so clear cut. There has not been disregard for the host country’s law; Mr Asghar has not been accused of drug smuggling. He has been accused of blasphemy (a crime that carries such fear with it that lawyers are very reluctant to defend those accused of it). He may technically have blasphemed (according to the very restrictive Pakistani law) but was demonstrably not in control of his thinking when he did so. Utterances and delusions concerning deities are common in schizophrenia. A judicial process that does not allow medical explanation of the accused’s behaviour surely cannot be condoned by the British government. When such process results in a death sentence the lack of urgency displayed the Prime Minister (and the lack of media coverage) seems extraordinary.

I am left with the uneasy feeling that people with the misfortune to have a mental health diagnosis are relegated to second class citizens regardless of their educational, financial or professional status. There is a long way to go still before we have parity of esteem.

 

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