Opinion: Mental Health Under Siege
Struggle for Reform and Integrity at Sir CJ Institute, Hyderabad
Political and bureaucratic interference in medical and academic affairs be restrained
Sir CJ Institute must be shielded from political experiments and allowed to serve the people of Sindh with integrity, professionalism, and care
By Dr. Mohammad Mataro Hingorjo | Ireland
As a concerned Sindhi doctor and graduate of Liaquat University of Medical and Health Sciences (LUMHS), I write with deep anxiety about the ongoing deterioration of one of South Asia’s most historic mental health institutions—the Sir Cowasji Jehangir Institute of Psychiatry and Behavioral Sciences (Sir CJ Institute) in Hyderabad.
This 159-year-old institution, founded during British colonial rule in 1865, has served as a lifeline for countless individuals battling psychiatric and behavioral illnesses across Pakistan. For decades, the institute operated in silence, with outdated infrastructure and neglected systems. However, for the first time since Pakistan’s creation, meaningful reform efforts began under the directives of the Supreme Court of Pakistan. This rare opportunity for institutional transformation now risks being squandered due to bureaucratic interference, political manipulation, and vested interests.
A Reform Mandated by the Supreme Court
It is reported that in response to the Supreme Court’s instructions, the Government of Sindh issued a formal notification assigning the Vice Chancellor of LUMHS to lead a legislative effort aimed at modernizing the institute. The initiative included drafting a comprehensive law to grant autonomy, academic affiliation, and updated governance to the institute—laying the groundwork for its elevation as a center of psychiatric excellence.
In 2019, this culminated in the passage of the Sir Cowasji Jehangir Institute of Psychiatry and Behavioral Sciences Act by the Sindh Assembly. However, it is reported that key elements of the original draft were altered during the legislative process, allegedly under pressure from political actors. Notably, the inclusion of Sindh University and the restructuring of the board of governors are viewed as calculated efforts to dilute the institute’s professional autonomy and embed political control.
Despite the passage of the Act, no effective implementation has occurred. Six years later, the institute remains under the administrative control of the provincial Health Department—contrary to the autonomy promised in the legislation. This inertia raises serious questions about political will and the repeated obstruction of mental health progress in Sindh.
Allegations of Political Capture and Regression
It is further reported that the institute is under the de facto control of a group of bureaucrats and political figures with overwhelming influence over operations. Among them are two highly powerful personalities who are reported to be closely linked to the ruling party in Sindh. Their reported involvement has raised alarm over the institution being used for purposes other than professional and public interest.
Of particular concern is the reported effort to displace the academic faculty from LUMHS, who have been affiliated with the institute since 2001. Over the last two decades, this faculty has trained 71 qualified psychiatrists, played a crucial role in postgraduate education, and helped transform the institute from a custodial asylum into a modern mental health facility. Dislodging these professionals would not only reverse years of progress but potentially disrupt ongoing psychiatric training in the province.
Mental health care, by its nature, demands expertise, compassion, and ethical leadership. The reported appointment of non-qualified general cadre doctors—without specialization in psychiatry or psychology—to senior administrative roles further undermines the integrity of mental health services. Clinical leadership should be entrusted only to those with adequate qualifications and domain knowledge. Placing unqualified individuals in control of psychiatric institutions compromises both patient care and institutional credibility.
The Role of Mental Health in Public Policy
According to national and global health reports, one in every four people in Pakistan suffers from a mental health condition. Despite this alarming prevalence, investment in mental health remains minimal. Pakistan’s own 2021–2030 National Action Framework for Mental Health and the Sindh Mental Health Act 2013 both emphasize not just treatment, but also education, training, and community outreach. Yet, these ideals remain unfulfilled.
At present, it is reported that there is no comprehensive district- or taluka-level mental health service across Sindh. In contrast, spiritual healers and pseudo-practitioners continue to operate unchecked in many areas, often with informal political or administrative backing. If Sindh is to meet the UN Sustainable Development Goals (SDGs) for mental health by 2030, genuine structural reform is non-negotiable.
A Way Forward: Restore the Mission, Respect the Law
The Sir CJ Institute must be recognized not just as a treatment center, but also as an academic hub that plays a critical role in postgraduate psychiatric education. Its affiliation with LUMHS should be strengthened, not severed. As a LUMHS alumnus and practicing doctor, I can attest to the need for continuity, expertise, and academic stewardship in mental health reform.
I respectfully advise that:
The provisions of the 2019 Act be implemented in full spirit.
Qualified psychiatrists and psychologists lead mental health institutions.
Academic partnerships, particularly with LUMHS, be preserved and enhanced.
Political and bureaucratic interference in medical and academic affairs be restrained.
Community-level mental health outreach programs be developed to serve rural and underserved populations.
This is not merely a question of institutional management—it is a matter of public health, human dignity, and social justice. The Sir CJ Institute must be shielded from political experiments and allowed to serve the people of Sindh with integrity, professionalism, and care.
Sindh’s mental health system cannot afford another setback. The time to act with wisdom, transparency, and responsibility is now.
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Dr. Muhammad Mataro Hingorjo is a Family Physician originally from village Dhandhi Hingorja, Tharpakar, Sindh, currently residing in Limerick Ireland.
